"BusinessYear","StateCode","IssuerId","SourceName","ImportDate","MarketCoverage","DentalOnlyPlan","TIN","StandardComponentId","PlanMarketingName","HIOSProductId","HPID","NetworkId","ServiceAreaId","FormularyId","IsNewPlan","PlanType","MetalLevel","DesignType","UniquePlanDesign","QHPNonQHPTypeId","IsNoticeRequiredForPregnancy","IsReferralRequiredForSpecialist","SpecialistRequiringReferral","PlanLevelExclusions","IndianPlanVariationEstimatedAdvancedPaymentAmountPerEnrollee","CompositeRatingOffered","ChildOnlyOffering","ChildOnlyPlanId","WellnessProgramOffered","DiseaseManagementProgramsOffered","EHBPercentTotalPremium","EHBPediatricDentalApportionmentQuantity","IsGuaranteedRate","PlanEffictiveDate","PlanExpirationDate","OutOfCountryCoverage","OutOfCountryCoverageDescription","OutOfServiceAreaCoverage","OutOfServiceAreaCoverageDescription","NationalNetwork","URLForEnrollmentPayment","FormularyURL","PlanId","PlanVariantMarketingName","CSRVariationType","IssuerActuarialValue","AVCalculatorOutputNumber","MedicalDrugDeductiblesIntegrated","MedicalDrugMaximumOutofPocketIntegrated","MultipleInNetworkTiers","FirstTierUtilization","SecondTierUtilization","SBCHavingaBabyDeductible","SBCHavingaBabyCopayment","SBCHavingaBabyCoinsurance","SBCHavingaBabyLimit","SBCHavingDiabetesDeductible","SBCHavingDiabetesCopayment","SBCHavingDiabetesCoinsurance","SBCHavingDiabetesLimit","SBCHavingSimplefractureDeductible","SBCHavingSimplefractureCopayment","SBCHavingSimplefractureCoinsurance","SBCHavingSimplefractureLimit","SpecialtyDrugMaximumCoinsurance","InpatientCopaymentMaximumDays","BeginPrimaryCareCostSharingAfterNumberOfVisits","BeginPrimaryCareDeductibleCoinsuranceAfterNumberOfCopays","MEHBInnTier1IndividualMOOP","MEHBInnTier1FamilyPerPersonMOOP","MEHBInnTier1FamilyPerGroupMOOP","MEHBInnTier2IndividualMOOP","MEHBInnTier2FamilyPerPersonMOOP","MEHBInnTier2FamilyPerGroupMOOP","MEHBOutOfNetIndividualMOOP","MEHBOutOfNetFamilyPerPersonMOOP","MEHBOutOfNetFamilyPerGroupMOOP","MEHBCombInnOonIndividualMOOP","MEHBCombInnOonFamilyPerPersonMOOP","MEHBCombInnOonFamilyPerGroupMOOP","DEHBInnTier1IndividualMOOP","DEHBInnTier1FamilyPerPersonMOOP","DEHBInnTier1FamilyPerGroupMOOP","DEHBInnTier2IndividualMOOP","DEHBInnTier2FamilyPerPersonMOOP","DEHBInnTier2FamilyPerGroupMOOP","DEHBOutOfNetIndividualMOOP","DEHBOutOfNetFamilyPerPersonMOOP","DEHBOutOfNetFamilyPerGroupMOOP","DEHBCombInnOonIndividualMOOP","DEHBCombInnOonFamilyPerPersonMOOP","DEHBCombInnOonFamilyPerGroupMOOP","TEHBInnTier1IndividualMOOP","TEHBInnTier1FamilyPerPersonMOOP","TEHBInnTier1FamilyPerGroupMOOP","TEHBInnTier2IndividualMOOP","TEHBInnTier2FamilyPerPersonMOOP","TEHBInnTier2FamilyPerGroupMOOP","TEHBOutOfNetIndividualMOOP","TEHBOutOfNetFamilyPerPersonMOOP","TEHBOutOfNetFamilyPerGroupMOOP","TEHBCombInnOonIndividualMOOP","TEHBCombInnOonFamilyPerPersonMOOP","TEHBCombInnOonFamilyPerGroupMOOP","MEHBDedInnTier1Individual","MEHBDedInnTier1FamilyPerPerson","MEHBDedInnTier1FamilyPerGroup","MEHBDedInnTier1Coinsurance","MEHBDedInnTier2Individual","MEHBDedInnTier2FamilyPerPerson","MEHBDedInnTier2FamilyPerGroup","MEHBDedInnTier2Coinsurance","MEHBDedOutOfNetIndividual","MEHBDedOutOfNetFamilyPerPerson","MEHBDedOutOfNetFamilyPerGroup","MEHBDedCombInnOonIndividual","MEHBDedCombInnOonFamilyPerPerson","MEHBDedCombInnOonFamilyPerGroup","DEHBDedInnTier1Individual","DEHBDedInnTier1FamilyPerPerson","DEHBDedInnTier1FamilyPerGroup","DEHBDedInnTier1Coinsurance","DEHBDedInnTier2Individual","DEHBDedInnTier2FamilyPerPerson","DEHBDedInnTier2FamilyPerGroup","DEHBDedInnTier2Coinsurance","DEHBDedOutOfNetIndividual","DEHBDedOutOfNetFamilyPerPerson","DEHBDedOutOfNetFamilyPerGroup","DEHBDedCombInnOonIndividual","DEHBDedCombInnOonFamilyPerPerson","DEHBDedCombInnOonFamilyPerGroup","TEHBDedInnTier1Individual","TEHBDedInnTier1FamilyPerPerson","TEHBDedInnTier1FamilyPerGroup","TEHBDedInnTier1Coinsurance","TEHBDedInnTier2Individual","TEHBDedInnTier2FamilyPerPerson","TEHBDedInnTier2FamilyPerGroup","TEHBDedInnTier2Coinsurance","TEHBDedOutOfNetIndividual","TEHBDedOutOfNetFamilyPerPerson","TEHBDedOutOfNetFamilyPerGroup","TEHBDedCombInnOonIndividual","TEHBDedCombInnOonFamilyPerPerson","TEHBDedCombInnOonFamilyPerGroup","IsHSAEligible","HSAOrHRAEmployerContribution","HSAOrHRAEmployerContributionAmount","URLForSummaryofBenefitsCoverage","PlanBrochure"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","Individual","Yes","93-0438772","21989AK0070001","Delta Dental Premier Healthy Smiles","21989AK007",,"AKN001","AKS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers are treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0070001-00","Delta Dental Premier Healthy Smiles","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierHealthySmilesPlan_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0090002","Delta Dental Premier Practical Plan 1500","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0090002-01","Delta Dental Premier Practical Plan 1500","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPracticalPlan1500_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0130001","Delta Dental Premier Pinnacle Plan 2000","21989AK013",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0130001-00","Delta Dental Premier Pinnacle Plan 2000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPinnaclePlan2000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","Individual","Yes","93-0438772","21989AK0030001","Delta Dental Premier Plan","21989AK003",,"AKN001","AKS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers are treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0030001-00","Delta Dental Premier Plan","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","Individual","Yes","93-0438772","21989AK0030001","Delta Dental Premier Plan","21989AK003",,"AKN001","AKS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers are treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0030001-01","Delta Dental Premier Plan","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0130002","Delta Dental Premier Pinnacle Plan 2500","21989AK013",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0130002-00","Delta Dental Premier Pinnacle Plan 2500","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPinnaclePlan2500_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0080001","Delta Dental Premier Advance Plan 1000","21989AK008",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0080001-00","Delta Dental Premier Advance Plan 1000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierAdvancePlan1000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","Individual","Yes","93-0438772","21989AK0050001","Delta Dental PPO 1000 Plan","21989AK005",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers are treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0050001-00","Delta Dental PPO 1000 Plan","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","Individual","Yes","93-0438772","21989AK0050001","Delta Dental PPO 1000 Plan","21989AK005",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers are treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0050001-01","Delta Dental PPO 1000 Plan","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0080002","Delta Dental Premier Advance Plan 1500","21989AK008",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0080002-00","Delta Dental Premier Advance Plan 1500","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierAdvancePlan1500_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0080003","Delta Dental Premier Advance Plan 2000","21989AK008",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0080003-00","Delta Dental Premier Advance Plan 2000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierAdvancePlan2000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0090001","Delta Dental Premier Practical Plan 1000","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0090001-00","Delta Dental Premier Practical Plan 1000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPracticalPlan1000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","Individual","Yes","93-0438772","21989AK0050002","Delta Dental PPO 1500 Plan","21989AK005",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers are treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0050002-00","Delta Dental PPO 1500 Plan","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","Individual","Yes","93-0438772","21989AK0050002","Delta Dental PPO 1500 Plan","21989AK005",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers are treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0050002-01","Delta Dental PPO 1500 Plan","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0090001","Delta Dental Premier Practical Plan 1000","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0090001-01","Delta Dental Premier Practical Plan 1000","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPracticalPlan1000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0090002","Delta Dental Premier Practical Plan 1500","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0090002-00","Delta Dental Premier Practical Plan 1500","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPracticalPlan1500_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0090003","Delta Dental Premier Practical Plan 2000","21989AK009",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0090003-00","Delta Dental Premier Practical Plan 2000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPracticalPlan2000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0100001","Delta Dental PPO Prosperous Plan 1000","21989AK010",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0100001-00","Delta Dental PPO Prosperous Plan 1000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOProsperousPlan1000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0100002","Delta Dental PPO Prosperous Plan 1500","21989AK010",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0100002-00","Delta Dental PPO Prosperous Plan 1500","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOProsperousPlan1500_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0100003","Delta Dental PPO Prosperous Plan 2000","21989AK010",,"AKN002","AKS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0100003-00","Delta Dental PPO Prosperous Plan 2000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOProsperousPlan2000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0110001","Delta Dental Premier Radiant Smiles","21989AK011",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0110001-00","Delta Dental Premier Radiant Smiles","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierRadiantSmilesPlan_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0140001","Delta Dental Premier Advance Voluntary Plan 1000","21989AK014",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0140001-00","Delta Dental Premier Advance Voluntary Plan 1000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierAdvanceVoluntaryPlan1000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0140002","Delta Dental Premier Advance Voluntary Plan 1500","21989AK014",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0140002-00","Delta Dental Premier Advance Voluntary Plan 1500","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierAdvanceVoluntaryPlan1500_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0150001","Delta Dental Premier Practical Voluntary Plan 1000","21989AK015",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0150001-00","Delta Dental Premier Practical Voluntary Plan 1000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPracticalVoluntaryPlan1000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0150002","Delta Dental Premier Practical Voluntary Plan 1500","21989AK015",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0150002-00","Delta Dental Premier Practical Voluntary Plan 1500","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierPracticalVoluntaryPlan1500_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0160001","Delta Dental PPO Prosperous Voluntary Plan 1000","21989AK016",,"AKN002","AKS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0160001-00","Delta Dental PPO Prosperous Voluntary Plan 1000","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOProsperousVoluntaryPlan1000_SG_2017_AK.pdf"
"2017","AK","21989","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","93-0438772","21989AK0160002","Delta Dental PPO Prosperous Voluntary Plan 1500","21989AK016",,"AKN002","AKS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0160002-00","Delta Dental PPO Prosperous Voluntary Plan 1500","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOProsperousVoluntaryPlan1500_SG_2017_AK.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550002","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK055",,"AKN002","AKS001","AKF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550002-00","Premera Blue Cross Preferred Plus Silver 3000 HSA","Standard Silver Off Exchange Plan",,"0.708646416664124","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/036270_2017.pdf","https://www.premera.com/documents/007528_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550002","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK055",,"AKN002","AKS001","AKF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550002-01","Premera Blue Cross Preferred Plus Silver 3000 HSA","Standard Silver On Exchange Plan",,"0.708646416664124","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/036271_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540003","Premera Blue Cross Preferred Plus Gold 1500","38344AK054",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540003-00","Premera Blue Cross Preferred Plus Gold 1500","Standard Gold Off Exchange Plan",,"0.784541726112366","Yes","Yes","No","100%",,"$1,500","$20","$1,150","$150","$1,500","$430","$210","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036251_2017.pdf","https://www.premera.com/documents/007528_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540003","Premera Blue Cross Preferred Plus Gold 1500","38344AK054",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540003-01","Premera Blue Cross Preferred Plus Gold 1500","Standard Gold On Exchange Plan",,"0.784541726112366","Yes","Yes","No","100%",,"$1,500","$20","$1,150","$150","$1,500","$430","$210","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036252_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540003","Premera Blue Cross Preferred Plus Gold 1500","38344AK054",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540003-02","Premera Blue Cross Preferred Plus Gold 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/036253_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540003","Premera Blue Cross Preferred Plus Gold 1500","38344AK054",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540003-03","Premera Blue Cross Preferred Plus Gold 1500","Limited Cost Sharing Plan Variation",,"0.784541726112366","Yes","Yes","No","100%",,"$1,500","$20","$1,150","$150","$1,500","$430","$210","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036254_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0800003","Moda Health Providence Caliber 2000","73836AK080",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800003-00","Moda Health Providence Caliber 2000","Standard Silver Off Exchange Plan",,"0.718516767024994","Yes","Yes","No","100%",,"$2,000","$20","$1,800","$200","$1,410","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Caliber2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Caliber2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0800003","Moda Health Providence Caliber 2000","73836AK080",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800003-01","Moda Health Providence Caliber 2000","Standard Silver On Exchange Plan",,"0.718516767024994","Yes","Yes","No","100%",,"$2,000","$20","$1,800","$200","$1,410","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Caliber2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Caliber2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0800004","Moda Health Providence Caliber 2500","73836AK080",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800004-00","Moda Health Providence Caliber 2500","Standard Silver Off Exchange Plan",,"0.713962614536285","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,410","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Caliber2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Caliber2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0800004","Moda Health Providence Caliber 2500","73836AK080",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800004-01","Moda Health Providence Caliber 2500","Standard Silver On Exchange Plan",,"0.713962614536285","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,410","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Caliber2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Caliber2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0810001","Moda Health Select Vital 7150","73836AK081",,"AKN001","AKS001","AKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810001-00","Moda Health Select Vital 7150","Standard Bronze Off Exchange Plan",,"0.61737322807312","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$4,260","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Vital7150_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Vital7150_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0810001","Moda Health Select Vital 7150","73836AK081",,"AKN001","AKS001","AKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810001-01","Moda Health Select Vital 7150","Standard Bronze On Exchange Plan",,"0.61737322807312","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$4,260","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Vital7150_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Vital7150_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0810002","Moda Health Providence Vital 7150","73836AK081",,"AKN002","AKS001","AKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810002-00","Moda Health Providence Vital 7150","Standard Bronze Off Exchange Plan",,"0.61737322807312","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$4,260","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Vital7150_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Vital7150_SG_2017_AK.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 3000","38344AK054",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540006-00","Premera Blue Cross Preferred Plus Silver 3000","Standard Silver Off Exchange Plan",,"0.714434087276459","Yes","Yes","No","100%",,"$3,000","$20","$1,060","$150","$3,000","$480","$150","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036255_2017.pdf","https://www.premera.com/documents/007528_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 3000","38344AK054",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540006-01","Premera Blue Cross Preferred Plus Silver 3000","Standard Silver On Exchange Plan",,"0.714434087276459","Yes","Yes","No","100%",,"$3,000","$20","$1,060","$150","$3,000","$480","$150","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036256_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 3000","38344AK054",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540006-02","Premera Blue Cross Preferred Plus Silver 3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/036257_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 3000","38344AK054",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540006-03","Premera Blue Cross Preferred Plus Silver 3000","Limited Cost Sharing Plan Variation",,"0.714434087276459","Yes","Yes","No","100%",,"$3,000","$20","$1,060","$150","$3,000","$480","$150","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036258_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 3000","38344AK054",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540006-04","Premera Blue Cross Preferred Plus Silver 3000 CSR1","73% AV Level Silver Plan",,"0.737601518630981","Yes","Yes","No","100%",,"$3,000","$20","$1,060","$150","$3,000","$480","$150","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036259_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 3000","38344AK054",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540006-05","Premera Blue Cross Preferred Plus Silver 3000 CSR2","87% AV Level Silver Plan",,"0.876988351345062","Yes","Yes","No","100%",,"$1,000","$0","$600","$150","$1,000","$370","$230","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036260_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 3000","38344AK054",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540006-06","Premera Blue Cross Preferred Plus Silver 3000 CSR3","94% AV Level Silver Plan",,"0.947731256484985","Yes","Yes","No","100%",,"$300","$0","$200","$150","$300","$130","$80","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","25.00%",,,,,"$600","$600 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036261_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550001","Premera Blue Cross Preferred Plus Bronze 5250 HSA","38344AK055",,"AKN002","AKS001","AKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550001-00","Premera Blue Cross Preferred Plus Bronze 5250 HSA","Standard Bronze Off Exchange Plan",,"0.619349837303162","Yes","Yes","No","100%",,"$5,250","$0","$610","$150","$5,250","$0","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/036266_2017.pdf","https://www.premera.com/documents/007528_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550001","Premera Blue Cross Preferred Plus Bronze 5250 HSA","38344AK055",,"AKN002","AKS001","AKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550001-01","Premera Blue Cross Preferred Plus Bronze 5250 HSA","Standard Bronze On Exchange Plan",,"0.619349837303162","Yes","Yes","No","100%",,"$5,250","$0","$610","$150","$5,250","$0","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/036267_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550001","Premera Blue Cross Preferred Plus Bronze 5250 HSA","38344AK055",,"AKN002","AKS001","AKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550001-02","Premera Blue Cross Preferred Plus Bronze 5250 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/036268_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550001","Premera Blue Cross Preferred Plus Bronze 5250 HSA","38344AK055",,"AKN002","AKS001","AKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550001-03","Premera Blue Cross Preferred Plus Bronze 5250 HSA","Limited Cost Sharing Plan Variation",,"0.619349837303162","Yes","Yes","No","100%",,"$5,250","$0","$610","$150","$5,250","$0","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/036269_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550002","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK055",,"AKN002","AKS001","AKF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550002-02","Premera Blue Cross Preferred Plus Silver 3000 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/036272_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710006","Value 2000 (Select)","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710006-01","Value 2000 (Select)","Standard Silver On Exchange Plan",,"0.71945583820343","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Value2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Value2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710007","Value 3000 (Select)","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710007-00","Value 3000 (Select)","Standard Silver Off Exchange Plan",,"0.711595594882965","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Value3000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Value3000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710007","Value 3000 (Select)","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710007-01","Value 3000 (Select)","Standard Silver On Exchange Plan",,"0.711595594882965","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Value3000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Value3000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710008","Value 4000 (Select)","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710008-00","Value 4000 (Select)","Standard Silver Off Exchange Plan",,"0.705326437950134","Yes","Yes","No","100%",,"$4,000","$20","$1,000","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Value4000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Value4000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710008","Value 4000 (Select)","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710008-01","Value 4000 (Select)","Standard Silver On Exchange Plan",,"0.705326437950134","Yes","Yes","No","100%",,"$4,000","$20","$1,000","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Value4000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Value4000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0800001","Moda Health Select Caliber 2000","73836AK080",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800001-00","Moda Health Select Caliber 2000","Standard Silver Off Exchange Plan",,"0.718516767024994","Yes","Yes","No","100%",,"$2,000","$20","$1,800","$200","$1,270","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Caliber2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Caliber2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0800001","Moda Health Select Caliber 2000","73836AK080",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800001-01","Moda Health Select Caliber 2000","Standard Silver On Exchange Plan",,"0.718516767024994","Yes","Yes","No","100%",,"$2,000","$20","$1,800","$200","$1,270","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Caliber2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Caliber2000_SG_2017_AK.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550002","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK055",,"AKN002","AKS001","AKF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550002-03","Premera Blue Cross Preferred Plus Silver 3000 HSA","Limited Cost Sharing Plan Variation",,"0.708646416664124","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/036273_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550002","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK055",,"AKN002","AKS001","AKF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550002-04","Premera Blue Cross Preferred Plus Silver 3000 HSA CSR1","73% AV Level Silver Plan",,"0.731817603111267","Yes","Yes","No","100%",,"$2,600","$0","$940","$150","$2,600","$0","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/036274_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550002","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK055",,"AKN002","AKS001","AKF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550002-05","Premera Blue Cross Preferred Plus Silver 3000 NQHSA CSR2","87% AV Level Silver Plan",,"0.868326127529144","Yes","Yes","No","100%",,"$750","$0","$750","$150","$750","$0","$750","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036275_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0550002","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK055",,"AKN002","AKS001","AKF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.999",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0550002-06","Premera Blue Cross Preferred Plus Silver 3000 NQHSA CSR3","94% AV Level Silver Plan",,"0.946193695068359","Yes","Yes","No","100%",,"$250","$0","$250","$150","$250","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036276_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540008","Premera Blue Cross Preferred Plus Bronze 6350","38344AK054",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540008-00","Premera Blue Cross Preferred Plus Bronze 6350","Standard Bronze Off Exchange Plan",,"0.619463264942169","Yes","Yes","No","100%",,"$6,350","$0","$190","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036262_2017.pdf","https://www.premera.com/documents/007528_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","91-0499247","38344AK0710003","Premera Blue Cross Plus Gold 1000","38344AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you’re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"https://www.premera.com/ak/drug-search/","38344AK0710003-00","Premera Blue Cross Plus Gold 1000","Standard Gold Off Exchange Plan",,"0.791506409645081","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$540","$220","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$45,000","$45000 per person","$90000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.premera.com/documents/036285_2017.pdf","https://www.premera.com/documents/027474.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540008","Premera Blue Cross Preferred Plus Bronze 6350","38344AK054",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540008-01","Premera Blue Cross Preferred Plus Bronze 6350","Standard Bronze On Exchange Plan",,"0.619463264942169","Yes","Yes","No","100%",,"$6,350","$0","$190","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036263_2017.pdf","https://www.premera.com/documents/031112_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540008","Premera Blue Cross Preferred Plus Bronze 6350","38344AK054",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540008-02","Premera Blue Cross Preferred Plus Bronze 6350","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/036264_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","91-0499247","38344AK0710003","Premera Blue Cross Plus Gold 1000","38344AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you’re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"https://www.premera.com/ak/drug-search/","38344AK0710003-01","Premera Blue Cross Plus Gold 1000","Standard Gold On Exchange Plan",,"0.791506409645081","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$590","$280","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$45,000","$45000 per person","$90000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.premera.com/documents/036286_2017.pdf","https://www.premera.com/documents/036248_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","Individual","No","91-0499247","38344AK0540008","Premera Blue Cross Preferred Plus Bronze 6350","38344AK054",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/drug-search/","38344AK0540008-03","Premera Blue Cross Preferred Plus Bronze 6350","Limited Cost Sharing Plan Variation",,"0.619463264942169","Yes","Yes","No","100%",,"$6,350","$0","$190","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/036265_2017.pdf","https://www.premera.com/documents/031040_2017.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","91-0499247","38344AK0710006","Premera Blue Cross Plus Silver 2000","38344AK071",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you’re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"https://www.premera.com/ak/drug-search/","38344AK0710006-00","Premera Blue Cross Plus Silver 2000","Standard Silver Off Exchange Plan",,"0.715546667575836","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$1,500","$600","$60","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$45,000","$45000 per person","$90000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.premera.com/documents/036287_2017.pdf","https://www.premera.com/documents/027474.pdf"
"2017","AK","38344","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","91-0499247","38344AK0710006","Premera Blue Cross Plus Silver 2000","38344AK071",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2017-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you’re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"https://www.premera.com/ak/drug-search/","38344AK0710006-01","Premera Blue Cross Plus Silver 2000","Standard Silver On Exchange Plan",,"0.715546667575836","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$1,500","$600","$60","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$45,000","$45000 per person","$90000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.premera.com/documents/036288_2017.pdf","https://www.premera.com/documents/036248_2017.pdf"
"2017","AK","45858","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","45858AK0040002","EHB High PPO","45858AK004",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45858AK0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AK","45858","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","45858AK0040001","EHB Low PPO","45858AK004",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45858AK0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AK","45858","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","45858AK0030002","EHB High Passive","45858AK003",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45858AK0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AK","45858","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","45858AK0030001","EHB Low Passive","45858AK003",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45858AK0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700001","PPO 500 (Providence)","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700001-00","PPO 500 (Providence)","Standard Gold Off Exchange Plan",,"0.81534731388092","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700001","PPO 500 (Providence)","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700001-01","PPO 500 (Providence)","Standard Gold On Exchange Plan",,"0.81534731388092","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700002","PPO 1000 (Providence)","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700002-00","PPO 1000 (Providence)","Standard Gold Off Exchange Plan",,"0.796711087226868","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO1000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO1000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700002","PPO 1000 (Providence)","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700002-01","PPO 1000 (Providence)","Standard Gold On Exchange Plan",,"0.796711087226868","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO1000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO1000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700003","PPO 1500 (Providence)","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700003-00","PPO 1500 (Providence)","Standard Gold Off Exchange Plan",,"0.782948136329651","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,270","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO1500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO1500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700003","PPO 1500 (Providence)","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700003-01","PPO 1500 (Providence)","Standard Gold On Exchange Plan",,"0.782948136329651","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,270","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO1500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO1500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700004","PPO 2500 (Providence)","73836AK070",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700004-00","PPO 2500 (Providence)","Standard Silver Off Exchange Plan",,"0.719503581523895","Yes","Yes","No","100%",,"$2,500","$20","$1,200","$200","$1,270","$1,300","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700004","PPO 2500 (Providence)","73836AK070",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700004-01","PPO 2500 (Providence)","Standard Silver On Exchange Plan",,"0.719503581523895","Yes","Yes","No","100%",,"$2,500","$20","$1,200","$200","$1,270","$1,300","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700005","PPO 3000 (Providence)","73836AK070",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700005-00","PPO 3000 (Providence)","Standard Silver Off Exchange Plan",,"0.716946959495544","Yes","Yes","No","100%",,"$3,000","$20","$1,100","$200","$1,270","$1,300","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO3000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO3000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700005","PPO 3000 (Providence)","73836AK070",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700005-01","PPO 3000 (Providence)","Standard Silver On Exchange Plan",,"0.716946959495544","Yes","Yes","No","100%",,"$3,000","$20","$1,100","$200","$1,270","$1,300","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_PPO3000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_PPO3000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700006","PPO 500 (Select)","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700006-00","PPO 500 (Select)","Standard Gold Off Exchange Plan",,"0.81534731388092","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700006","PPO 500 (Select)","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700006-01","PPO 500 (Select)","Standard Gold On Exchange Plan",,"0.81534731388092","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700007","PPO 1000 (Select)","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700007-00","PPO 1000 (Select)","Standard Gold Off Exchange Plan",,"0.796711087226868","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO1000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO1000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700007","PPO 1000 (Select)","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700007-01","PPO 1000 (Select)","Standard Gold On Exchange Plan",,"0.796711087226868","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO1000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO1000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700008","PPO 1500 (Select)","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700008-00","PPO 1500 (Select)","Standard Gold Off Exchange Plan",,"0.782948136329651","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,270","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO1500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO1500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700008","PPO 1500 (Select)","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700008-01","PPO 1500 (Select)","Standard Gold On Exchange Plan",,"0.782948136329651","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,270","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO1500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO1500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700009","PPO 2500 (Select)","73836AK070",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700009-00","PPO 2500 (Select)","Standard Silver Off Exchange Plan",,"0.719503581523895","Yes","Yes","No","100%",,"$2,500","$20","$1,200","$200","$1,270","$1,300","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700009","PPO 2500 (Select)","73836AK070",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700009-01","PPO 2500 (Select)","Standard Silver On Exchange Plan",,"0.719503581523895","Yes","Yes","No","100%",,"$2,500","$20","$1,200","$200","$1,270","$1,300","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700010","PPO 3000 (Select)","73836AK070",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700010-00","PPO 3000 (Select)","Standard Silver Off Exchange Plan",,"0.716946959495544","Yes","Yes","No","100%",,"$3,000","$20","$1,100","$200","$1,270","$1,300","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO3000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO3000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0700010","PPO 3000 (Select)","73836AK070",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700010-01","PPO 3000 (Select)","Standard Silver On Exchange Plan",,"0.716946959495544","Yes","Yes","No","100%",,"$3,000","$20","$1,100","$200","$1,270","$1,300","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_PPO3000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_PPO3000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710002","Value 2000 (Providence)","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710002-00","Value 2000 (Providence)","Standard Silver Off Exchange Plan",,"0.71945583820343","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Value2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Value2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710002","Value 2000 (Providence)","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710002-01","Value 2000 (Providence)","Standard Silver On Exchange Plan",,"0.71945583820343","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Value2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Value2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710003","Value 3000 (Providence)","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710003-00","Value 3000 (Providence)","Standard Silver Off Exchange Plan",,"0.711595594882965","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Value3000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Value3000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710003","Value 3000 (Providence)","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710003-01","Value 3000 (Providence)","Standard Silver On Exchange Plan",,"0.711595594882965","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Value3000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Value3000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710004","Value 4000 (Providence)","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710004-00","Value 4000 (Providence)","Standard Silver Off Exchange Plan",,"0.705326437950134","Yes","Yes","No","100%",,"$4,000","$20","$1,000","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Value4000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Value4000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710004","Value 4000 (Providence)","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710004-01","Value 4000 (Providence)","Standard Silver On Exchange Plan",,"0.705326437950134","Yes","Yes","No","100%",,"$4,000","$20","$1,000","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Value4000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Value4000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0710006","Value 2000 (Select)","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710006-00","Value 2000 (Select)","Standard Silver Off Exchange Plan",,"0.71945583820343","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$1,270","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Value2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Value2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0800002","Moda Health Select Caliber 2500","73836AK080",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800002-00","Moda Health Select Caliber 2500","Standard Silver Off Exchange Plan",,"0.713962614536285","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Caliber2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Caliber2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0800002","Moda Health Select Caliber 2500","73836AK080",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800002-01","Moda Health Select Caliber 2500","Standard Silver On Exchange Plan",,"0.713962614536285","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Caliber2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Caliber2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0810002","Moda Health Providence Vital 7150","73836AK081",,"AKN002","AKS001","AKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810002-01","Moda Health Providence Vital 7150","Standard Bronze On Exchange Plan",,"0.61737322807312","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$4,260","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Vital7150_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Vital7150_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0820001","Moda Health Select Expedition 4000","73836AK082",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820001-00","Moda Health Select Expedition 4000","Standard Bronze Off Exchange Plan",,"0.612630367279053","Yes","Yes","No","100%",,"$4,000","$0","$1,600","$200","$4,000","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Expedition4000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Expedition4000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0820001","Moda Health Select Expedition 4000","73836AK082",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820001-01","Moda Health Select Expedition 4000","Standard Bronze On Exchange Plan",,"0.612630367279053","Yes","Yes","No","100%",,"$4,000","$0","$1,600","$200","$4,000","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Expedition4000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Expedition4000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0820002","Moda Health Select Expedition 5000","73836AK082",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820002-00","Moda Health Select Expedition 5000","Standard Bronze Off Exchange Plan",,"0.601711213588715","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Expedition5000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Expedition5000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0820002","Moda Health Select Expedition 5000","73836AK082",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820002-01","Moda Health Select Expedition 5000","Standard Bronze On Exchange Plan",,"0.601711213588715","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_Expedition5000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_Expedition5000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0820003","Moda Health Providence Expedition 4000","73836AK082",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820003-00","Moda Health Providence Expedition 4000","Standard Bronze Off Exchange Plan",,"0.612630367279053","Yes","Yes","No","100%",,"$4,000","$0","$1,600","$200","$4,000","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Expedition4000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Expedition4000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0820003","Moda Health Providence Expedition 4000","73836AK082",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820003-01","Moda Health Providence Expedition 4000","Standard Bronze On Exchange Plan",,"0.612630367279053","Yes","Yes","No","100%",,"$4,000","$0","$1,600","$200","$4,000","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Expedition4000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Expedition4000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0820004","Moda Health Providence Expedition 5000","73836AK082",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820004-00","Moda Health Providence Expedition 5000","Standard Bronze Off Exchange Plan",,"0.601711213588715","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Expedition5000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Expedition5000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0820004","Moda Health Providence Expedition 5000","73836AK082",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820004-01","Moda Health Providence Expedition 5000","Standard Bronze On Exchange Plan",,"0.601711213588715","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_Expedition5000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_Expedition5000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0880001","Moda Health Select HSA 2000","73836AK088",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880001-00","Moda Health Select HSA 2000","Standard Silver Off Exchange Plan",,"0.70830899477005","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_HSA2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_HSA2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0880001","Moda Health Select HSA 2000","73836AK088",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880001-01","Moda Health Select HSA 2000","Standard Silver On Exchange Plan",,"0.70830899477005","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_HSA2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_HSA2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0880002","Moda Health Select HSA 2500","73836AK088",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880002-00","Moda Health Select HSA 2500","Standard Silver Off Exchange Plan",,"0.691085517406464","Yes","Yes","No","100%",,"$2,500","$0","$1,200","$200","$2,500","$0","$800","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25.00%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_HSA2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_HSA2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0880002","Moda Health Select HSA 2500","73836AK088",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880002-01","Moda Health Select HSA 2500","Standard Silver On Exchange Plan",,"0.691085517406464","Yes","Yes","No","100%",,"$2,500","$0","$1,200","$200","$2,500","$0","$800","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25.00%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Select_HSA2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Select_HSA2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0880003","Moda Health Providence HSA 2000","73836AK088",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880003-00","Moda Health Providence HSA 2000","Standard Silver Off Exchange Plan",,"0.70830899477005","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_HSA2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_HSA2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0880003","Moda Health Providence HSA 2000","73836AK088",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880003-01","Moda Health Providence HSA 2000","Standard Silver On Exchange Plan",,"0.70830899477005","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_HSA2000_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_HSA2000_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0880004","Moda Health Providence HSA 2500","73836AK088",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880004-00","Moda Health Providence HSA 2500","Standard Silver Off Exchange Plan",,"0.691085517406464","Yes","Yes","No","100%",,"$2,500","$0","$1,200","$200","$2,500","$0","$800","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25.00%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_HSA2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_HSA2500_SG_2017_AK.pdf"
"2017","AK","73836","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","93-0989307","73836AK0880004","Moda Health Providence HSA 2500","73836AK088",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,"2017-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880004-01","Moda Health Providence HSA 2500","Standard Silver On Exchange Plan",,"0.691085517406464","Yes","Yes","No","100%",,"$2,500","$0","$1,200","$200","$2,500","$0","$800","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25.00%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Providence_HSA2500_SBC_SG_2017_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Providence_HSA2500_SG_2017_AK.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","Individual","Yes","95-6042390","74819AK0020003","BESTOne Advantage Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/2017/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010007","BESTDental Premium","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010007","BESTDental Premium","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","Individual","Yes","95-6042390","74819AK0020003","BESTOne Advantage Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/2017/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","Individual","Yes","95-6042390","74819AK0020004","BESTOne Plus Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/2017/AK_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010008","BESTDental Standard - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010008","BESTDental Standard - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","Individual","Yes","95-6042390","74819AK0020004","BESTOne Plus Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/2017/AK_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010010","BESTDental Choice - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010010","BESTDental Choice - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010009","BESTDental Standard - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","Individual","Yes","95-6042390","74819AK0020005","BESTOne Plus Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/2017/AK_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","Individual","Yes","95-6042390","74819AK0020005","BESTOne Plus Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/2017/AK_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010009","BESTDental Standard - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010011","BESTDental Choice - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","Individual","Yes","95-6042390","74819AK0020006","BESTOne Basic Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/2017/AK_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","Individual","Yes","95-6042390","74819AK0020006","BESTOne Basic Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/2017/AK_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010011","BESTDental Choice - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010012","BESTDental Value","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AK","74819","HIOS","2016-08-21 04:30:14","SHOP (Small Group)","Yes","95-6042390","74819AK0010012","BESTDental Value","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","24106","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","36-3757528","24106AZ0040001","TruAssure Dental Small Group Preferred Plan","24106AZ004",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","24106","HIOS","2016-08-24 02:30:21","Individual","Yes","36-3757528","24106AZ0020001","TruAssure Preferred Adult or Child Dental Plan","24106AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ"
"2017","AZ","24106","HIOS","2016-08-24 02:30:21","Individual","Yes","36-3757528","24106AZ0020001","TruAssure Preferred Adult or Child Dental Plan","24106AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","86-0274899","30045AZ0020021","Delta Dental Essential - Family or Child Only","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020021-00","Delta Dental Essential - Family or Child Only","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0280001","Blue Choice Platinum for Business","46944AL028","7346243505","ALN001","ALS001","ALF002","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.998530494273737",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_2.0.pdf","46944AL0280001-00","Blue Choice Platinum for Business","Standard Platinum Off Exchange Plan","91.45%",,"No","Yes","No","100%",,"$0","$300","$0","$200","$20","$900","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2017BlueChoicePlatinum","https://www.AlabamaBlue.com/b2017BlueChoicePlatinum"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0280001","Blue Choice Platinum for Business","46944AL028","7346243505","ALN001","ALS001","ALF002","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.998530494273737",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_2.0.pdf","46944AL0280001-01","Blue Choice Platinum for Business","Standard Platinum On Exchange Plan","91.45%",,"No","Yes","No","100%",,"$0","$300","$0","$200","$20","$900","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2017BlueChoicePlatinum","https://www.AlabamaBlue.com/b2017BlueChoicePlatinum"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0370001-01","Blue Value Gold","Standard Gold On Exchange Plan","78.27%",,"No","Yes","Yes","95%","5%","$800","$400","$0","$200","$20","$1,300","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vgi.pdf","https://www.alabamablue.com/bb/2017vgi.pdf"
"2017","AK","81761","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","81761AK0040002","EHB High PPO","81761AK004",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","81761AK0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AK","81761","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","81761AK0040001","EHB Low PPO","81761AK004",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","81761AK0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AK","81761","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","81761AK0030002","EHB High Passive","81761AK003",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","81761AK0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AK","81761","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","81761AK0030001","EHB Low Passive","81761AK003",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","81761AK0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AK","84859","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","84859AK0040002","EHB High PPO","84859AK004",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84859AK0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AK","84859","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","84859AK0040001","EHB Low PPO","84859AK004",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84859AK0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AK","84859","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","84859AK0030002","EHB High Passive","84859AK003",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84859AK0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AK","84859","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","84859AK0030001","EHB Low Passive","84859AK003",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84859AK0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010007","BESTDental Premium","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Premium_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","12538AL0020003","BESTOne Advantage Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","12538AL0020003","BESTOne Advantage Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010007","BESTDental Premium","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Premium_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010008","BESTDental Standard - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Standard-H_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","12538AL0020004","BESTOne Plus Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","12538AL0020004","BESTOne Plus Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010008","BESTDental Standard - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Standard-H_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010010","BESTDental Choice - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Choice-H_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010010","BESTDental Choice - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Choice-H_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010009","BESTDental Standard - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","","12538AL0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Standard-L_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","12538AL0020005","BESTOne Plus Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","","12538AL0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","12538AL0020005","BESTOne Plus Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","","12538AL0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010009","BESTDental Standard - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","","12538AL0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Standard-L_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010011","BESTDental Choice - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Choice-L_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","12538AL0020006","BESTOne Basic Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","12538AL0020006","BESTOne Basic Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010011","BESTDental Choice - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Choice-L_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010012","BESTDental Value","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Value_Plan.pdf"
"2017","AL","12538","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","12538AL0010012","BESTDental Value","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/2017/AL_BESTDental_Value_Plan.pdf"
"2017","AL","17017","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","57-0523959","17017AL0020001","Group Dental Policy","17017AL002",,"ALN001","ALS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","17017AL0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AL","18756","HIOS","2016-06-24 02:40:05","SHOP (Small Group)","Yes","13-5581829","18756AL0140001","EHB Basic Dental Plan (Low)","18756AL014",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","18756AL0140001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AL","28725","HIOS","2016-06-01 23:04:04","SHOP (Small Group)","Yes","47-0397286","28725AL0090001","Renaissance Group Dental PPO, EHB Certified","28725AL009",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28725AL0090001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AL","28725","HIOS","2016-06-01 23:04:04","SHOP (Small Group)","Yes","47-0397286","28725AL0090002","Renaissance Group Dental PPO, EHB Certified","28725AL009",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28725AL0090002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AL","28732","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","28732AL0040002","EHB High PPO","28732AL004",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","28732AL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AL","28732","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","28732AL0040001","EHB Low PPO","28732AL004",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","28732AL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AL","28732","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","28732AL0030002","EHB High Passive","28732AL003",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","28732AL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AL","28732","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","28732AL0030001","EHB Low Passive","28732AL003",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","28732AL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AL","28899","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","28899AL0040002","EHB High PPO","28899AL004",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","28899AL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AL","28899","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","28899AL0040001","EHB Low PPO","28899AL004",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","28899AL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AL","28899","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","28899AL0030002","EHB High Passive","28899AL003",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","28899AL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AL","28899","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","28899AL0030001","EHB Low Passive","28899AL003",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","28899AL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AL","44580","HIOS","2016-07-01 08:12:23","Individual","Yes","39-1263473","44580AL0380001","Humana Dental Smart Choice","44580AL038",,"ALN003","ALS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9877","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44580AL0380001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2856971"
"2017","AL","44580","HIOS","2016-07-01 08:12:23","Individual","Yes","39-1263473","44580AL0380001","Humana Dental Smart Choice","44580AL038",,"ALN003","ALS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9877","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44580AL0380001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2856971"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0370001-00","Blue Value Gold","Standard Gold Off Exchange Plan","78.27%",,"No","Yes","Yes","95%","5%","$800","$400","$0","$200","$20","$1,300","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vgi.pdf","https://www.alabamablue.com/bb/2017vgi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","Yes","63-0103830","46944AL0530001","Dental Blue Plus for Business","46944AL053","7346243505","ALN002","ALS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Benefits are paid toward the lesser of the allowed amount or the dentist's acutal charge for the service.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","","46944AL0530001-01","Dental Blue Plus for Business","Standard Low On Exchange Plan","69.34%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.AlabamaBlue.com/b2017DentalBluePlus"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","Yes","63-0103830","46944AL0500001","Dental Blue Plus","46944AL050","7346243505","ALN002","ALS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service.","No","https://sso.bcbsal.org/sp/ACS.saml2","","46944AL0500001-01","Dental Blue Plus","Standard Low On Exchange Plan","69.34%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0370001-02","Blue Value Gold","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$200","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vgi-nocost.pdf","https://www.alabamablue.com/bb/2017vgi-nocost.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0370001-03","Blue Value Gold","Limited Cost Sharing Plan Variation","78.27%",,"No","Yes","Yes","95%","5%","$800","$400","$0","$200","$20","$1,300","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vgi-limited.pdf","https://www.alabamablue.com/bb/2017vgi-limited.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-00","Blue Value Silver","Standard Silver Off Exchange Plan","68.34%",,"No","Yes","Yes","95%","5%","$2,600","$700","$0","$200","$20","$1,800","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vsi.pdf","https://www.alabamablue.com/bb/2017vsi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0340001","Blue Access Gold for Business","46944AL034","7346243505","ALN001","ALS001","ALF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_2.0.pdf","46944AL0340001-00","Blue Access Gold for Business","Standard Gold Off Exchange Plan","81.02%",,"No","Yes","Yes","95%","5%","$600","$400","$0","$200","$20","$1,000","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%","$600","$600 per person","$1200 per group","20.00%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2017BlueAccessGold","https://www.AlabamaBlue.com/b2017BlueAccessGold"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0340001","Blue Access Gold for Business","46944AL034","7346243505","ALN001","ALS001","ALF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_2.0.pdf","46944AL0340001-01","Blue Access Gold for Business","Standard Gold On Exchange Plan","81.02%",,"No","Yes","Yes","95%","5%","$600","$400","$0","$200","$20","$1,000","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%","$600","$600 per person","$1200 per group","20.00%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2017BlueAccessGold","https://www.AlabamaBlue.com/b2017BlueAccessGold"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-01","Blue Value Silver","Standard Silver On Exchange Plan","68.34%",,"No","Yes","Yes","95%","5%","$2,600","$700","$0","$200","$20","$1,800","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vsi.pdf","https://www.alabamablue.com/bb/2017vsi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-02","Blue Value Silver","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$200","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vsi-nocost.pdf","https://www.alabamablue.com/bb/2017vsi-nocost.pdf"
"2017","AL","82285","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","82285AL0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0020004-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0020004-17"
"2017","AL","82285","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","82285AL0010004","Delta Dental PPO Preferred Plan for Families","82285AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0010004-17"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-03","Blue Value Silver","Limited Cost Sharing Plan Variation","68.34%",,"No","Yes","Yes","95%","5%","$2,600","$700","$0","$200","$20","$1,800","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vsi-limited.pdf","https://www.alabamablue.com/bb/2017vsi-limited.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-04","Blue Value Silver","73% AV Level Silver Plan","73.93%",,"No","Yes","Yes","95%","5%","$1,800","$600","$0","$200","$20","$1,600","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%","$1,750","$1750 per person","$3500 per group","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vsi-73.pdf","https://www.alabamablue.com/bb/2017vsi-73.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-05","Blue Value Silver","87% AV Level Silver Plan","87.07%",,"No","Yes","Yes","95%","5%","$400","$600","$0","$200","$20","$1,000","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20.00%","$400","$400 per person","$800 per group","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vsi-87.pdf","https://www.alabamablue.com/bb/2017vsi-87.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-06","Blue Value Silver","94% AV Level Silver Plan","94.45%",,"No","Yes","Yes","95%","5%","$100","$200","$0","$200","$20","$400","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","$450","$450 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%","$100","$100 per person","$200 per group","10.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017vsi-94.pdf","https://www.alabamablue.com/bb/2017vsi-94.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0560001-00","Blue HSA Bronze","Standard Bronze Off Exchange Plan",,"0.615404665470123","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,000","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.alabamablue.com/sb/2017hbi.pdf","https://www.alabamablue.com/bb/2017hbi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0310001","Blue HSA Gold for Business","46944AL031","7346243505","ALN001","ALS001","ALF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_2.0.pdf","46944AL0310001-00","Blue HSA Gold for Business","Standard Gold Off Exchange Plan",,"0.789817988872528","Yes","Yes","No","100%",,"$1,600","$0","$600","$200","$1,600","$0","$300","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","10.00%",,,,,"$1,600","$3200 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2017BlueHSAGold","https://www.AlabamaBlue.com/b2017BlueHSAGold"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0310001","Blue HSA Gold for Business","46944AL031","7346243505","ALN001","ALS001","ALF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_2.0.pdf","46944AL0310001-01","Blue HSA Gold for Business","Standard Gold On Exchange Plan",,"0.789817988872528","Yes","Yes","No","100%",,"$1,600","$0","$600","$200","$1,600","$0","$300","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","10.00%",,,,,"$1,600","$3200 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2017BlueHSAGold","https://www.AlabamaBlue.com/b2017BlueHSAGold"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0560001-01","Blue HSA Bronze","Standard Bronze On Exchange Plan",,"0.615404665470123","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,000","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.alabamablue.com/sb/2017hbi.pdf","https://www.alabamablue.com/bb/2017hbi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0560001-02","Blue HSA Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.alabamablue.com/sb/2017hbi-nocost.pdf","https://www.alabamablue.com/bb/2017hbi-nocost.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0560001-03","Blue HSA Bronze","Limited Cost Sharing Plan Variation",,"0.615404665470123","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,000","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2017hbi-limited.pdf","https://www.alabamablue.com/bb/2017hbi-limited.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0460001-00","Blue Saver Bronze","Standard Bronze Off Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$1,700","$900","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2017sbi.pdf","https://www.alabamablue.com/bb/2017sbi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0380001","Blue Secure Silver for Business","46944AL038","7346243505","ALN001","ALS001","ALF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0380001-00","Blue Secure Silver for Business","Standard Silver Off Exchange Plan","70.53%",,"No","Yes","Yes","95%","5%","$2,200","$700","$0","$200","$20","$1,500","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%","$2,200","$2200 per person","$4400 per group","20.00%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2017BlueSecureSilver","https://www.AlabamaBlue.com/b2017BlueSecureSilver"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0380001","Blue Secure Silver for Business","46944AL038","7346243505","ALN001","ALS001","ALF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0380001-01","Blue Secure Silver for Business","Standard Silver On Exchange Plan","70.53%",,"No","Yes","Yes","95%","5%","$2,200","$700","$0","$200","$20","$1,500","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%","$2,200","$2200 per person","$4400 per group","20.00%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2017BlueSecureSilver","https://www.AlabamaBlue.com/b2017BlueSecureSilver"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0460001-01","Blue Saver Bronze","Standard Bronze On Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$1,700","$900","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2017sbi.pdf","https://www.alabamablue.com/bb/2017sbi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0460001-02","Blue Saver Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.alabamablue.com/sb/2017sbi-nocost.pdf","https://www.alabamablue.com/bb/2017sbi-nocost.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0460001-03","Blue Saver Bronze","Limited Cost Sharing Plan Variation","61.87%",,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$1,700","$900","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2017sbi-limited.pdf","https://www.alabamablue.com/bb/2017sbi-limited.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0470001","Blue Protect","46944AL047","7346243505","ALN001","ALS001","ALF012","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0470001-00","Blue Protect","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$4,700","$200","$0","$400","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2017bpi.pdf","https://www.alabamablue.com/bb/2017bpi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0430001","Blue Saver Bronze for Business","46944AL043","7346243505","ALN001","ALS001","ALF010","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0430001-00","Blue Saver Bronze for Business","Standard Bronze Off Exchange Plan","61.85%",,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$1,700","$900","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.AlabamaBlue.com/b2017BlueSaverBronze","https://www.AlabamaBlue.com/b2017BlueSaverBronze"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0430001","Blue Saver Bronze for Business","46944AL043","7346243505","ALN001","ALS001","ALF010","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0430001-01","Blue Saver Bronze for Business","Standard Bronze On Exchange Plan","61.85%",,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$1,700","$900","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.AlabamaBlue.com/b2017BlueSaverBronze","https://www.AlabamaBlue.com/b2017BlueSaverBronze"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","Individual","No","63-0103830","46944AL0470001","Blue Protect","46944AL047","7346243505","ALN001","ALS001","ALF012","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0470001-01","Blue Protect","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$4,700","$200","$0","$400","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2017bpi.pdf","https://www.alabamablue.com/bb/2017bpi.pdf"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0570001","Blue HSA Bronze for Business","46944AL057","7346243505","ALN001","ALS001","ALF016","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0570001-00","Blue HSA Bronze for Business","Standard Bronze Off Exchange Plan",,"0.615404665470123","Yes","Yes","No","100%",,"$6,450","$0","$0","$200","$5,000","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2017BlueHSABronze","https://www.AlabamaBlue.com/b2017BlueHSABronze"
"2017","AL","46944","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","63-0103830","46944AL0570001","Blue HSA Bronze for Business","46944AL057","7346243505","ALN001","ALS001","ALF016","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0570001-01","Blue HSA Bronze for Business","Standard Bronze On Exchange Plan",,"0.615404665470123","Yes","Yes","No","100%",,"$6,450","$0","$0","$200","$5,000","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2017BlueHSABronze","https://www.AlabamaBlue.com/b2017BlueHSABronze"
"2017","AL","60075","HIOS","2016-08-18 02:41:03","SHOP (Small Group)","Yes","36-3757528","60075AL0030001","TruAssure Dental Small Group Basic Plan","60075AL003",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AL","60075","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","60075AL0010001","TruAssure Basic Adult or Child Dental Plan","60075AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL"
"2017","AL","60075","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","60075AL0010001","TruAssure Basic Adult or Child Dental Plan","60075AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL"
"2017","AL","60075","HIOS","2016-08-18 02:41:03","SHOP (Small Group)","Yes","36-3757528","60075AL0040001","TruAssure Dental Small Group Preferred Plan","60075AL004",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AL","60075","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","60075AL0020001","TruAssure Preferred Adult or Child Dental Plan","60075AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL"
"2017","AL","60075","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","60075AL0020001","TruAssure Preferred Adult or Child Dental Plan","60075AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL"
"2017","AL","68707","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","68707AL0040002","EHB High PPO","68707AL004",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","68707AL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AL","68707","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","68707AL0040001","EHB Low PPO","68707AL004",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","68707AL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AL","68707","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","68707AL0030002","EHB High Passive","68707AL003",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","68707AL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AL","68707","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","68707AL0030001","EHB Low Passive","68707AL003",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","68707AL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AL","82285","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","82285AL0010002","Delta Dental PPO Pediatric Preferred Plan","82285AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0010002-17"
"2017","AL","82285","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","82285AL0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0020002-17"
"2017","AL","82285","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","82285AL0010001","Delta Dental PPO Pediatric Basic Plan","82285AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0010001-17"
"2017","AL","82285","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","82285AL0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0020001-17"
"2017","AL","82285","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","82285AL0010006","Delta Dental PPO Basic Plan for Families","82285AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0010006-17"
"2017","AL","82285","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","82285AL0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0020006-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0020006-17"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","Individual","Yes","59-0397210","12303AZ0010001","DentaQuest PPO  Pediatric High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","59-0397210","12303AZ0020003","DentaQuest PPO Family High","12303AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0020003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","59-0397210","12303AZ0020003","DentaQuest PPO Family High","12303AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0020003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","Individual","Yes","59-0397210","12303AZ0010001","DentaQuest PPO  Pediatric High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","59-0397210","12303AZ0020004","DentaQuest PPO Family Low","12303AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0020004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","59-0397210","12303AZ0020004","DentaQuest PPO Family Low","12303AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0020004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","Individual","Yes","59-0397210","12303AZ0010003","DentaQuest PPO Family High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","Individual","Yes","59-0397210","12303AZ0010003","DentaQuest PPO Family High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","Individual","Yes","59-0397210","12303AZ0010004","DentaQuest PPO Family Low","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","12303","HIOS","2016-08-16 03:04:39","Individual","Yes","59-0397210","12303AZ0010004","DentaQuest PPO Family Low","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2017","AZ","17100","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","17100AZ0160001","EHB Basic Dental Plan (Low)","17100AZ016",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0160001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","17100","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","17100AZ0180001","Family Basic Dental Plan (Low)","17100AZ018",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0180001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49067"
"2017","AZ","17100","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","17100AZ0180001","Family Basic Dental Plan (Low)","17100AZ018",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0180001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49067"
"2017","AZ","17100","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","17100AZ0190001","Family Enhanced Dental Plan (High)","17100AZ019",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0190001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49069"
"2017","AZ","17100","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","17100AZ0190001","Family Enhanced Dental Plan (High)","17100AZ019",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0190001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49069"
"2017","AZ","17454","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","17454AZ0010003","Guardian Pediatric Advantage","17454AZ001",,"AZN001","AZS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","17454AZ0010003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","AZ","17454","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","17454AZ0020003","Guardian Pediatric Essentials","17454AZ002",,"AZN001","AZS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","17454AZ0020003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","AZ","24106","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","36-3757528","24106AZ0030001","TruAssure Dental Small Group Basic Plan","24106AZ003",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","24106","HIOS","2016-08-24 02:30:21","Individual","Yes","36-3757528","24106AZ0010001","TruAssure Basic Adult or Child Dental Plan","24106AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ"
"2017","AZ","24106","HIOS","2016-08-24 02:30:21","Individual","Yes","36-3757528","24106AZ0010001","TruAssure Basic Adult or Child Dental Plan","24106AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ"
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340005","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340005-02","EverydayHealth HMO 1000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340005","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340005-03","EverydayHealth HMO 1000 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340015","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340015-04","EverydayHealth HMO 4000 - Neighborhood Network","73% AV Level Silver Plan","72.61%","0.732269465923309","No","Yes","No","100%",,"$3,000","$60","$430","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood73",
"2017","AZ","66915","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","66915AZ0030002","EHB High Passive","66915AZ003",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","66915AZ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AZ","66915","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","66915AZ0030001","EHB Low Passive","66915AZ003",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","66915AZ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","77352AZ0020003","BESTOne Advantage Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf","","77352AZ0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010007","BESTDental Premium","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Premium_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010007","BESTDental Premium","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Premium_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","77352AZ0020003","BESTOne Advantage Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf","","77352AZ0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","Individual","Yes","86-0274899","30045AZ0010021","Delta Dental Essential - Family or Child Only","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010021-00","Delta Dental Essential - Family or Child Only","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Essential%20Off2017%2000632%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Essential%20Off2017%2000632%20002.000.pdf"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","Individual","Yes","86-0274899","30045AZ0010021","Delta Dental Essential - Family or Child Only","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010021-01","Delta Dental Essential - Family or Child Only","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Essential%20Off2017%2000632%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Essential%20Off2017%2000632%20002.000.pdf"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","86-0274899","30045AZ0020021","Delta Dental Essential - Family or Child Only","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020021-01","Delta Dental Essential - Family or Child Only","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","86-0274899","30045AZ0020032","Delta Dental Select PPO - Family or Child Only","30045AZ002",,"AZN002","AZS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020032-00","Delta Dental Select PPO - Family or Child Only","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","Individual","Yes","86-0274899","30045AZ0010032","Delta Dental Select PPO - Family or Child Only","30045AZ001",,"AZN002","AZS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010032-00","Delta Dental Select PPO - Family or Child Only","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Select%20Off2017%2000633%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Select%20Off2017%2000633%20002.000.pdf"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","Individual","Yes","86-0274899","30045AZ0010032","Delta Dental Select PPO - Family or Child Only","30045AZ001",,"AZN002","AZS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010032-01","Delta Dental Select PPO - Family or Child Only","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Select%20Off2017%2000633%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Select%20Off2017%2000633%20002.000.pdf"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","86-0274899","30045AZ0020032","Delta Dental Select PPO - Family or Child Only","30045AZ002",,"AZN002","AZS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020032-01","Delta Dental Select PPO - Family or Child Only","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2017","AZ","30045","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","86-0274899","30045AZ0020030","Delta Dental Child Only PPO Plan","30045AZ002",,"AZN002","AZS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020030-00","Delta Dental Child Only PPO Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2017","AZ","33851","HIOS","2016-08-04 02:29:22","Individual","Yes","91-1857813","33851AZ0110007","Premier Choice","33851AZ011",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","http://www.premierlife.com/payment","","33851AZ0110007-00","Premier Choice","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/prospective-members/hbex","https://www.premierlife.com/prospective-members/hbex"
"2017","AZ","33851","HIOS","2016-08-04 02:29:22","Individual","Yes","91-1857813","33851AZ0110007","Premier Choice","33851AZ011",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","http://www.premierlife.com/payment","","33851AZ0110007-01","Premier Choice","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/prospective-members/hbex","https://www.premierlife.com/prospective-members/hbex"
"2017","AZ","52147","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","52147AZ0040002","EHB High PPO","52147AZ004",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","52147AZ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AZ","52147","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","52147AZ0040001","EHB Low PPO","52147AZ004",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","52147AZ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AZ","52147","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","52147AZ0030002","EHB High Passive","52147AZ003",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","52147AZ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AZ","52147","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","52147AZ0030001","EHB Low Passive","52147AZ003",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","52147AZ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AZ","53613","HIOS","2016-08-18 02:41:03","Individual","Yes","20-4023720","53613AZ0010001","EMI Health Choice PPO (High)","53613AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010001-00","EMI Health Choice PPO (High)","Standard High Off Exchange Plan","84.64%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,"$0","$0 per person","$0 per group",,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx"
"2017","AZ","53613","HIOS","2016-08-18 02:41:03","Individual","Yes","20-4023720","53613AZ0010001","EMI Health Choice PPO (High)","53613AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010001-01","EMI Health Choice PPO (High)","Standard High On Exchange Plan","84.64%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,"$0","$0 per person","$0 per group",,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx"
"2017","AZ","53613","HIOS","2016-08-18 02:41:03","Individual","Yes","20-4023720","53613AZ0010002","EMI Health Choice PPO (Low)","53613AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010002-00","EMI Health Choice PPO (Low)","Standard Low Off Exchange Plan","71.86%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx"
"2017","AZ","53613","HIOS","2016-08-18 02:41:03","Individual","Yes","20-4023720","53613AZ0010002","EMI Health Choice PPO (Low)","53613AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010002-01","EMI Health Choice PPO (Low)","Standard Low On Exchange Plan","71.86%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx"
"2017","AZ","53613","HIOS","2016-08-18 02:41:03","Individual","Yes","20-4023720","53613AZ0010003","EMI Health Advantage Co-Pay","53613AZ001",,"AZN002","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010003-00","EMI Health Advantage Co-Pay","Standard Low Off Exchange Plan","68.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx"
"2017","AZ","53613","HIOS","2016-08-18 02:41:03","Individual","Yes","20-4023720","53613AZ0010003","EMI Health Advantage Co-Pay","53613AZ001",,"AZN002","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010003-01","EMI Health Advantage Co-Pay","Standard Low On Exchange Plan","68.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx"
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0004538","53901AZ0790001","EverydayHealth PPO1000 - Statewide Network","53901AZ079",,"AZN001","AZS011","AZF007","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790001-00","EverydayHealth PPO1000 - Statewide Network","Standard Gold Off Exchange Plan",,"0.788293182849884","No","Yes","No","100%",,"$1,000","$70","$830","$150","$140","$1,450","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2017plans/EverydayHealth1000SHOP",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0004538","53901AZ0790001","EverydayHealth PPO1000 - Statewide Network","53901AZ079",,"AZN001","AZS011","AZF007","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790001-01","EverydayHealth PPO1000 - Statewide Network","Standard Gold On Exchange Plan",,"0.788293182849884","No","Yes","No","100%",,"$1,000","$70","$830","$150","$140","$1,450","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2017plans/EverydayHealth1000SHOP",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0004538","53901AZ0790002","EverydayHealth PPO 2000 - Statewide Network","53901AZ079",,"AZN001","AZS011","AZF008","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790002-00","EverydayHealth PPO 2000 - Statewide Network","Standard Silver Off Exchange Plan",,"0.707607567310333","No","Yes","No","100%",,"$2,000","$90","$630","$150","$140","$2,170","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2017plans/EverydayHealth2000SHOP",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0004538","53901AZ0790002","EverydayHealth PPO 2000 - Statewide Network","53901AZ079",,"AZN001","AZS011","AZF008","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790002-01","EverydayHealth PPO 2000 - Statewide Network","Standard Silver On Exchange Plan",,"0.707607567310333","No","Yes","No","100%",,"$2,000","$90","$630","$150","$140","$2,170","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2017plans/EverydayHealth2000SHOP",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0004538","53901AZ0790004","EverydayHealth PPO 6000 - Statewide Network","53901AZ079",,"AZN001","AZS011","AZF009","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790004-00","EverydayHealth PPO 6000 - Statewide Network","Standard Bronze Off Exchange Plan",,"0.61848521232605","No","Yes","No","100%",,"$5,170","$110","$0","$150","$140","$2,920","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2017plans/EverydayHealth6000SHOP",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0004538","53901AZ0790004","EverydayHealth PPO 6000 - Statewide Network","53901AZ079",,"AZN001","AZS011","AZF009","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790004-01","EverydayHealth PPO 6000 - Statewide Network","Standard Bronze On Exchange Plan",,"0.61848521232605","No","Yes","No","100%",,"$5,170","$110","$0","$150","$140","$2,920","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2017plans/EverydayHealth6000SHOP",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360009","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS002","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360009-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340011","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340011-02","EverydayHealth HMO 1000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340011","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340011-03","EverydayHealth HMO 1000 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340016","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340016-02","EverydayHealth HMO 6500 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360009","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS002","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360009-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340005","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340005-00","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold Off Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340005","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340005-01","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold On Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340006","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340006-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340006","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340006-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340006","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340006-02","EverydayHealth HMO 4000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340006","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340006-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340006","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340006-04","EverydayHealth HMO 4000 - Neighborhood Network","73% AV Level Silver Plan","72.61%","0.732269465923309","No","Yes","No","100%",,"$3,000","$60","$430","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood73",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340006","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340006-05","EverydayHealth HMO 4000 - Neighborhood Network","87% AV Level Silver Plan","86.09%","0.861103415489197","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood87",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340006","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340006-06","EverydayHealth HMO 4000 - Neighborhood Network","94% AV Level Silver Plan","93.09%","0.929519891738892","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood94",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340007","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340007-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340007","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340007-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340007","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340007-02","EverydayHealth HMO 6500 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340007","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS004","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340007-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360003","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS004","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360003-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360003","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS004","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360003-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340008","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340008-00","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold Off Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340008","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340008-01","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold On Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340008","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340008-02","EverydayHealth HMO 1000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340008","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340008-03","EverydayHealth HMO 1000 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340009-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340009-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340009-02","EverydayHealth HMO 4000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340009-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340009-04","EverydayHealth HMO 4000 - Neighborhood Network","73% AV Level Silver Plan","72.61%","0.732269465923309","No","Yes","No","100%",,"$3,000","$60","$430","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood73",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340009-05","EverydayHealth HMO 4000 - Neighborhood Network","87% AV Level Silver Plan","86.09%","0.861103415489197","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood87",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340009-06","EverydayHealth HMO 4000 - Neighborhood Network","94% AV Level Silver Plan","93.09%","0.929519891738892","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood94",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340010","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340010-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340010","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340010-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340010","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340010-02","EverydayHealth HMO 6500 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340010","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS005","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340010-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360004","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS005","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360004-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360004","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS005","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360004-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340011","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340011-00","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold Off Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340011","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340011-01","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold On Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340012-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340012-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340012-02","EverydayHealth HMO 4000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340012-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340012-04","EverydayHealth HMO 4000 - Neighborhood Network","73% AV Level Silver Plan","72.61%","0.732269465923309","No","Yes","No","100%",,"$3,000","$60","$430","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood73",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340012-05","EverydayHealth HMO 4000 - Neighborhood Network","87% AV Level Silver Plan","86.09%","0.861103415489197","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood87",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340012-06","EverydayHealth HMO 4000 - Neighborhood Network","94% AV Level Silver Plan","93.09%","0.929519891738892","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood94",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340013","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340013-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340013","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340013-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340013","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340013-02","EverydayHealth HMO 6500 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340013","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS006","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340013-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360005","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS006","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360005-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360005","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS006","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360005-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340014","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340014-00","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold Off Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340014","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340014-01","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold On Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340014","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340014-02","EverydayHealth HMO 1000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340014","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340014-03","EverydayHealth HMO 1000 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340015","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340015-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340015","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340015-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340015","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340015-02","EverydayHealth HMO 4000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340015","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340015-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340015","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340015-05","EverydayHealth HMO 4000 - Neighborhood Network","87% AV Level Silver Plan","86.09%","0.861103415489197","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood87",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340015","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340015-06","EverydayHealth HMO 4000 - Neighborhood Network","94% AV Level Silver Plan","93.09%","0.929519891738892","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood94",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340016","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340016-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340016","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340016-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340016","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS007","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340016-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360006","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS007","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360006-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360006","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS007","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360006-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340017","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340017-00","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold Off Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340017","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340017-01","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold On Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340017","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340017-02","EverydayHealth HMO 1000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340017","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340017-03","EverydayHealth HMO 1000 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340018","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340018-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340018","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340018-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340018","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340018-02","EverydayHealth HMO 4000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340018","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340018-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340018","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340018-04","EverydayHealth HMO 4000 - Neighborhood Network","73% AV Level Silver Plan","72.61%","0.732269465923309","No","Yes","No","100%",,"$3,000","$60","$430","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood73",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340018","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340018-05","EverydayHealth HMO 4000 - Neighborhood Network","87% AV Level Silver Plan","86.09%","0.861103415489197","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood87",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340018","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340018-06","EverydayHealth HMO 4000 - Neighborhood Network","94% AV Level Silver Plan","93.09%","0.929519891738892","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood94",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340019","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340019-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340019","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340019-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340019","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340019-02","EverydayHealth HMO 6500 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340019","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS008","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340019-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360007","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS008","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360007-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360007","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS008","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360007-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340020","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340020-00","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold Off Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340020","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340020-01","EverydayHealth HMO 1000 - Neighborhood Network","Standard Gold On Exchange Plan","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340020","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340020-02","EverydayHealth HMO 1000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340020","EverydayHealth HMO 1000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340020-03","EverydayHealth HMO 1000 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.07%","0.785674571990967","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth1000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340021","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340021-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340021","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340021-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340021","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340021-02","EverydayHealth HMO 4000 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340021","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340021-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","68.08%","0.688470363616943","No","Yes","No","100%",,"$4,000","$60","$230","$150","$310","$1,230","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340021","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340021-04","EverydayHealth HMO 4000 - Neighborhood Network","73% AV Level Silver Plan","72.61%","0.732269465923309","No","Yes","No","100%",,"$3,000","$60","$430","$150","$310","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood73",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340021","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340021-05","EverydayHealth HMO 4000 - Neighborhood Network","87% AV Level Silver Plan","86.09%","0.861103415489197","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood87",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340021","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340021-06","EverydayHealth HMO 4000 - Neighborhood Network","94% AV Level Silver Plan","93.09%","0.929519891738892","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth4000Neighborhood94",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340022","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340022-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340022","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340022-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340022","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340022-02","EverydayHealth HMO 6500 - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1340022","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ134",,"AZN002","AZS009","AZF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340022-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","60.28%","0.607267260551453","No","Yes","No","100%",,"$5,170","$120","$0","$150","$310","$2,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2017plans/EverydayHealth6500Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360008","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS009","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360008-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1360008","SimpleHealth HMO - Neighborhood Network","53901AZ136",,"AZN002","AZS009","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360008-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/SimpleHealth7150Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1350003","Portfolio HSA HMO 6550 - Neighborhood Network","53901AZ135",,"AZN002","AZS010","AZF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350003-00","Portfolio HSA HMO 6550 - Neighborhood Network","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2017plans/Portfolio6550Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1350003","Portfolio HSA HMO 6550 - Neighborhood Network","53901AZ135",,"AZN002","AZS010","AZF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350003-01","Portfolio HSA HMO 6550 - Neighborhood Network","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2017plans/Portfolio6550Neighborhood",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1350003","Portfolio HSA HMO 6550 - Neighborhood Network","53901AZ135",,"AZN002","AZS010","AZF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350003-02","Portfolio HMO 6550 - Neighborhood Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.azblue.com/2017plans/Portfolio6550NeighborhoodZero",
"2017","AZ","53901","HIOS","2017-01-19 02:20:17","Individual","No","86-0004538","53901AZ1350003","Portfolio HSA HMO 6550 - Neighborhood Network","53901AZ135",,"AZN002","AZS010","AZF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2017-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350003-03","Portfolio HMO 6550 - Neighborhood Network","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2017plans/Portfolio6550Neighborhood",
"2017","AZ","58292","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","58292AZ0010001","Dentegra Dental PPO Pediatric Basic Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010001-17"
"2017","AZ","58292","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","58292AZ0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","58292AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0020001-17"
"2017","AZ","58292","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","58292AZ0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","58292AZ002",,"AZN001","AZS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0020008-17"
"2017","AZ","58292","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","58292AZ0010008","Dentegra Dental PPO Family Preferred Plan","58292AZ001",,"AZN001","AZS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010008-17"
"2017","AZ","58292","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","58292AZ0010007","Dentegra Dental PPO Family Basic Plan","58292AZ001",,"AZN001","AZS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010007-17"
"2017","AZ","58292","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","58292AZ0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","58292AZ002",,"AZN001","AZS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0020007-17"
"2017","AZ","59748","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","44-0308260","59748AZ0010001","KCL EHB Low PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","59748","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","44-0308260","59748AZ0010003","KCL EHB Low PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010003-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","59748","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","44-0308260","59748AZ0010005","KCL EHB Low PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010005-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","59748","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","44-0308260","59748AZ0010007","KCL EHB Low PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010007-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","59748","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","44-0308260","59748AZ0010002","KCL EHB High PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","59748","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","44-0308260","59748AZ0010004","KCL EHB High PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010004-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","59748","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","44-0308260","59748AZ0010006","KCL EHB High PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010006-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","59748","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","44-0308260","59748AZ0010008","KCL EHB High PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010008-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AZ","66105","HIOS","2016-07-01 08:12:23","Individual","Yes","39-1263473","66105AZ0620002","Humana Dental Smart Choice","66105AZ062",,"AZN001","AZS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9874","Guaranteed Rate","2017-01-01",,"No","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","No","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","66105AZ0620002-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2856984"
"2017","AZ","66105","HIOS","2016-07-01 08:12:23","Individual","Yes","39-1263473","66105AZ0620002","Humana Dental Smart Choice","66105AZ062",,"AZN001","AZS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9874","Guaranteed Rate","2017-01-01",,"No","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","No","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","66105AZ0620002-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2856984"
"2017","AZ","66915","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","66915AZ0040002","EHB High PPO","66915AZ004",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","66915AZ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AZ","66915","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","66915AZ0040001","EHB Low PPO","66915AZ004",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","66915AZ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","77352AZ0020004","BESTOne Plus Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf","","77352AZ0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010008","BESTDental Standard - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Standard-H_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010008","BESTDental Standard - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Standard-H_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","77352AZ0020004","BESTOne Plus Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf","","77352AZ0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010010","BESTDental Choice - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Choice-H_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010010","BESTDental Choice - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Choice-H_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010009","BESTDental Standard - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Standard-L_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","77352AZ0020005","BESTOne Plus Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf","","77352AZ0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","77352AZ0020005","BESTOne Plus Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf","","77352AZ0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010009","BESTDental Standard - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Standard-L_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010011","BESTDental Choice - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Choice-L_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","77352AZ0020006","BESTOne Basic Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf","","77352AZ0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","77352AZ0020006","BESTOne Basic Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf","","77352AZ0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010011","BESTDental Choice - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Choice-L_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010012","BESTDental Value","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Value_Plan.pdf"
"2017","AZ","77352","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","77352AZ0010012","BESTDental Value","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2017/AZ_BESTDental_Value_Plan.pdf"
"2017","AZ","86830","HIOS","2016-06-26 07:33:26","Individual","Yes","59-1031071","86830AZ0050001","Cigna Dental Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","AZ","86830","HIOS","2016-06-26 07:33:26","Individual","Yes","59-1031071","86830AZ0050001","Cigna Dental Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050001-01","Cigna Dental Pediatric","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","AZ","86830","HIOS","2016-06-26 07:33:26","Individual","Yes","59-1031071","86830AZ0050002","Cigna Dental Family + Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050002-01","Cigna Dental Family + Pediatric","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-family-pediatric-fedvip"
"2017","AZ","90264","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","90264AZ0040002","EHB High PPO","90264AZ004",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","90264AZ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01",,"No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080035-03","Ambetter Balanced Care 4 (2017)","Limited Cost Sharing Plan Variation",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_70_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_70.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01",,"No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080035-04","Ambetter Balanced Care 4 (2017)","73% AV Level Silver Plan",,"0.732531428337097","Yes","Yes","No","100%",,"$5,200","$40","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_73_csr_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_73_csr.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01",,"No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080035-05","Ambetter Balanced Care 4 (2017)","87% AV Level Silver Plan",,"0.865934371948242","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_87_csr_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_87_csr.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01",,"No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080035-06","Ambetter Balanced Care 4 (2017)","94% AV Level Silver Plan",,"0.947982847690582","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_94_csr_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_94_csr.pdf"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","13-5123390","15833FL0090003","Managed DentalGuard FL10 Family Plan","15833FL009",,"FLN002","FLS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.943","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","15833FL0090003-01","Managed DentalGuard FL10 Family Plan","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","Individual","Yes","13-5123390","15833FL0120002","Managed DentalGuard FL Essentials 1","15833FL012",,"FLN004","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.947","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/payments","","15833FL0120002-00","Managed DentalGuard FL Essentials 1","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","Individual","Yes","13-5123390","15833FL0120002","Managed DentalGuard FL Essentials 1","15833FL012",,"FLN004","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.947","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/payments","","15833FL0120002-01","Managed DentalGuard FL Essentials 1","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","Individual","Yes","13-5123390","15833FL0130001","Guardian Essentials for Families and Individuals","15833FL013",,"FLN003","FLS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","15833FL0130001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS004","AZF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-05","Ambetter Balanced Care 9 (2017)","87% AV Level Silver Plan",,"0.879836797714233","Yes","Yes","No","100%",,"$600","$300","$1,200","$200","$600","$1,200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ ab_balanced9_silver_87_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ ab_balanced9_silver_87_csr.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS004","AZF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-06","Ambetter Balanced Care 9 (2017)","94% AV Level Silver Plan",,"0.949740052223206","Yes","Yes","No","100%",,"$10","$400","$900","$200","$10","$1,100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,275","$1275 per person","$2550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5","$5 per person","$10 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ ab_balanced9_silver_94_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ ab_balanced9_silver_94_csr.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080034-00","Ambetter Balanced Care 9 (2017)","Standard Silver Off Exchange Plan",,"0.686337351799011","Yes","Yes","No","100%",,"$4,200","$20","$600","$200","$4,200","$300","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver.pdf"
"2017","AZ","90264","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","90264AZ0040001","EHB Low PPO","90264AZ004",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","90264AZ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AZ","90264","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","90264AZ0030002","EHB High Passive","90264AZ003",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","90264AZ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AZ","90264","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","90264AZ0030001","EHB Low Passive","90264AZ003",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","90264AZ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080029","Ambetter Secure Care 4 (2017)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080029-00","Ambetter Secure Care 4 (2017)","Standard Gold Off Exchange Plan",,"0.784063458442688","Yes","Yes","No","100%",,"$1,400","$800","$0","$200","$1,400","$600","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080029","Ambetter Secure Care 4 (2017)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080029-01","Ambetter Secure Care 4 (2017)","Standard Gold On Exchange Plan",,"0.784063458442688","Yes","Yes","No","100%",,"$1,400","$800","$0","$200","$1,400","$600","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080029","Ambetter Secure Care 4 (2017)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080029-02","Ambetter Secure Care 4 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold _trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold _trbl.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080029","Ambetter Secure Care 4 (2017)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080029-03","Ambetter Secure Care 4 (2017)","Limited Cost Sharing Plan Variation",,"0.784063458442688","Yes","Yes","No","100%",,"$1,400","$800","$0","$200","$1,400","$600","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080033","Ambetter Secure Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF004","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080033-00","Ambetter Secure Care 4 (2017)","Standard Gold Off Exchange Plan",,"0.784063458442688","Yes","Yes","No","100%",,"$1,400","$800","$0","$200","$1,400","$600","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080033","Ambetter Secure Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF004","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080033-01","Ambetter Secure Care 4 (2017)","Standard Gold On Exchange Plan",,"0.784063458442688","Yes","Yes","No","100%",,"$1,400","$800","$0","$200","$1,400","$600","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080033","Ambetter Secure Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF004","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080033-02","Ambetter Secure Care 4 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold _trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold _trbl.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080033","Ambetter Secure Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF004","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080033-03","Ambetter Secure Care 4 (2017)","Limited Cost Sharing Plan Variation",,"0.784063458442688","Yes","Yes","No","100%",,"$1,400","$800","$0","$200","$1,400","$600","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_secure4_gold.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS004","AZF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-00","Ambetter Balanced Care 9 (2017)","Standard Silver Off Exchange Plan",,"0.686337351799011","Yes","Yes","No","100%",,"$4,200","$20","$600","$200","$4,200","$300","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS004","AZF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-01","Ambetter Balanced Care 9 (2017)","Standard Silver On Exchange Plan",,"0.686337351799011","Yes","Yes","No","100%",,"$4,200","$20","$600","$200","$4,200","$300","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS004","AZF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-02","Ambetter Balanced Care 9 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_trbl.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS004","AZF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-03","Ambetter Balanced Care 9 (2017)","Limited Cost Sharing Plan Variation",,"0.686337351799011","Yes","Yes","No","100%",,"$4,200","$20","$600","$200","$4,200","$300","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS004","AZF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-04","Ambetter Balanced Care 9 (2017)","73% AV Level Silver Plan",,"0.739988088607788","Yes","Yes","No","100%",,"$2,350","$200","$900","$200","$2,350","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_73_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_73_csr.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080034-01","Ambetter Balanced Care 9 (2017)","Standard Silver On Exchange Plan",,"0.686337351799011","Yes","Yes","No","100%",,"$4,200","$20","$600","$200","$4,200","$300","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080034-02","Ambetter Balanced Care 9 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_trbl.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080034-03","Ambetter Balanced Care 9 (2017)","Limited Cost Sharing Plan Variation",,"0.686337351799011","Yes","Yes","No","100%",,"$4,200","$20","$600","$200","$4,200","$300","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080034-04","Ambetter Balanced Care 9 (2017)","73% AV Level Silver Plan",,"0.739988088607788","Yes","Yes","No","100%",,"$2,350","$200","$900","$200","$2,350","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_73_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced9_silver_73_csr.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080034-05","Ambetter Balanced Care 9 (2017)","87% AV Level Silver Plan",,"0.879836797714233","Yes","Yes","No","100%",,"$600","$300","$1,200","$200","$600","$1,200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ ab_balanced9_silver_87_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ ab_balanced9_silver_87_csr.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2017)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080034-06","Ambetter Balanced Care 9 (2017)","94% AV Level Silver Plan",,"0.949740052223206","Yes","Yes","No","100%",,"$10","$400","$900","$200","$10","$1,100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,275","$1275 per person","$2550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5","$5 per person","$10 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ ab_balanced9_silver_94_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ ab_balanced9_silver_94_csr.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080036","Ambetter Essential Care 1 (2017)","91450AZ008",,"AZN004","AZS001","AZF009","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080036-00","Ambetter Essential Care 1 (2017)","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_essential1_bronze_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_essential1_bronze.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080036","Ambetter Essential Care 1 (2017)","91450AZ008",,"AZN004","AZS001","AZF009","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080036-01","Ambetter Essential Care 1 (2017)","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_essential1_bronze_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_essential1_bronze.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080036","Ambetter Essential Care 1 (2017)","91450AZ008",,"AZN004","AZS001","AZF009","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080036-02","Ambetter Essential Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_essential1_bronze_trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_essential1_bronze_trbl.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080036","Ambetter Essential Care 1 (2017)","91450AZ008",,"AZN004","AZS001","AZF009","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080036-03","Ambetter Essential Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_essential1_bronze_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_essential1_bronze.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01",,"No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080035-00","Ambetter Balanced Care 4 (2017)","Standard Silver Off Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_70_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_70.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01",,"No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080035-01","Ambetter Balanced Care 4 (2017)","Standard Silver On Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_70_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_70.pdf"
"2017","AZ","91450","HIOS","2016-11-16 02:20:23","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2017)","91450AZ008",,"AZN004","AZS001","AZF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,"2017-01-01",,"No",,"No",,"No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080035-02","Ambetter Balanced Care 4 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_70_trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2017_az_iex_ab_balanced4_silver_70_trbl.pdf"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","13-5123390","15833FL0040003","Guardian Family Advantage","15833FL004",,"FLN001","FLS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","15833FL0040003-01","Guardian Family Advantage","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","13-5123390","15833FL0060003","Guardian Family Essentials","15833FL006",,"FLN001","FLS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","15833FL0060003-01","Guardian Family Essentials","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","Individual","Yes","13-5123390","15833FL0130001","Guardian Essentials for Families and Individuals","15833FL013",,"FLN003","FLS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","15833FL0130001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","Individual","Yes","13-5123390","15833FL0140001","Guardian Select for Families and Individuals","15833FL014",,"FLN003","FLS002",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","15833FL0140001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120062","BlueSelect Platinum 1451","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120062-02","BlueSelect Platinum 1451U","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1451U.pdf","https://www.flblue.com/plan-brochure/bs?id=1451U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120062","BlueSelect Platinum 1451","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120062-03","BlueSelect Platinum 1451O","Limited Cost Sharing Plan Variation",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1451O.pdf","https://www.flblue.com/plan-brochure/bs?id=1451O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120076","BlueSelect Gold 1535","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120076-03","BlueSelect Gold 1535O","Limited Cost Sharing Plan Variation","80.06%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1535O.pdf","https://www.flblue.com/plan-brochure/bs?id=1535O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070106","BlueOptions Platinum Premier 1418V","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9599",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070106-00","BlueOptions Platinum Premier 1418V","Standard Platinum Off Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1418V.pdf","https://www.flblue.com/plan-brochure/bo?id=1418V"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070106","BlueOptions Platinum Premier 1418V","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9599",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070106-01","BlueOptions Platinum Premier 1418V","Standard Platinum On Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1418V.pdf","https://www.flblue.com/plan-brochure/bo?id=1418V"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120044","BlueSelect Bronze 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120044-01","BlueSelect Bronze 1452","Standard Bronze On Exchange Plan",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1452.pdf","https://www.flblue.com/plan-brochure/bs?id=1452"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070106","BlueOptions Platinum Premier 1418V","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9599",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070106-02","BlueOptions Platinum Premier 1418UV","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1418UV.pdf","https://www.flblue.com/plan-brochure/bo?id=1418UV"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070106","BlueOptions Platinum Premier 1418V","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9599",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070106-03","BlueOptions Platinum Premier 1418OV","Limited Cost Sharing Plan Variation",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1418OV.pdf","https://www.flblue.com/plan-brochure/bo?id=1418OV"
"2017","FL","15833","HIOS","2016-06-29 04:36:58","Individual","Yes","13-5123390","15833FL0140001","Guardian Select for Families and Individuals","15833FL014",,"FLN003","FLS002",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","15833FL0140001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","FL","15980","HIOS","2016-08-12 02:50:28","Individual","Yes","39-1263473","15980FL0160002","Humana Dental Smart Choice","15980FL016",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9879","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","15980FL0160002-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2856997"
"2017","FL","15980","HIOS","2016-08-12 02:50:28","Individual","Yes","39-1263473","15980FL0160002","Humana Dental Smart Choice","15980FL016",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9879","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","15980FL0160002-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2856997"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-00","BlueOptions Silver 1410","Standard Silver Off Exchange Plan",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1410.pdf","https://www.flblue.com/plan-brochure/bo?id=1410"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","59-2015694","16842FL0010001","BlueOptions Essential Health S1400","16842FL001","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0010001-00","BlueOptions Essential Health S1400","Standard Silver Off Exchange Plan",,"0.718185245990753","No","Yes","No","100%",,"$2,000","$0","$900","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/S1400.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2017/S1400.pdf"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","59-2015694","16842FL0010001","BlueOptions Essential Health S1400","16842FL001","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0010001-01","BlueOptions Essential Health S1400","Standard Silver On Exchange Plan",,"0.718185245990753","No","Yes","No","100%",,"$2,000","$0","$900","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/S1400.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2017/S1400.pdf"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-01","BlueOptions Silver 1410","Standard Silver On Exchange Plan",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1410.pdf","https://www.flblue.com/plan-brochure/bo?id=1410"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-02","BlueOptions Silver 1410U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1410U.pdf","https://www.flblue.com/plan-brochure/bo?id=1410U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","59-2015694","16842FL0010002","BlueOptions Essential Health S1401","16842FL001","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0010002-00","BlueOptions Essential Health S1401","Standard Gold Off Exchange Plan",,"0.806475698947906","No","Yes","No","100%",,"$1,000","$0","$1,100","$200","$1,000","$0","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/S1401.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2017/S1401.pdf"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","59-2015694","16842FL0010002","BlueOptions Essential Health S1401","16842FL001","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0010002-01","BlueOptions Essential Health S1401","Standard Gold On Exchange Plan",,"0.806475698947906","No","Yes","No","100%",,"$1,000","$0","$1,100","$200","$1,000","$0","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/S1401.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2017/S1401.pdf"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-03","BlueOptions Silver 1410O","Limited Cost Sharing Plan Variation",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1410O.pdf","https://www.flblue.com/plan-brochure/bo?id=1410O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-04","BlueOptions Silver 1410A","73% AV Level Silver Plan",,"0.734303295612335","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1410A.pdf","https://www.flblue.com/plan-brochure/bo?id=1410A"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-05","BlueOptions Silver 1410B","87% AV Level Silver Plan",,"0.879640758037567","Yes","Yes","No","100%",,"$0","$40","$1,400","$200","$0","$100","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1410B.pdf","https://www.flblue.com/plan-brochure/bo?id=1410B"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-06","BlueOptions Silver 1410C","94% AV Level Silver Plan",,"0.949100613594055","Yes","Yes","No","100%",,"$0","$20","$900","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1410C.pdf","https://www.flblue.com/plan-brochure/bo?id=1410C"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-00","BlueSelect Silver 1443","Standard Silver Off Exchange Plan",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1443.pdf","https://www.flblue.com/plan-brochure/bs?id=1443"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-01","BlueSelect Silver 1443","Standard Silver On Exchange Plan",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1443.pdf","https://www.flblue.com/plan-brochure/bs?id=1443"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-02","BlueSelect Silver 1443U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1443U.pdf","https://www.flblue.com/plan-brochure/bs?id=1443U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-03","BlueSelect Silver 1443O","Limited Cost Sharing Plan Variation",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1443O.pdf","https://www.flblue.com/plan-brochure/bs?id=1443O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-04","BlueSelect Silver 1443A","73% AV Level Silver Plan",,"0.734303295612335","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1443A.pdf","https://www.flblue.com/plan-brochure/bs?id=1443A"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-05","BlueSelect Silver 1443B","87% AV Level Silver Plan",,"0.879640758037567","Yes","Yes","No","100%",,"$0","$40","$1,400","$200","$0","$100","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1443B.pdf","https://www.flblue.com/plan-brochure/bs?id=1443B"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-06","BlueSelect Silver 1443C","94% AV Level Silver Plan",,"0.949100613594055","Yes","Yes","No","100%",,"$0","$20","$900","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1443C.pdf","https://www.flblue.com/plan-brochure/bs?id=1443C"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120062","BlueSelect Platinum 1451","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120062-00","BlueSelect Platinum 1451","Standard Platinum Off Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1451.pdf","https://www.flblue.com/plan-brochure/bs?id=1451"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120062","BlueSelect Platinum 1451","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120062-01","BlueSelect Platinum 1451","Standard Platinum On Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1451.pdf","https://www.flblue.com/plan-brochure/bs?id=1451"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120066","BlueSelect Platinum Premier 1451V","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9599",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120066-00","BlueSelect Platinum Premier 1451V","Standard Platinum Off Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1451V.pdf","https://www.flblue.com/plan-brochure/bs?id=1451V"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120066","BlueSelect Platinum Premier 1451V","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9599",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120066-01","BlueSelect Platinum Premier 1451V","Standard Platinum On Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1451V.pdf","https://www.flblue.com/plan-brochure/bs?id=1451V"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120066","BlueSelect Platinum Premier 1451V","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9599",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120066-02","BlueSelect Platinum Premier 1451UV","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1451UV.pdf","https://www.flblue.com/plan-brochure/bs?id=1451UV"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120066","BlueSelect Platinum Premier 1451V","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9599",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120066-03","BlueSelect Platinum Premier 1451OV","Limited Cost Sharing Plan Variation",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1451OV.pdf","https://www.flblue.com/plan-brochure/bs?id=1451OV"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120044","BlueSelect Bronze 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120044-00","BlueSelect Bronze 1452","Standard Bronze Off Exchange Plan",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1452.pdf","https://www.flblue.com/plan-brochure/bs?id=1452"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120044","BlueSelect Bronze 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120044-02","BlueSelect Bronze 1452U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1452U.pdf","https://www.flblue.com/plan-brochure/bs?id=1452U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120044","BlueSelect Bronze 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120044-03","BlueSelect Bronze 1452O","Limited Cost Sharing Plan Variation",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1452O.pdf","https://www.flblue.com/plan-brochure/bs?id=1452O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-00","BlueSelect Silver 1456","Standard Silver Off Exchange Plan","68.51%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1456.pdf","https://www.flblue.com/plan-brochure/bs?id=1456"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-01","BlueSelect Silver 1456","Standard Silver On Exchange Plan","68.51%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1456.pdf","https://www.flblue.com/plan-brochure/bs?id=1456"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-02","BlueSelect Silver 1456U","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1456U.pdf","https://www.flblue.com/plan-brochure/bs?id=1456U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-03","BlueSelect Silver 1456O","Limited Cost Sharing Plan Variation","68.51%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1456O.pdf","https://www.flblue.com/plan-brochure/bs?id=1456O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-04","BlueSelect Silver 1456A","73% AV Level Silver Plan","73.88%","0","No","Yes","No","100%",,"$2,800","$1,000","$0","$200","$0","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1456A.pdf","https://www.flblue.com/plan-brochure/bs?id=1456A"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-05","BlueSelect Silver 1456B","87% AV Level Silver Plan","87.94%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1456B.pdf","https://www.flblue.com/plan-brochure/bs?id=1456B"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-06","BlueSelect Silver 1456C","94% AV Level Silver Plan","94.75%","0","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1456C.pdf","https://www.flblue.com/plan-brochure/bs?id=1456C"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120070","BlueSelect Platinum 1457","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120070-00","BlueSelect Platinum 1457","Standard Platinum Off Exchange Plan","89.70%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1457.pdf","https://www.flblue.com/plan-brochure/bs?id=1457"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120070","BlueSelect Platinum 1457","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120070-01","BlueSelect Platinum 1457","Standard Platinum On Exchange Plan","89.70%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1457.pdf","https://www.flblue.com/plan-brochure/bs?id=1457"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120070","BlueSelect Platinum 1457","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120070-02","BlueSelect Platinum 1457U","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1457U.pdf","https://www.flblue.com/plan-brochure/bs?id=1457U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070108","BlueOptions Bronze 1416","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070108-01","BlueOptions Bronze 1416","Standard Bronze On Exchange Plan",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1416.pdf","https://www.flblue.com/plan-brochure/bo?id=1416"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070108","BlueOptions Bronze 1416","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070108-02","BlueOptions Bronze 1416U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1416U.pdf","https://www.flblue.com/plan-brochure/bo?id=1416U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070108","BlueOptions Bronze 1416","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070108-03","BlueOptions Bronze 1416O","Limited Cost Sharing Plan Variation",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1416O.pdf","https://www.flblue.com/plan-brochure/bo?id=1416O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070102","BlueOptions Platinum 1418","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070102-00","BlueOptions Platinum 1418","Standard Platinum Off Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1418.pdf","https://www.flblue.com/plan-brochure/bo?id=1418"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120070","BlueSelect Platinum 1457","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120070-03","BlueSelect Platinum 1457O","Limited Cost Sharing Plan Variation","89.70%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1457O.pdf","https://www.flblue.com/plan-brochure/bs?id=1457O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070110","BlueOptions Platinum 1424","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070110-00","BlueOptions Platinum 1424","Standard Platinum Off Exchange Plan","89.69%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1424.pdf","https://www.flblue.com/plan-brochure/bo?id=1424"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070110","BlueOptions Platinum 1424","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070110-01","BlueOptions Platinum 1424","Standard Platinum On Exchange Plan","89.69%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1424.pdf","https://www.flblue.com/plan-brochure/bo?id=1424"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070110","BlueOptions Platinum 1424","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070110-02","BlueOptions Platinum 1424U","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1424U.pdf","https://www.flblue.com/plan-brochure/bo?id=1424U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070110","BlueOptions Platinum 1424","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070110-03","BlueOptions Platinum 1424O","Limited Cost Sharing Plan Variation","89.69%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1424O.pdf","https://www.flblue.com/plan-brochure/bo?id=1424O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070120","BlueOptions Gold 1505","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070120-00","BlueOptions Gold 1505","Standard Gold Off Exchange Plan","80.05%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1505.pdf","https://www.flblue.com/plan-brochure/bo?id=1505"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070120","BlueOptions Gold 1505","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070120-01","BlueOptions Gold 1505","Standard Gold On Exchange Plan","80.05%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1505.pdf","https://www.flblue.com/plan-brochure/bo?id=1505"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070120","BlueOptions Gold 1505","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070120-02","BlueOptions Gold 1505U","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1505U.pdf","https://www.flblue.com/plan-brochure/bo?id=1505U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070120","BlueOptions Gold 1505","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070120-03","BlueOptions Gold 1505O","Limited Cost Sharing Plan Variation","80.05%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1505O.pdf","https://www.flblue.com/plan-brochure/bo?id=1505O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120076","BlueSelect Gold 1535","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120076-00","BlueSelect Gold 1535","Standard Gold Off Exchange Plan","80.06%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1535.pdf","https://www.flblue.com/plan-brochure/bs?id=1535"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120076","BlueSelect Gold 1535","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120076-01","BlueSelect Gold 1535","Standard Gold On Exchange Plan","80.06%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1535.pdf","https://www.flblue.com/plan-brochure/bs?id=1535"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120076","BlueSelect Gold 1535","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120076-02","BlueSelect Gold 1535U","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1535U.pdf","https://www.flblue.com/plan-brochure/bs?id=1535U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120068","BlueSelect Bronze 1449","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120068-00","BlueSelect Bronze 1449","Standard Bronze Off Exchange Plan",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1449.pdf","https://www.flblue.com/plan-brochure/bs?id=1449"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120068","BlueSelect Bronze 1449","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120068-01","BlueSelect Bronze 1449","Standard Bronze On Exchange Plan",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1449.pdf","https://www.flblue.com/plan-brochure/bs?id=1449"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF021","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120080-03","BlueSelect Silver 1736OS","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1736OS.pdf","https://www.flblue.com/plan-brochure/bs?id=1736OS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF021","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120080-04","BlueSelect Silver 1736AS","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$100","$200","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1736AS.pdf","https://www.flblue.com/plan-brochure/bs?id=1736AS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF021","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120080-05","BlueSelect Silver 1736BS","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$50","$700","$200","$100","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1736BS.pdf","https://www.flblue.com/plan-brochure/bs?id=1736BS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF021","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120080-06","BlueSelect Silver 1736CS","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$30","$200","$200","$100","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1736CS.pdf","https://www.flblue.com/plan-brochure/bs?id=1736CS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070126","BlueOptions Bronze 1707S","16842FL007","7700889661","FLN001","FLS001","FLF011","New","EPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070126-00","BlueOptions Bronze 1707S","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$26,600","$26600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1707S.pdf","https://www.flblue.com/plan-brochure/bo?id=1707S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070126","BlueOptions Bronze 1707S","16842FL007","7700889661","FLN001","FLS001","FLF011","New","EPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070126-01","BlueOptions Bronze 1707S","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$26,600","$26600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1707S.pdf","https://www.flblue.com/plan-brochure/bo?id=1707S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120068","BlueSelect Bronze 1449","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120068-02","BlueSelect Bronze 1449U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1449U.pdf","https://www.flblue.com/plan-brochure/bs?id=1449U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120068","BlueSelect Bronze 1449","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120068-03","BlueSelect Bronze 1449O","Limited Cost Sharing Plan Variation",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1449O.pdf","https://www.flblue.com/plan-brochure/bs?id=1449O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-00","BlueSelect Silver 1464","Standard Silver Off Exchange Plan",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1464.pdf","https://www.flblue.com/plan-brochure/bs?id=1464"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-01","BlueSelect Silver 1464","Standard Silver On Exchange Plan",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1464.pdf","https://www.flblue.com/plan-brochure/bs?id=1464"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-02","BlueSelect Silver 1464U","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1464U.pdf","https://www.flblue.com/plan-brochure/bs?id=1464U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-03","BlueSelect Silver 1464O","Limited Cost Sharing Plan Variation",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1464O.pdf","https://www.flblue.com/plan-brochure/bs?id=1464O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-04","BlueSelect Silver 1464A","73% AV Level Silver Plan",,"0.73715752363205","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1464A.pdf","https://www.flblue.com/plan-brochure/bs?id=1464A"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-05","BlueSelect Silver 1464B","87% AV Level Silver Plan",,"0.869602680206299","No","Yes","No","100%",,"$1,500","$80","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1464B.pdf","https://www.flblue.com/plan-brochure/bs?id=1464B"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-06","BlueSelect Silver 1464C","94% AV Level Silver Plan",,"0.935952186584473","No","Yes","No","100%",,"$500","$20","$0","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1464C.pdf","https://www.flblue.com/plan-brochure/bs?id=1464C"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070108","BlueOptions Bronze 1416","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070108-00","BlueOptions Bronze 1416","Standard Bronze Off Exchange Plan",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1416.pdf","https://www.flblue.com/plan-brochure/bo?id=1416"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070102","BlueOptions Platinum 1418","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070102-01","BlueOptions Platinum 1418","Standard Platinum On Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1418.pdf","https://www.flblue.com/plan-brochure/bo?id=1418"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070102","BlueOptions Platinum 1418","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070102-02","BlueOptions Platinum 1418U","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1418U.pdf","https://www.flblue.com/plan-brochure/bo?id=1418U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070102","BlueOptions Platinum 1418","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070102-03","BlueOptions Platinum 1418O","Limited Cost Sharing Plan Variation",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1418O.pdf","https://www.flblue.com/plan-brochure/bo?id=1418O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070124-04","BlueOptions Silver 1706AS","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$100","$200","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1706AS.pdf","https://www.flblue.com/plan-brochure/bo?id=1706AS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070124-05","BlueOptions Silver 1706BS","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$50","$700","$200","$100","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1706BS.pdf","https://www.flblue.com/plan-brochure/bo?id=1706BS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070124-06","BlueOptions Silver 1706CS","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$30","$200","$200","$100","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1706CS.pdf","https://www.flblue.com/plan-brochure/bo?id=1706CS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF021","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120080-00","BlueSelect Silver 1736S","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1736S.pdf","https://www.flblue.com/plan-brochure/bs?id=1736S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF021","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120080-01","BlueSelect Silver 1736S","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1736S.pdf","https://www.flblue.com/plan-brochure/bs?id=1736S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070084","BlueOptions Bronze 1419","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070084-00","BlueOptions Bronze 1419","Standard Bronze Off Exchange Plan",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1419.pdf","https://www.flblue.com/plan-brochure/bo?id=1419"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070084","BlueOptions Bronze 1419","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070084-01","BlueOptions Bronze 1419","Standard Bronze On Exchange Plan",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1419.pdf","https://www.flblue.com/plan-brochure/bo?id=1419"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070084","BlueOptions Bronze 1419","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070084-02","BlueOptions Bronze 1419U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1419U.pdf","https://www.flblue.com/plan-brochure/bo?id=1419U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070084","BlueOptions Bronze 1419","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070084-03","BlueOptions Bronze 1419O","Limited Cost Sharing Plan Variation",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1419O.pdf","https://www.flblue.com/plan-brochure/bo?id=1419O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-00","BlueOptions Silver 1423","Standard Silver Off Exchange Plan","68.50%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1423.pdf","https://www.flblue.com/plan-brochure/bo?id=1423"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-01","BlueOptions Silver 1423","Standard Silver On Exchange Plan","68.50%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1423.pdf","https://www.flblue.com/plan-brochure/bo?id=1423"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-02","BlueOptions Silver 1423U","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1423U.pdf","https://www.flblue.com/plan-brochure/bo?id=1423U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-03","BlueOptions Silver 1423O","Limited Cost Sharing Plan Variation","68.50%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1423O.pdf","https://www.flblue.com/plan-brochure/bo?id=1423O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-04","BlueOptions Silver 1423A","73% AV Level Silver Plan","73.87%","0","No","Yes","No","100%",,"$2,800","$1,000","$0","$200","$0","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1423A.pdf","https://www.flblue.com/plan-brochure/bo?id=1423A"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-05","BlueOptions Silver 1423B","87% AV Level Silver Plan","87.94%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1423B.pdf","https://www.flblue.com/plan-brochure/bo?id=1423B"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-06","BlueOptions Silver 1423C","94% AV Level Silver Plan","94.75%","0","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1423C.pdf","https://www.flblue.com/plan-brochure/bo?id=1423C"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-00","BlueOptions Silver 1431","Standard Silver Off Exchange Plan",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1431.pdf","https://www.flblue.com/plan-brochure/bo?id=1431"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-01","BlueOptions Silver 1431","Standard Silver On Exchange Plan",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1431.pdf","https://www.flblue.com/plan-brochure/bo?id=1431"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-02","BlueOptions Silver 1431U","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1431U.pdf","https://www.flblue.com/plan-brochure/bo?id=1431U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-03","BlueOptions Silver 1431O","Limited Cost Sharing Plan Variation",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1431O.pdf","https://www.flblue.com/plan-brochure/bo?id=1431O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-04","BlueOptions Silver 1431A","73% AV Level Silver Plan",,"0.73715752363205","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1431A.pdf","https://www.flblue.com/plan-brochure/bo?id=1431A"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-05","BlueOptions Silver 1431B","87% AV Level Silver Plan",,"0.869602680206299","No","Yes","No","100%",,"$1,500","$80","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1431B.pdf","https://www.flblue.com/plan-brochure/bo?id=1431B"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-06","BlueOptions Silver 1431C","94% AV Level Silver Plan",,"0.935952186584473","No","Yes","No","100%",,"$500","$20","$0","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1431C.pdf","https://www.flblue.com/plan-brochure/bo?id=1431C"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070122","BlueOptions Bronze (HSA) 1705","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","16842FL0070122-00","BlueOptions Bronze (HSA) 1705","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1705.pdf","https://www.flblue.com/plan-brochure/bo?id=1705"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070122","BlueOptions Bronze (HSA) 1705","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","16842FL0070122-01","BlueOptions Bronze (HSA) 1705","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1705.pdf","https://www.flblue.com/plan-brochure/bo?id=1705"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070122","BlueOptions Bronze (HSA) 1705","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","16842FL0070122-02","BlueOptions Bronze 1705U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1705U.pdf","https://www.flblue.com/plan-brochure/bo?id=1705U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070122","BlueOptions Bronze (HSA) 1705","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","16842FL0070122-03","BlueOptions Bronze 1705O","Limited Cost Sharing Plan Variation",,"0.618602871894836","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1705O.pdf","https://www.flblue.com/plan-brochure/bo?id=1705O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120078","BlueSelect Bronze (HSA) 1735","16842FL012","7700889661","FLN002","FLS002","FLF020","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","16842FL0120078-00","BlueSelect Bronze (HSA) 1735","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1735.pdf","https://www.flblue.com/plan-brochure/bs?id=1735"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120078","BlueSelect Bronze (HSA) 1735","16842FL012","7700889661","FLN002","FLS002","FLF020","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","16842FL0120078-01","BlueSelect Bronze (HSA) 1735","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1735.pdf","https://www.flblue.com/plan-brochure/bs?id=1735"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120078","BlueSelect Bronze (HSA) 1735","16842FL012","7700889661","FLN002","FLS002","FLF020","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","16842FL0120078-02","BlueSelect Bronze 1735U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1735U.pdf","https://www.flblue.com/plan-brochure/bs?id=1735U"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120078","BlueSelect Bronze (HSA) 1735","16842FL012","7700889661","FLN002","FLS002","FLF020","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","16842FL0120078-03","BlueSelect Bronze 1735O","Limited Cost Sharing Plan Variation",,"0.618602871894836","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1735O.pdf","https://www.flblue.com/plan-brochure/bs?id=1735O"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070124-00","BlueOptions Silver 1706S","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1706S.pdf","https://www.flblue.com/plan-brochure/bo?id=1706S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070124-01","BlueOptions Silver 1706S","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1706S.pdf","https://www.flblue.com/plan-brochure/bo?id=1706S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070124-02","BlueOptions Silver 1706US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1706US.pdf","https://www.flblue.com/plan-brochure/bo?id=1706US"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070124-03","BlueOptions Silver 1706OS","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1706OS.pdf","https://www.flblue.com/plan-brochure/bo?id=1706OS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF021","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120080-02","BlueSelect Silver 1736US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1736US.pdf","https://www.flblue.com/plan-brochure/bs?id=1736US"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070126","BlueOptions Bronze 1707S","16842FL007","7700889661","FLN001","FLS001","FLF011","New","EPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070126-02","BlueOptions Bronze 1707US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1707US.pdf","https://www.flblue.com/plan-brochure/bo?id=1707US"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2017)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-03","Ambetter Balanced Care 2 (2017)","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130003-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130003-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2017)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-04","Ambetter Balanced Care 2 (2017)","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130003-04.pdf","https://api.centene.com/Brochures/2017/21663FL0130003-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2017)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-05","Ambetter Balanced Care 2 (2017)","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130003-05.pdf","https://api.centene.com/Brochures/2017/21663FL0130003-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2017)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-06","Ambetter Balanced Care 2 (2017)","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130003-06.pdf","https://api.centene.com/Brochures/2017/21663FL0130003-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-00","Ambetter Balanced Care 10 (2017)","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130005-00.pdf","https://api.centene.com/Brochures/2017/21663FL0130005-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-01","Ambetter Balanced Care 10 (2017)","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130005-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130005-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-02","Ambetter Balanced Care 10 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130005-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130005-02.pdf"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070126","BlueOptions Bronze 1707S","16842FL007","7700889661","FLN001","FLS001","FLF011","New","EPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070126-03","BlueOptions Bronze 1707OS","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$26,600","$26600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1707OS.pdf","https://www.flblue.com/plan-brochure/bo?id=1707OS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120082","BlueSelect Bronze 1737S","16842FL012","7700889661","FLN002","FLS002","FLF022","New","EPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120082-00","BlueSelect Bronze 1737S","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$26,600","$26600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1737S.pdf","https://www.flblue.com/plan-brochure/bs?id=1737S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120082","BlueSelect Bronze 1737S","16842FL012","7700889661","FLN002","FLS002","FLF022","New","EPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120082-01","BlueSelect Bronze 1737S","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$26,600","$26600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1737S.pdf","https://www.flblue.com/plan-brochure/bs?id=1737S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120082","BlueSelect Bronze 1737S","16842FL012","7700889661","FLN002","FLS002","FLF022","New","EPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120082-02","BlueSelect Bronze 1737US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1737US.pdf","https://www.flblue.com/plan-brochure/bs?id=1737US"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120082","BlueSelect Bronze 1737S","16842FL012","7700889661","FLN002","FLS002","FLF022","New","EPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120082-03","BlueSelect Bronze 1737OS","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$26,600","$26600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1737OS.pdf","https://www.flblue.com/plan-brochure/bs?id=1737OS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070128","BlueOptions Gold 1708S","16842FL007","7700889661","FLN001","FLS001","FLF012","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070128-00","BlueOptions Gold 1708S","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1708S.pdf","https://www.flblue.com/plan-brochure/bo?id=1708S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070128","BlueOptions Gold 1708S","16842FL007","7700889661","FLN001","FLS001","FLF012","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070128-01","BlueOptions Gold 1708S","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1708S.pdf","https://www.flblue.com/plan-brochure/bo?id=1708S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070128","BlueOptions Gold 1708S","16842FL007","7700889661","FLN001","FLS001","FLF012","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070128-02","BlueOptions Gold 1708US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1708US.pdf","https://www.flblue.com/plan-brochure/bo?id=1708US"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0070128","BlueOptions Gold 1708S","16842FL007","7700889661","FLN001","FLS001","FLF012","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070128-03","BlueOptions Gold 1708OS","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1708OS.pdf","https://www.flblue.com/plan-brochure/bo?id=1708OS"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120084","BlueSelect Gold 1738S","16842FL012","7700889661","FLN002","FLS002","FLF023","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120084-00","BlueSelect Gold 1738S","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1738S.pdf","https://www.flblue.com/plan-brochure/bs?id=1738S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120084","BlueSelect Gold 1738S","16842FL012","7700889661","FLN002","FLS002","FLF023","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120084-01","BlueSelect Gold 1738S","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1738S.pdf","https://www.flblue.com/plan-brochure/bs?id=1738S"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120084","BlueSelect Gold 1738S","16842FL012","7700889661","FLN002","FLS002","FLF023","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120084-02","BlueSelect Gold 1738US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1738US.pdf","https://www.flblue.com/plan-brochure/bs?id=1738US"
"2017","FL","16842","HIOS","2016-09-14 22:21:51","Individual","No","59-2015694","16842FL0120084","BlueSelect Gold 1738S","16842FL012","7700889661","FLN002","FLS002","FLF023","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120084-03","BlueSelect Gold 1738OS","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1738OS.pdf","https://www.flblue.com/plan-brochure/bs?id=1738OS"
"2017","FL","17121","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","17121FL0020003","BEST Dental Advantage - Gold","17121FL002",,"FLN001","FLS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020003-00","BEST Dental Advantage - Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","17121","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","17121FL0020003","BEST Dental Advantage - Gold","17121FL002",,"FLN001","FLS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020003-01","BEST Dental Advantage - Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","17121","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","17121FL0020004","BEST Dental Plus - Gold","17121FL002",,"FLN001","FLS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020004-00","BEST Dental Plus - Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","17121","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","17121FL0020004","BEST Dental Plus - Gold","17121FL002",,"FLN001","FLS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020004-01","BEST Dental Plus - Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","17121","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","17121FL0020005","BEST Dental Advantage - Gold","17121FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020005-00","BEST Dental Advantage - Gold","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","17121","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","17121FL0020005","BEST Dental Advantage - Gold","17121FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020005-01","BEST Dental Advantage - Gold","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","17121","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","17121FL0020006","BEST Dental Plus - Gold","17121FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020006-00","BEST Dental Plus - Gold","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","17121","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","17121FL0020006","BEST Dental Plus - Gold","17121FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020006-01","BEST Dental Plus - Gold","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 3 (2017) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130001-00","Ambetter Secure Care 3 (2017) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.796237766742706","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/21663FL0130001-00.pdf","https://api.centene.com/Brochures/2017/21663FL0130001-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 3 (2017) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130001-01","Ambetter Secure Care 3 (2017) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.796237766742706","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/21663FL0130001-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130001-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 3 (2017) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130001-02","Ambetter Secure Care 3 (2017) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/21663FL0130001-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130001-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 3 (2017) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130001-03","Ambetter Secure Care 3 (2017) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.796237766742706","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/21663FL0130001-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130001-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-00","Ambetter Balanced Care 1 (2017)","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130002-00.pdf","https://api.centene.com/Brochures/2017/21663FL0130002-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-01","Ambetter Balanced Care 1 (2017)","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130002-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130002-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-02","Ambetter Balanced Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130002-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130002-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-03","Ambetter Balanced Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130002-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130002-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-04","Ambetter Balanced Care 1 (2017)","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130002-04.pdf","https://api.centene.com/Brochures/2017/21663FL0130002-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-05","Ambetter Balanced Care 1 (2017)","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130002-05.pdf","https://api.centene.com/Brochures/2017/21663FL0130002-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-06","Ambetter Balanced Care 1 (2017)","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130002-06.pdf","https://api.centene.com/Brochures/2017/21663FL0130002-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2017)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-00","Ambetter Balanced Care 2 (2017)","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130003-00.pdf","https://api.centene.com/Brochures/2017/21663FL0130003-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2017)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-01","Ambetter Balanced Care 2 (2017)","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130003-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130003-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2017)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-02","Ambetter Balanced Care 2 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130003-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130003-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-03","Ambetter Balanced Care 10 (2017)","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130005-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130005-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-04","Ambetter Balanced Care 10 (2017)","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130005-04.pdf","https://api.centene.com/Brochures/2017/21663FL0130005-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-05","Ambetter Balanced Care 10 (2017)","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130005-05.pdf","https://api.centene.com/Brochures/2017/21663FL0130005-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2017)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-06","Ambetter Balanced Care 10 (2017)","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130005-06.pdf","https://api.centene.com/Brochures/2017/21663FL0130005-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2017)","21663FL013",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130008-00","Ambetter Balanced Care 3 (2017)","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130008-00.pdf","https://api.centene.com/Brochures/2017/21663FL0130008-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2017)","21663FL013",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130008-01","Ambetter Balanced Care 3 (2017)","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130008-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130008-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2017)","21663FL013",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130008-02","Ambetter Balanced Care 3 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130008-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130008-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2017)","21663FL013",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130008-03","Ambetter Balanced Care 3 (2017)","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130008-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130008-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2017)","21663FL013",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130008-04","Ambetter Balanced Care 3 (2017)","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130008-04.pdf","https://api.centene.com/Brochures/2017/21663FL0130008-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2017)","21663FL013",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130008-05","Ambetter Balanced Care 3 (2017)","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130008-05.pdf","https://api.centene.com/Brochures/2017/21663FL0130008-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2017)","21663FL013",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130008-06","Ambetter Balanced Care 3 (2017)","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130008-06.pdf","https://api.centene.com/Brochures/2017/21663FL0130008-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2017)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130009-00","Ambetter Balanced Care 4 (2017)","Standard Silver Off Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130009-00.pdf","https://api.centene.com/Brochures/2017/21663FL0130009-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2017)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130009-01","Ambetter Balanced Care 4 (2017)","Standard Silver On Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130009-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130009-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2017)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130009-02","Ambetter Balanced Care 4 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130009-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130009-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2017)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130009-03","Ambetter Balanced Care 4 (2017)","Limited Cost Sharing Plan Variation",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130009-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130009-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2017)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130009-04","Ambetter Balanced Care 4 (2017)","73% AV Level Silver Plan",,"0.732531428337097","Yes","Yes","No","100%",,"$5,200","$40","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130009-04.pdf","https://api.centene.com/Brochures/2017/21663FL0130009-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2017)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130009-05","Ambetter Balanced Care 4 (2017)","87% AV Level Silver Plan",,"0.865934371948242","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130009-05.pdf","https://api.centene.com/Brochures/2017/21663FL0130009-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2017)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130009-06","Ambetter Balanced Care 4 (2017)","94% AV Level Silver Plan",,"0.947982847690582","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130009-06.pdf","https://api.centene.com/Brochures/2017/21663FL0130009-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2017)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130010-00","Ambetter Balanced Care 12 (2017)","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130010-00.pdf","https://api.centene.com/Brochures/2017/21663FL0130010-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2017)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130010-01","Ambetter Balanced Care 12 (2017)","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130010-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130010-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2017)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130010-02","Ambetter Balanced Care 12 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130010-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130010-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2017)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130010-03","Ambetter Balanced Care 12 (2017)","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130010-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130010-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2017)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130010-04","Ambetter Balanced Care 12 (2017)","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$400","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130010-04.pdf","https://api.centene.com/Brochures/2017/21663FL0130010-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2017)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130010-05","Ambetter Balanced Care 12 (2017)","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$900","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130010-05.pdf","https://api.centene.com/Brochures/2017/21663FL0130010-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2017)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130010-06","Ambetter Balanced Care 12 (2017)","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$300","$200","$250","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130010-06.pdf","https://api.centene.com/Brochures/2017/21663FL0130010-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130006-00","Ambetter Essential Care 1 (2017)","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130006-00.pdf","https://api.centene.com/Brochures/2017/21663FL0130006-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130006-01","Ambetter Essential Care 1 (2017)","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130006-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130006-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130006-02","Ambetter Essential Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130006-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130006-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2017)","21663FL013",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130006-03","Ambetter Essential Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0130006-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130006-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9857",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-00","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140001-00.pdf","https://api.centene.com/Brochures/2017/21663FL0140001-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9857",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-01","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140001-01.pdf","https://api.centene.com/Brochures/2017/21663FL0140001-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9857",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-02","Ambetter Balanced Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140001-02.pdf","https://api.centene.com/Brochures/2017/21663FL0140001-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9857",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-03","Ambetter Balanced Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140001-03.pdf","https://api.centene.com/Brochures/2017/21663FL0140001-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9857",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-04","Ambetter Balanced Care 1 (2017) + Vision","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140001-04.pdf","https://api.centene.com/Brochures/2017/21663FL0140001-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9857",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-05","Ambetter Balanced Care 1 (2017) + Vision","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140001-05.pdf","https://api.centene.com/Brochures/2017/21663FL0140001-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9857",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-06","Ambetter Balanced Care 1 (2017) + Vision","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140001-06.pdf","https://api.centene.com/Brochures/2017/21663FL0140001-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-00","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140002-00.pdf","https://api.centene.com/Brochures/2017/21663FL0140002-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-01","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140002-01.pdf","https://api.centene.com/Brochures/2017/21663FL0140002-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-02","Ambetter Balanced Care 2 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140002-02.pdf","https://api.centene.com/Brochures/2017/21663FL0140002-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-03","Ambetter Balanced Care 2 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140002-03.pdf","https://api.centene.com/Brochures/2017/21663FL0140002-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-04","Ambetter Balanced Care 2 (2017) + Vision","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140002-04.pdf","https://api.centene.com/Brochures/2017/21663FL0140002-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-05","Ambetter Balanced Care 2 (2017) + Vision","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140002-05.pdf","https://api.centene.com/Brochures/2017/21663FL0140002-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-06","Ambetter Balanced Care 2 (2017) + Vision","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140002-06.pdf","https://api.centene.com/Brochures/2017/21663FL0140002-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-00","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140003-00.pdf","https://api.centene.com/Brochures/2017/21663FL0140003-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-01","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140003-01.pdf","https://api.centene.com/Brochures/2017/21663FL0140003-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-02","Ambetter Balanced Care 10 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140003-02.pdf","https://api.centene.com/Brochures/2017/21663FL0140003-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-03","Ambetter Balanced Care 10 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140003-03.pdf","https://api.centene.com/Brochures/2017/21663FL0140003-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-04","Ambetter Balanced Care 10 (2017) + Vision","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140003-04.pdf","https://api.centene.com/Brochures/2017/21663FL0140003-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-05","Ambetter Balanced Care 10 (2017) + Vision","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140003-05.pdf","https://api.centene.com/Brochures/2017/21663FL0140003-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-06","Ambetter Balanced Care 10 (2017) + Vision","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140003-06.pdf","https://api.centene.com/Brochures/2017/21663FL0140003-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9853",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140006-00","Ambetter Balanced Care 3 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140006-00.pdf","https://api.centene.com/Brochures/2017/21663FL0140006-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9853",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140006-01","Ambetter Balanced Care 3 (2017) + Vision","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140006-01.pdf","https://api.centene.com/Brochures/2017/21663FL0140006-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9853",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140006-02","Ambetter Balanced Care 3 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140006-02.pdf","https://api.centene.com/Brochures/2017/21663FL0140006-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9853",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140006-03","Ambetter Balanced Care 3 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140006-03.pdf","https://api.centene.com/Brochures/2017/21663FL0140006-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9853",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140006-04","Ambetter Balanced Care 3 (2017) + Vision","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140006-04.pdf","https://api.centene.com/Brochures/2017/21663FL0140006-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9853",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140006-05","Ambetter Balanced Care 3 (2017) + Vision","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140006-05.pdf","https://api.centene.com/Brochures/2017/21663FL0140006-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9853",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140006-06","Ambetter Balanced Care 3 (2017) + Vision","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140006-06.pdf","https://api.centene.com/Brochures/2017/21663FL0140006-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140004-00","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140004-00.pdf","https://api.centene.com/Brochures/2017/21663FL0140004-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140004-01","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140004-01.pdf","https://api.centene.com/Brochures/2017/21663FL0140004-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140004-02","Ambetter Essential Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140004-02.pdf","https://api.centene.com/Brochures/2017/21663FL0140004-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2017) + Vision","21663FL014",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140004-03","Ambetter Essential Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0140004-03.pdf","https://api.centene.com/Brochures/2017/21663FL0140004-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9532",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-00","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150001-00.pdf","https://api.centene.com/Brochures/2017/21663FL0150001-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9532",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-01","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150001-01.pdf","https://api.centene.com/Brochures/2017/21663FL0150001-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9532",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-02","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150001-02.pdf","https://api.centene.com/Brochures/2017/21663FL0150001-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9532",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-03","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150001-03.pdf","https://api.centene.com/Brochures/2017/21663FL0150001-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9532",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-04","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150001-04.pdf","https://api.centene.com/Brochures/2017/21663FL0150001-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9532",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-05","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150001-05.pdf","https://api.centene.com/Brochures/2017/21663FL0150001-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9532",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-06","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150001-06.pdf","https://api.centene.com/Brochures/2017/21663FL0150001-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-00","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150002-00.pdf","https://api.centene.com/Brochures/2017/21663FL0150002-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-01","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150002-01.pdf","https://api.centene.com/Brochures/2017/21663FL0150002-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-02","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150002-02.pdf","https://api.centene.com/Brochures/2017/21663FL0150002-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-03","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150002-03.pdf","https://api.centene.com/Brochures/2017/21663FL0150002-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-04","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150002-04.pdf","https://api.centene.com/Brochures/2017/21663FL0150002-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-05","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150002-05.pdf","https://api.centene.com/Brochures/2017/21663FL0150002-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-06","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150002-06.pdf","https://api.centene.com/Brochures/2017/21663FL0150002-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9515",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-00","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150003-00.pdf","https://api.centene.com/Brochures/2017/21663FL0150003-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9515",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-01","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150003-01.pdf","https://api.centene.com/Brochures/2017/21663FL0150003-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9515",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-02","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150003-02.pdf","https://api.centene.com/Brochures/2017/21663FL0150003-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9515",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-03","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150003-03.pdf","https://api.centene.com/Brochures/2017/21663FL0150003-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9515",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-04","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150003-04.pdf","https://api.centene.com/Brochures/2017/21663FL0150003-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9515",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-05","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150003-05.pdf","https://api.centene.com/Brochures/2017/21663FL0150003-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9515",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-06","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150003-06.pdf","https://api.centene.com/Brochures/2017/21663FL0150003-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9518",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150006-00","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150006-00.pdf","https://api.centene.com/Brochures/2017/21663FL0150006-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9518",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150006-01","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150006-01.pdf","https://api.centene.com/Brochures/2017/21663FL0150006-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9518",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150006-02","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150006-02.pdf","https://api.centene.com/Brochures/2017/21663FL0150006-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9518",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150006-03","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150006-03.pdf","https://api.centene.com/Brochures/2017/21663FL0150006-03.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9518",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150006-04","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150006-04.pdf","https://api.centene.com/Brochures/2017/21663FL0150006-04.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9518",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150006-05","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150006-05.pdf","https://api.centene.com/Brochures/2017/21663FL0150006-05.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9518",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150006-06","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150006-06.pdf","https://api.centene.com/Brochures/2017/21663FL0150006-06.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9506",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150004-00","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150004-00.pdf","https://api.centene.com/Brochures/2017/21663FL0150004-00.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9506",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150004-01","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150004-01.pdf","https://api.centene.com/Brochures/2017/21663FL0150004-01.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9506",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150004-02","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150004-02.pdf","https://api.centene.com/Brochures/2017/21663FL0150004-02.pdf"
"2017","FL","21663","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9506",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150004-03","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/21663FL0150004-03.pdf","https://api.centene.com/Brochures/2017/21663FL0150004-03.pdf"
"2017","FL","30115","HIOS","2017-01-20 09:19:19","Individual","Yes","59-2876465","30115FL0010001","BlueDental Copayment Q","30115FL001",,"FLN002","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Out of area service benefits are available as defined in the Policy but members may have a higher cost share","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0010001-00","BlueDental Copayment Q","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","30115","HIOS","2017-01-20 09:19:19","Individual","Yes","59-2876465","30115FL0010001","BlueDental Copayment Q","30115FL001",,"FLN002","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Out of area service benefits are available as defined in the Policy but members may have a higher cost share","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0010001-01","BlueDental Copayment Q","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-05","BlueCare Silver 1477B","87% AV Level Silver Plan",,"0.879640758037567","Yes","Yes","No","100%",,"$0","$40","$1,400","$200","$0","$100","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1477B.pdf","https://www.flblue.com/plan-brochure/bc?id=1477B"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-06","BlueCare Silver 1477C","94% AV Level Silver Plan",,"0.949100613594055","Yes","Yes","No","100%",,"$0","$20","$900","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1477C.pdf","https://www.flblue.com/plan-brochure/bc?id=1477C"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020066","BlueCare Bronze 1483","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020066-00","BlueCare Bronze 1483","Standard Bronze Off Exchange Plan",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1483.pdf","https://www.flblue.com/plan-brochure/bc?id=1483"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020066","BlueCare Bronze 1483","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020066-01","BlueCare Bronze 1483","Standard Bronze On Exchange Plan",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1483.pdf","https://www.flblue.com/plan-brochure/bc?id=1483"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020066","BlueCare Bronze 1483","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020066-02","BlueCare Bronze 1483U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1483U.pdf","https://www.flblue.com/plan-brochure/bc?id=1483U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020066","BlueCare Bronze 1483","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020066-03","BlueCare Bronze 1483O","Limited Cost Sharing Plan Variation",,"0.617810070514679","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1483O.pdf","https://www.flblue.com/plan-brochure/bc?id=1483O"
"2017","FL","30115","HIOS","2017-01-20 09:19:19","Individual","Yes","59-2876465","30115FL0020001","BlueDental Choice Q","30115FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Out of service area benefits are available as defined in the Policy but may have a higher members cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0020001-00","BlueDental Choice Q","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","30115","HIOS","2017-01-20 09:19:19","Individual","Yes","59-2876465","30115FL0020001","BlueDental Choice Q","30115FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Out of service area benefits are available as defined in the Policy but may have a higher members cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0020001-01","BlueDental Choice Q","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-05","BlueCare Silver 1490B","87% AV Level Silver Plan","87.93%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1490B.pdf","https://www.flblue.com/plan-brochure/bc?id=1490B"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-06","BlueCare Silver 1490C","94% AV Level Silver Plan","94.78%","0","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1490C.pdf","https://www.flblue.com/plan-brochure/bc?id=1490C"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-00","BlueCare Silver 1498","Standard Silver Off Exchange Plan",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1498.pdf","https://www.flblue.com/plan-brochure/bc?id=1498"
"2017","FL","30115","HIOS","2017-01-20 09:19:19","Individual","Yes","59-2876465","30115FL0040001","BlueDental Copayment QF","30115FL004",,"FLN002","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Out of service areas benefits are available as defined in the Policy buy may have a higher member cost share","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0040001-00","BlueDental Copayment QF","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","30115","HIOS","2017-01-20 09:19:19","Individual","Yes","59-2876465","30115FL0040001","BlueDental Copayment QF","30115FL004",,"FLN002","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Out of service areas benefits are available as defined in the Policy buy may have a higher member cost share","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0040001-01","BlueDental Copayment QF","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","30115","HIOS","2017-01-20 09:19:19","Individual","Yes","59-2876465","30115FL0050001","BlueDental Choice QF","30115FL005",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Out of service area benefits are available as defined in the Policy but may have a higher member cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0050001-00","BlueDental Choice QF","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","30115","HIOS","2017-01-20 09:19:19","Individual","Yes","59-2876465","30115FL0050001","BlueDental Choice QF","30115FL005",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Out of service area benefits are available as defined in the Policy but may have a higher member cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0050001-01","BlueDental Choice QF","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","30219","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","65-0073323","30219FL0030001","Family Basic Dental Plan (Low)","30219FL003",,"FLN001","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0030001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48032"
"2017","FL","30219","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","65-0073323","30219FL0030001","Family Basic Dental Plan (Low)","30219FL003",,"FLN001","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0030001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48032"
"2017","FL","30219","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","65-0073323","30219FL0040001","Family Enhanced Dental Plan (High)","30219FL004",,"FLN001","FLS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0040001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49073"
"2017","FL","30219","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","65-0073323","30219FL0040001","Family Enhanced Dental Plan (High)","30219FL004",,"FLN001","FLS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0040001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49073"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-00","BlueCare Silver 1477","Standard Silver Off Exchange Plan",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1477.pdf","https://www.flblue.com/plan-brochure/bc?id=1477"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","59-2403696","30252FL0010001","BlueCare Essential Health S1450","30252FL001","7346243208","FLN001","FLS003","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0010001-00","BlueCare Essential Health S1450","Standard Silver Off Exchange Plan",,"0.718185245990753","No","Yes","No","100%",,"$2,000","$0","$900","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/S1450.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2017/S1450.pdf"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","59-2403696","30252FL0010001","BlueCare Essential Health S1450","30252FL001","7346243208","FLN001","FLS003","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0010001-01","BlueCare Essential Health S1450","Standard Silver On Exchange Plan",,"0.718185245990753","No","Yes","No","100%",,"$2,000","$0","$900","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/S1450.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2017/S1450.pdf"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-01","BlueCare Silver 1477","Standard Silver On Exchange Plan",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1477.pdf","https://www.flblue.com/plan-brochure/bc?id=1477"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-02","BlueCare Silver 1477U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1477U.pdf","https://www.flblue.com/plan-brochure/bc?id=1477U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","59-2403696","30252FL0010002","BlueCare Essential Health S1451","30252FL001","7346243208","FLN001","FLS003","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0010002-00","BlueCare Essential Health S1451","Standard Gold Off Exchange Plan",,"0.806475698947906","No","Yes","No","100%",,"$1,000","$0","$1,100","$200","$1,000","$0","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/S1451.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2017/S1451.pdf"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","59-2403696","30252FL0010002","BlueCare Essential Health S1451","30252FL001","7346243208","FLN001","FLS003","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0010002-01","BlueCare Essential Health S1451","Standard Gold On Exchange Plan",,"0.806475698947906","No","Yes","No","100%",,"$1,000","$0","$1,100","$200","$1,000","$0","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/S1451.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2017/S1451.pdf"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-03","BlueCare Silver 1477O","Limited Cost Sharing Plan Variation",,"0.680959284305573","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1477O.pdf","https://www.flblue.com/plan-brochure/bc?id=1477O"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-04","BlueCare Silver 1477A","73% AV Level Silver Plan",,"0.734303295612335","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1477A.pdf","https://www.flblue.com/plan-brochure/bc?id=1477A"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020044","BlueCare Bronze 1486","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020044-00","BlueCare Bronze 1486","Standard Bronze Off Exchange Plan",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1486.pdf","https://www.flblue.com/plan-brochure/bc?id=1486"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020044","BlueCare Bronze 1486","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020044-01","BlueCare Bronze 1486","Standard Bronze On Exchange Plan",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1486.pdf","https://www.flblue.com/plan-brochure/bc?id=1486"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020044","BlueCare Bronze 1486","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020044-02","BlueCare Bronze 1486U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1486U.pdf","https://www.flblue.com/plan-brochure/bc?id=1486U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020044","BlueCare Bronze 1486","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020044-03","BlueCare Bronze 1486O","Limited Cost Sharing Plan Variation",,"0.609735608100891","Yes","Yes","No","100%",,"$6,700","$0","$0","$200","$1,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1486O.pdf","https://www.flblue.com/plan-brochure/bc?id=1486O"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020062","BlueCare Platinum 1485","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020062-00","BlueCare Platinum 1485","Standard Platinum Off Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1485.pdf","https://www.flblue.com/plan-brochure/bc?id=1485"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020062","BlueCare Platinum 1485","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020062-01","BlueCare Platinum 1485","Standard Platinum On Exchange Plan",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1485.pdf","https://www.flblue.com/plan-brochure/bc?id=1485"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020062","BlueCare Platinum 1485","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020062-02","BlueCare Platinum 1485U","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1485U.pdf","https://www.flblue.com/plan-brochure/bc?id=1485U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020062","BlueCare Platinum 1485","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020062-03","BlueCare Platinum 1485O","Limited Cost Sharing Plan Variation",,"0.895302355289459","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1485O.pdf","https://www.flblue.com/plan-brochure/bc?id=1485O"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020068","BlueCare Platinum 1491","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020068-00","BlueCare Platinum 1491","Standard Platinum Off Exchange Plan","89.63%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1491.pdf","https://www.flblue.com/plan-brochure/bc?id=1491"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020068","BlueCare Platinum 1491","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020068-01","BlueCare Platinum 1491","Standard Platinum On Exchange Plan","89.63%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1491.pdf","https://www.flblue.com/plan-brochure/bc?id=1491"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020068","BlueCare Platinum 1491","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020068-02","BlueCare Platinum 1491U","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1491U.pdf","https://www.flblue.com/plan-brochure/bc?id=1491U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020068","BlueCare Platinum 1491","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020068-03","BlueCare Platinum 1491O","Limited Cost Sharing Plan Variation","89.63%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1491O.pdf","https://www.flblue.com/plan-brochure/bc?id=1491O"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-00","BlueCare Silver 1490","Standard Silver Off Exchange Plan","68.31%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1490.pdf","https://www.flblue.com/plan-brochure/bc?id=1490"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-01","BlueCare Silver 1490","Standard Silver On Exchange Plan","68.31%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1490.pdf","https://www.flblue.com/plan-brochure/bc?id=1490"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-02","BlueCare Silver 1490U","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1490U.pdf","https://www.flblue.com/plan-brochure/bc?id=1490U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-03","BlueCare Silver 1490O","Limited Cost Sharing Plan Variation","68.31%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1490O.pdf","https://www.flblue.com/plan-brochure/bc?id=1490O"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-04","BlueCare Silver 1490A","73% AV Level Silver Plan","73.75%","0","No","Yes","No","100%",,"$2,800","$1,000","$0","$200","$0","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1490A.pdf","https://www.flblue.com/plan-brochure/bc?id=1490A"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-01","BlueCare Silver 1498","Standard Silver On Exchange Plan",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1498.pdf","https://www.flblue.com/plan-brochure/bc?id=1498"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-02","BlueCare Silver 1498U","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1498U.pdf","https://www.flblue.com/plan-brochure/bc?id=1498U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-03","BlueCare Silver 1498O","Limited Cost Sharing Plan Variation",,"0.709689497947693","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1498O.pdf","https://www.flblue.com/plan-brochure/bc?id=1498O"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-04","BlueCare Silver 1498A","73% AV Level Silver Plan",,"0.73715752363205","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1498A.pdf","https://www.flblue.com/plan-brochure/bc?id=1498A"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-05","BlueCare Silver 1498B","87% AV Level Silver Plan",,"0.869602680206299","No","Yes","No","100%",,"$1,500","$80","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1498B.pdf","https://www.flblue.com/plan-brochure/bc?id=1498B"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-06","BlueCare Silver 1498C","94% AV Level Silver Plan",,"0.935952186584473","No","Yes","No","100%",,"$500","$20","$0","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1498C.pdf","https://www.flblue.com/plan-brochure/bc?id=1498C"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020074","BlueCare Gold 1565","30252FL002","7346243208","FLN001","FLS001","FLF016","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020074-00","BlueCare Gold 1565","Standard Gold Off Exchange Plan","79.93%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1565.pdf","https://www.flblue.com/plan-brochure/bc?id=1565"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020074","BlueCare Gold 1565","30252FL002","7346243208","FLN001","FLS001","FLF016","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020074-01","BlueCare Gold 1565","Standard Gold On Exchange Plan","79.93%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1565.pdf","https://www.flblue.com/plan-brochure/bc?id=1565"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020074","BlueCare Gold 1565","30252FL002","7346243208","FLN001","FLS001","FLF016","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020074-02","BlueCare Gold 1565U","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1565U.pdf","https://www.flblue.com/plan-brochure/bc?id=1565U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020074","BlueCare Gold 1565","30252FL002","7346243208","FLN001","FLS001","FLF016","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020074-03","BlueCare Gold 1565O","Limited Cost Sharing Plan Variation","79.93%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1565O.pdf","https://www.flblue.com/plan-brochure/bc?id=1565O"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020076","BlueCare Bronze (HSA) 1765","30252FL002","7346243208","FLN001","FLS001","FLF017","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","30252FL0020076-00","BlueCare Bronze (HSA) 1765","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$3,700","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1765.pdf","https://www.flblue.com/plan-brochure/bc?id=1765"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020076","BlueCare Bronze (HSA) 1765","30252FL002","7346243208","FLN001","FLS001","FLF017","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","30252FL0020076-01","BlueCare Bronze (HSA) 1765","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$3,700","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1765.pdf","https://www.flblue.com/plan-brochure/bc?id=1765"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020076","BlueCare Bronze (HSA) 1765","30252FL002","7346243208","FLN001","FLS001","FLF017","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","30252FL0020076-02","BlueCare Bronze 1765U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1765U.pdf","https://www.flblue.com/plan-brochure/bc?id=1765U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020076","BlueCare Bronze (HSA) 1765","30252FL002","7346243208","FLN001","FLS001","FLF017","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplacePreventive.pdf","30252FL0020076-03","BlueCare Bronze 1765O","Limited Cost Sharing Plan Variation",,"0.618602871894836","Yes","Yes","No","100%",,"$3,700","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1765O.pdf","https://www.flblue.com/plan-brochure/bc?id=1765O"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF018","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020078-00","BlueCare Silver 1766S","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1766S.pdf","https://www.flblue.com/plan-brochure/bc?id=1766S"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF018","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020078-01","BlueCare Silver 1766S","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1766S.pdf","https://www.flblue.com/plan-brochure/bc?id=1766S"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF018","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020078-02","BlueCare Silver 1766US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1766US.pdf","https://www.flblue.com/plan-brochure/bc?id=1766US"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF018","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020078-03","BlueCare Silver 1766OS","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1766OS.pdf","https://www.flblue.com/plan-brochure/bc?id=1766OS"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF018","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020078-04","BlueCare Silver 1766AS","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$100","$200","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1766AS.pdf","https://www.flblue.com/plan-brochure/bc?id=1766AS"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF018","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020078-05","BlueCare Silver 1766BS","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$50","$700","$200","$100","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1766BS.pdf","https://www.flblue.com/plan-brochure/bc?id=1766BS"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF018","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020078-06","BlueCare Silver 1766CS","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$30","$200","$200","$100","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1766CS.pdf","https://www.flblue.com/plan-brochure/bc?id=1766CS"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020080","BlueCare Bronze 1767S","30252FL002","7346243208","FLN001","FLS001","FLF019","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020080-00","BlueCare Bronze 1767S","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1767S.pdf","https://www.flblue.com/plan-brochure/bc?id=1767S"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020080","BlueCare Bronze 1767S","30252FL002","7346243208","FLN001","FLS001","FLF019","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020080-01","BlueCare Bronze 1767S","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1767S.pdf","https://www.flblue.com/plan-brochure/bc?id=1767S"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020080","BlueCare Bronze 1767S","30252FL002","7346243208","FLN001","FLS001","FLF019","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020080-02","BlueCare Bronze 1767US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1767US.pdf","https://www.flblue.com/plan-brochure/bc?id=1767US"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020080","BlueCare Bronze 1767S","30252FL002","7346243208","FLN001","FLS001","FLF019","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020080-03","BlueCare Bronze 1767OS","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1767OS.pdf","https://www.flblue.com/plan-brochure/bc?id=1767OS"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020082","BlueCare Gold 1768S","30252FL002","7346243208","FLN001","FLS001","FLF020","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020082-00","BlueCare Gold 1768S","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1768S.pdf","https://www.flblue.com/plan-brochure/bc?id=1768S"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020082","BlueCare Gold 1768S","30252FL002","7346243208","FLN001","FLS001","FLF020","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020082-01","BlueCare Gold 1768S","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1768S.pdf","https://www.flblue.com/plan-brochure/bc?id=1768S"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020082","BlueCare Gold 1768S","30252FL002","7346243208","FLN001","FLS001","FLF020","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020082-02","BlueCare Gold 1768US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1768US.pdf","https://www.flblue.com/plan-brochure/bc?id=1768US"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0020082","BlueCare Gold 1768S","30252FL002","7346243208","FLN001","FLS001","FLF020","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020082-03","BlueCare Gold 1768OS","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$100","$600","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1768OS.pdf","https://www.flblue.com/plan-brochure/bc?id=1768OS"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160001","Humana Basic 7150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160001-01","Humana Basic 7150/South Florida HUMx (HMOx)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842476",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160031","Humana Bronze 6550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160031-00","Humana Bronze 6550/Volusia HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2843022",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160031","Humana Bronze 6550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160031-01","Humana Bronze 6550/Volusia HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2843022",
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070001","myBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070001-00","myBlue Bronze 1601","Standard Bronze Off Exchange Plan",,"0.617020726203918","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1601.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze1"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070001","myBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070001-01","myBlue Bronze 1601","Standard Bronze On Exchange Plan",,"0.617020726203918","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1601.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze1"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070001","myBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070001-02","myBlue Bronze 1601U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1601U.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070001","myBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070001-03","myBlue Bronze 1601O","Limited Cost Sharing Plan Variation",,"0.617020726203918","Yes","Yes","No","100%",,"$3,600","$400","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1601O.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze1"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070003","myBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070003-00","myBlue Bronze 1602","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1602.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze2"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070003","myBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070003-01","myBlue Bronze 1602","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1602.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze2"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070003","myBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070003-02","myBlue Bronze 1602U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1602U.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070003","myBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070003-03","myBlue Bronze 1602O","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1602O.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze2"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-00","myBlue Silver 1603","Standard Silver Off Exchange Plan","68.66%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1603.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver3"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-01","myBlue Silver 1603","Standard Silver On Exchange Plan","68.66%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1603.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver3"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-02","myBlue Silver 1603U","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1603U.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-03","myBlue Silver 1603O","Limited Cost Sharing Plan Variation","68.66%","0","No","Yes","No","100%",,"$3,600","$500","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1603O.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver3"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-04","myBlue Silver 1603A","73% AV Level Silver Plan","73.81%","0","No","Yes","No","100%",,"$2,800","$1,000","$0","$200","$0","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1603A.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver3a"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-05","myBlue Silver 1603B","87% AV Level Silver Plan","87.54%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$100","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1603B.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver3b"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-06","myBlue Silver 1603C","94% AV Level Silver Plan","94.54%","0","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1603C.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver3c"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-00","myBlue Silver 1604","Standard Silver Off Exchange Plan",,"0.687763631343842","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1604.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver4"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-01","myBlue Silver 1604","Standard Silver On Exchange Plan",,"0.687763631343842","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1604.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver4"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-02","myBlue Silver 1604U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1604U.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-03","myBlue Silver 1604O","Limited Cost Sharing Plan Variation",,"0.687763631343842","Yes","Yes","No","100%",,"$6,500","$90","$0","$200","$600","$0","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1604O.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver4"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-04","myBlue Silver 1604A","73% AV Level Silver Plan",,"0.734459817409515","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1604A.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver4a"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-05","myBlue Silver 1604B","87% AV Level Silver Plan",,"0.878292620182037","Yes","Yes","No","100%",,"$0","$30","$1,400","$200","$0","$90","$0","$600","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1604B.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver4b"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-06","myBlue Silver 1604C","94% AV Level Silver Plan",,"0.947718679904938","Yes","Yes","No","100%",,"$0","$10","$900","$200","$0","$20","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1604C.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver4c"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070009","myBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF006","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070009-00","myBlue Gold 1605","Standard Gold Off Exchange Plan",,"0.780141890048981","Yes","Yes","No","100%",,"$900","$300","$500","$200","$0","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$940","$940 per person","$1880 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1605.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=gold5"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070009","myBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF006","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070009-01","myBlue Gold 1605","Standard Gold On Exchange Plan",,"0.780141890048981","Yes","Yes","No","100%",,"$900","$300","$500","$200","$0","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$940","$940 per person","$1880 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1605.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=gold5"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070009","myBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF006","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070009-02","myBlue Gold 1605U","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1605U.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070009","myBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF006","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070009-03","myBlue Gold 1605O","Limited Cost Sharing Plan Variation",,"0.780141890048981","Yes","Yes","No","100%",,"$900","$300","$500","$200","$0","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$940","$940 per person","$1880 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1605O.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=gold5"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF007","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070013-00","myBlue Silver 1710","Standard Silver Off Exchange Plan","71.19%","0.710987389087677","No","Yes","No","100%",,"$3,600","$90","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1710.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver10"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF007","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070013-01","myBlue Silver 1710","Standard Silver On Exchange Plan","71.19%","0.710987389087677","No","Yes","No","100%",,"$3,600","$90","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1710.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver10"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF007","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070013-02","myBlue Silver 1710U","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1710U.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF007","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070013-03","myBlue Silver 1710O","Limited Cost Sharing Plan Variation","71.19%","0.710987389087677","No","Yes","No","100%",,"$3,600","$90","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1710O.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver10"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF007","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070013-04","myBlue Silver 1710A","73% AV Level Silver Plan","73.94%","0.73846447467804","No","Yes","No","100%",,"$3,600","$90","$0","$200","$0","$300","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1710A.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver10a"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF007","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070013-05","myBlue Silver 1710B","87% AV Level Silver Plan","86.93%","0.868786215782166","No","Yes","No","100%",,"$1,500","$60","$0","$200","$0","$200","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1710B.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver10b"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF007","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070013-06","myBlue Silver 1710C","94% AV Level Silver Plan","93.00%","0.929201066493988","No","Yes","No","100%",,"$500","$20","$0","$200","$0","$60","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1710C.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver10c"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070015","myBlue Bronze 1711S","30252FL007","7346243208","FLN002","FLS002","FLF008","New","HMO","Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070015-00","myBlue Bronze 1711S","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1711S.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze11"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070015","myBlue Bronze 1711S","30252FL007","7346243208","FLN002","FLS002","FLF008","New","HMO","Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070015-01","myBlue Bronze 1711S","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1711S.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze11"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070015","myBlue Bronze 1711S","30252FL007","7346243208","FLN002","FLS002","FLF008","New","HMO","Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070015-02","myBlue Bronze 1711US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1711US.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070015","myBlue Bronze 1711S","30252FL007","7346243208","FLN002","FLS002","FLF008","New","HMO","Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070015-03","myBlue Bronze 1711OS","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$0","$300","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1711OS.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=bronze11"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF009","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070017-00","myBlue Silver 1712S","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1712S.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver12"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF009","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070017-01","myBlue Silver 1712S","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1712S.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver12"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF009","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070017-02","myBlue Silver 1712US","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1712US.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=U"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF009","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070017-03","myBlue Silver 1712OS","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$100","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1712OS.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver12"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF009","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070017-04","myBlue Silver 1712AS","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$100","$200","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1712AS.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver12as"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF009","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070017-05","myBlue Silver 1712BS","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$50","$700","$200","$100","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1712BS.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver12bs"
"2017","FL","30252","HIOS","2016-09-14 22:21:51","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF009","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_FL_6T_HealthInsuranceMarketplaceStandard.pdf","30252FL0070017-06","myBlue Silver 1712CS","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$30","$200","$200","$100","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2017/1712CS.pdf","https://www.flblue.com/es/plan-brochure/myblue?type=silver12cs"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030050","Humana Simplicity Gold 003/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF005","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030050-00","Humana Simplicity Gold 003/100 HMO Premier","Standard Gold Off Exchange Plan","79.53%","0","No","Yes","No","100%",,"$0","$1,300","$0","$30","$0","$2,000","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861183","http://apps.humana.com/marketing/documents.asp?file=2861287"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160035","Humana Basic 7150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160035-00","Humana Basic 7150/South Florida HUMx (HMOx)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842476",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030014","Humana Copay Silver 80/2000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030014-00","Humana Copay Silver 80/2000 HMO Premier","Standard Silver Off Exchange Plan",,"0.718427658081055","No","Yes","No","100%",,"$2,000","$20","$2,000","$30","$2,000","$1,200","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861248","http://apps.humana.com/marketing/documents.asp?file=2861326"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160036","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160036-02","Humana Bronze 6550/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842931",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160036","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160036-03","Humana Bronze 6550/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842944",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160039","Humana Gold 1250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160039-03","Humana Gold 1250/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843100",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060021","Florida Hospital Silver POS 80 1640","36194FL006",,"FLN002","FLS002","FLF021","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060021-06","Florida Hospital Silver AV94 POS 95 1643","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$250","$150","$250","$190","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1643",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040022","Health First Gold HMO 80 1350","36194FL004",,"FLN001","FLS001","FLF007","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040022-00","Health First Gold HMO 80 1350","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1350",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040022","Health First Gold HMO 80 1350","36194FL004",,"FLN001","FLS001","FLF007","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040022-01","Health First Gold HMO 80 1350","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1350",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040022","Health First Gold HMO 80 1350","36194FL004",,"FLN001","FLS001","FLF007","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040022-02","Health First Gold HMO 80 1350","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1350_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040022","Health First Gold HMO 80 1350","36194FL004",,"FLN001","FLS001","FLF007","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040022-03","Health First Gold HMO 80 1350","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1350",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080022","Florida Hospital Gold HMO 80 1644","36194FL008",,"FLN002","FLS002","FLF019","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080022-00","Florida Hospital Gold HMO 80 1644","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1644",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160035","Humana Basic 7150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160035-01","Humana Basic 7150/South Florida HUMx (HMOx)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842476",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030050","Humana Simplicity Gold 003/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF005","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030050-01","Humana Simplicity Gold 003/100 HMO Premier","Standard Gold On Exchange Plan","79.53%","0","No","Yes","No","100%",,"$0","$1,300","$0","$30","$0","$2,000","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861183","http://apps.humana.com/marketing/documents.asp?file=2861287"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160001","Humana Basic 7150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160001-00","Humana Basic 7150/South Florida HUMx (HMOx)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842476",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030085","Humana Simplicity Gold 005/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF006","New","HMO","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030085-00","Humana Simplicity Gold 005/100 HMO Premier","Standard Gold Off Exchange Plan","78.04%","0","No","Yes","No","100%",,"$0","$1,800","$0","$30","$0","$2,000","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861209","http://apps.humana.com/marketing/documents.asp?file=2861274"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030085","Humana Simplicity Gold 005/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF006","New","HMO","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030085-01","Humana Simplicity Gold 005/100 HMO Premier","Standard Gold On Exchange Plan","78.04%","0","No","Yes","No","100%",,"$0","$1,800","$0","$30","$0","$2,000","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861209","http://apps.humana.com/marketing/documents.asp?file=2861274"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030052","Humana Simplicity Silver 006/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF007","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030052-00","Humana Simplicity Silver 006/100 HMO Premier","Standard Silver Off Exchange Plan","71.73%","0","No","Yes","No","100%",,"$0","$2,400","$0","$30","$0","$2,300","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861222","http://apps.humana.com/marketing/documents.asp?file=2861300"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160041","Humana Basic 7150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160041-00","Humana Basic 7150/South Florida HUMx (HMOx)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842476",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160041","Humana Basic 7150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160041-01","Humana Basic 7150/South Florida HUMx (HMOx)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842476",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030052","Humana Simplicity Silver 006/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF007","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030052-01","Humana Simplicity Silver 006/100 HMO Premier","Standard Silver On Exchange Plan","71.73%","0","No","Yes","No","100%",,"$0","$2,400","$0","$30","$0","$2,300","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861222","http://apps.humana.com/marketing/documents.asp?file=2861300"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160013","Humana Basic 7150/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160013-00","Humana Basic 7150/Tampa Bay HUMx (HMOx)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842515",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160013","Humana Basic 7150/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160013-01","Humana Basic 7150/Tampa Bay HUMx (HMOx)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842515",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160030","Humana Basic 7150/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160030-00","Humana Basic 7150/Volusia HUMx (HMOx)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842541",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160030","Humana Basic 7150/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160030-01","Humana Basic 7150/Volusia HUMx (HMOx)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842541",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030005","Humana Copay Gold 100/1000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030005-00","Humana Copay Gold 100/1000 HMO Premier","Standard Gold Off Exchange Plan",,"0.813893854618073","No","Yes","No","100%",,"$1,000","$0","$3,000","$30","$1,000","$1,200","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861235","http://apps.humana.com/marketing/documents.asp?file=2861313"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160036","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160036-00","Humana Bronze 6550/South Florida HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2842918",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160036","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160036-01","Humana Bronze 6550/South Florida HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2842918",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030005","Humana Copay Gold 100/1000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030005-01","Humana Copay Gold 100/1000 HMO Premier","Standard Gold On Exchange Plan",,"0.813893854618073","No","Yes","No","100%",,"$1,000","$0","$3,000","$30","$1,000","$1,200","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861235","http://apps.humana.com/marketing/documents.asp?file=2861313"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030014","Humana Copay Silver 80/2000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030014-01","Humana Copay Silver 80/2000 HMO Premier","Standard Silver On Exchange Plan",,"0.718427658081055","No","Yes","No","100%",,"$2,000","$20","$2,000","$30","$2,000","$1,200","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861248","http://apps.humana.com/marketing/documents.asp?file=2861326"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160002","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160002-00","Humana Bronze 6550/South Florida HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2842918",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160002","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160002-01","Humana Bronze 6550/South Florida HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2842918",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160002","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160002-02","Humana Bronze 6550/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842931",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160002","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160002-03","Humana Bronze 6550/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842944",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160042","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160042-00","Humana Bronze 6550/South Florida HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2842918",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160042","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160042-01","Humana Bronze 6550/South Florida HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2842918",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160042","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160042-02","Humana Bronze 6550/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842931",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160042","Humana Bronze 6550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160042-03","Humana Bronze 6550/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842944",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160014","Humana Bronze 6550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160014-00","Humana Bronze 6550/Tampa Bay HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2842970",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160014","Humana Bronze 6550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160014-01","Humana Bronze 6550/Tampa Bay HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2842970",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160014","Humana Bronze 6550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160014-02","Humana Bronze 6550/Tampa Bay HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842983",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160014","Humana Bronze 6550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160014-03","Humana Bronze 6550/Tampa Bay HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2842996",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160031","Humana Bronze 6550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160031-02","Humana Bronze 6550/Volusia HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843035",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160031","Humana Bronze 6550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-FL","35783FL1160031-03","Humana Bronze 6550/Volusia HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843048",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160037","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160037-00","Humana Bronze 6150/South Florida HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842710",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160038","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160038-02","Humana Silver 3550/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843295",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160038","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160038-03","Humana Silver 3550/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843308",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080021","Florida Hospital Silver HMO 80 1636","36194FL008",,"FLN002","FLS002","FLF021","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080021-04","Florida Hospital Silver AV73 HMO 80 1637","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$330","$150","$1,270","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1637",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080021","Florida Hospital Silver HMO 80 1636","36194FL008",,"FLN002","FLS002","FLF021","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080021-05","Florida Hospital Silver AV87 HMO 80 1638","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$890","$150","$700","$270","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1638",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080021","Florida Hospital Silver HMO 80 1636","36194FL008",,"FLN002","FLS002","FLF021","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080021-06","Florida Hospital Silver AV94 HMO 95 1639","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$250","$150","$250","$190","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1639",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020021","Health First Silver POS 80 1346","36194FL002",,"FLN001","FLS001","FLF009","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020021-00","Health First Silver POS 80 1346","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1346",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020021","Health First Silver POS 80 1346","36194FL002",,"FLN001","FLS001","FLF009","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020021-01","Health First Silver POS 80 1346","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1346",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020021","Health First Silver POS 80 1346","36194FL002",,"FLN001","FLS001","FLF009","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020021-02","Health First Silver POS 80 1346","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1346_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020021","Health First Silver POS 80 1346","36194FL002",,"FLN001","FLS001","FLF009","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020021-03","Health First Silver POS 80 1346","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1346",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020021","Health First Silver POS 80 1346","36194FL002",,"FLN001","FLS001","FLF009","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020021-04","Health First Silver AV73 POS 80 1347","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$330","$150","$1,270","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1347",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030042","Humana Copay Silver 50/5000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030042-00","Humana Copay Silver 50/5000 HMO Premier","Standard Silver Off Exchange Plan",,"0.706673502922058","No","Yes","No","100%",,"$4,500","$0","$0","$30","$4,000","$500","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861261","http://apps.humana.com/marketing/documents.asp?file=2861339"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","61-1103898","35783FL1030042","Humana Copay Silver 50/5000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB-FL","35783FL1030042-01","Humana Copay Silver 50/5000 HMO Premier","Standard Silver On Exchange Plan",,"0.706673502922058","No","Yes","No","100%",,"$4,500","$0","$0","$30","$4,000","$500","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861261","http://apps.humana.com/marketing/documents.asp?file=2861339"
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160037","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160037-01","Humana Bronze 6150/South Florida HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842710",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160037","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160037-02","Humana Bronze 6150/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842723",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160037","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160037-03","Humana Bronze 6150/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842736",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160003","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160003-00","Humana Bronze 6150/South Florida HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842710",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160003","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160003-01","Humana Bronze 6150/South Florida HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842710",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160003","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160003-02","Humana Bronze 6150/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842723",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160003","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160003-03","Humana Bronze 6150/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842736",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160043","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160043-00","Humana Bronze 6150/South Florida HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842710",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160043","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160043-01","Humana Bronze 6150/South Florida HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842710",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160043","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160043-02","Humana Bronze 6150/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842723",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160043","Humana Bronze 6150/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160043-03","Humana Bronze 6150/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842736",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160015","Humana Bronze 6150/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160015-00","Humana Bronze 6150/Tampa Bay HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842762",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160015","Humana Bronze 6150/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160015-01","Humana Bronze 6150/Tampa Bay HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842762",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160015","Humana Bronze 6150/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160015-02","Humana Bronze 6150/Tampa Bay HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842775",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160015","Humana Bronze 6150/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160015-03","Humana Bronze 6150/Tampa Bay HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842788",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160060","Humana Bronze 6150/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160060-00","Humana Bronze 6150/Volusia HUMx (HMOx)","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842814",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160060","Humana Bronze 6150/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160060-01","Humana Bronze 6150/Volusia HUMx (HMOx)","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842814",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160060","Humana Bronze 6150/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160060-02","Humana Bronze 6150/Volusia HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842827",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160060","Humana Bronze 6150/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160060-03","Humana Bronze 6150/Volusia HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2842840",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160038","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160038-00","Humana Silver 3550/South Florida HUMx (HMOx)","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843282",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160038","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160038-01","Humana Silver 3550/South Florida HUMx (HMOx)","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843282",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160038","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160038-04","Humana Silver 3550/South Florida HUMx (HMOx)","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843191",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160038","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160038-05","Humana Silver 3550/South Florida HUMx (HMOx)","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843464",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160038","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160038-06","Humana Silver 3550/South Florida HUMx (HMOx)","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843139",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160039","Humana Gold 1250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160039-00","Humana Gold 1250/South Florida HUMx (HMOx)","Standard Gold Off Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843074",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160039","Humana Gold 1250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160039-01","Humana Gold 1250/South Florida HUMx (HMOx)","Standard Gold On Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843074",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160039","Humana Gold 1250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160039-02","Humana Gold 1250/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843087",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160004","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160004-00","Humana Silver 3550/South Florida HUMx (HMOx)","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843282",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160004","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160004-01","Humana Silver 3550/South Florida HUMx (HMOx)","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843282",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160004","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160004-02","Humana Silver 3550/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843295",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160004","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160004-03","Humana Silver 3550/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843308",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160004","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160004-04","Humana Silver 3550/South Florida HUMx (HMOx)","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843191",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160004","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160004-05","Humana Silver 3550/South Florida HUMx (HMOx)","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843464",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160004","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160004-06","Humana Silver 3550/South Florida HUMx (HMOx)","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843139",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160044","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160044-00","Humana Silver 3550/South Florida HUMx (HMOx)","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843282",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160044","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160044-01","Humana Silver 3550/South Florida HUMx (HMOx)","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843282",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160044","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160044-02","Humana Silver 3550/South Florida HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843295",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160044","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160044-03","Humana Silver 3550/South Florida HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843308",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160044","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160044-04","Humana Silver 3550/South Florida HUMx (HMOx)","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843191",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160044","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160044-05","Humana Silver 3550/South Florida HUMx (HMOx)","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843464",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160044","Humana Silver 3550/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160044-06","Humana Silver 3550/South Florida HUMx (HMOx)","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843139",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160016","Humana Silver 3550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160016-00","Humana Silver 3550/Tampa Bay HUMx (HMOx)","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843334",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160016","Humana Silver 3550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160016-01","Humana Silver 3550/Tampa Bay HUMx (HMOx)","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843334",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160016","Humana Silver 3550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160016-02","Humana Silver 3550/Tampa Bay HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843347",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160016","Humana Silver 3550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160016-03","Humana Silver 3550/Tampa Bay HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843373",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160016","Humana Silver 3550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160016-04","Humana Silver 3550/Tampa Bay HUMx (HMOx)","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843204",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160016","Humana Silver 3550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160016-05","Humana Silver 3550/Tampa Bay HUMx (HMOx)","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843477",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160016","Humana Silver 3550/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160016-06","Humana Silver 3550/Tampa Bay HUMx (HMOx)","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843152",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160032","Humana Silver 3550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160032-00","Humana Silver 3550/Volusia HUMx (HMOx)","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843399",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160032","Humana Silver 3550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160032-01","Humana Silver 3550/Volusia HUMx (HMOx)","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843399",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160032","Humana Silver 3550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160032-02","Humana Silver 3550/Volusia HUMx (HMOx)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843412",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160032","Humana Silver 3550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160032-03","Humana Silver 3550/Volusia HUMx (HMOx)","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843425",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160032","Humana Silver 3550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160032-04","Humana Silver 3550/Volusia HUMx (HMOx)","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843217",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160032","Humana Silver 3550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160032-05","Humana Silver 3550/Volusia HUMx (HMOx)","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843490",
"2017","FL","35783","HIOS","2017-01-19 02:20:17","Individual","No","61-1103898","35783FL1160032","Humana Silver 3550/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-FL","35783FL1160032-06","Humana Silver 3550/Volusia HUMx (HMOx)","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843165",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040020","Health First Bronze HMO 50 1340","36194FL004",,"FLN001","FLS001","FLF010","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040020-00","Health First Bronze HMO 50 1340","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1340",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030007","Health First Silver HMO 80 5433","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9784",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030007-00","Health First Silver HMO 80 5433","Standard Silver Off Exchange Plan","71.09%","0","No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5433",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030007","Health First Silver HMO 80 5433","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9784",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030007-01","Health First Silver HMO 80 5433","Standard Silver On Exchange Plan","71.09%","0","No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5433",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040020","Health First Bronze HMO 50 1340","36194FL004",,"FLN001","FLS001","FLF010","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040020-01","Health First Bronze HMO 50 1340","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1340",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040020","Health First Bronze HMO 50 1340","36194FL004",,"FLN001","FLS001","FLF010","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040020-02","Health First Bronze HMO 50 1340","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1340_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070007","Florida Hospital Silver HMO 80 5435","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9784",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070007-00","Florida Hospital Silver HMO 80 5435","Standard Silver Off Exchange Plan","71.09%","0","No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5435",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070007","Florida Hospital Silver HMO 80 5435","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9784",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070007-01","Florida Hospital Silver HMO 80 5435","Standard Silver On Exchange Plan","71.09%","0","No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5435",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040020","Health First Bronze HMO 50 1340","36194FL004",,"FLN001","FLS001","FLF010","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040020-03","Health First Bronze HMO 50 1340","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1340",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080020","Florida Hospital Bronze HMO 50 1634","36194FL008",,"FLN002","FLS002","FLF022","New","HMO","Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080020-00","Florida Hospital Bronze HMO 50 1634","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1634",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080020","Florida Hospital Bronze HMO 50 1634","36194FL008",,"FLN002","FLS002","FLF022","New","HMO","Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080020-01","Florida Hospital Bronze HMO 50 1634","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1634",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080020","Florida Hospital Bronze HMO 50 1634","36194FL008",,"FLN002","FLS002","FLF022","New","HMO","Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080020-02","Florida Hospital Bronze HMO 50 1634","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1634_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080020","Florida Hospital Bronze HMO 50 1634","36194FL008",,"FLN002","FLS002","FLF022","New","HMO","Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080020-03","Florida Hospital Bronze HMO 50 1634","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1634",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020020","Health First Bronze POS 50 1341","36194FL002",,"FLN001","FLS001","FLF010","New","POS","Bronze","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020020-00","Health First Bronze POS 50 1341","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1341",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020020","Health First Bronze POS 50 1341","36194FL002",,"FLN001","FLS001","FLF010","New","POS","Bronze","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020020-01","Health First Bronze POS 50 1341","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1341",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020020","Health First Bronze POS 50 1341","36194FL002",,"FLN001","FLS001","FLF010","New","POS","Bronze","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020020-02","Health First Bronze POS 50 1341","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1341_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020020","Health First Bronze POS 50 1341","36194FL002",,"FLN001","FLS001","FLF010","New","POS","Bronze","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020020-03","Health First Bronze POS 50 1341","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1341",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060020","Florida Hospital Bronze POS 50 1635","36194FL006",,"FLN002","FLS002","FLF022","New","POS","Bronze","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060020-00","Florida Hospital Bronze POS 50 1635","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1635",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060020","Florida Hospital Bronze POS 50 1635","36194FL006",,"FLN002","FLS002","FLF022","New","POS","Bronze","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060020-01","Florida Hospital Bronze POS 50 1635","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1635",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060020","Florida Hospital Bronze POS 50 1635","36194FL006",,"FLN002","FLS002","FLF022","New","POS","Bronze","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060020-02","Florida Hospital Bronze POS 50 1635","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1635_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060020","Florida Hospital Bronze POS 50 1635","36194FL006",,"FLN002","FLS002","FLF022","New","POS","Bronze","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060020-03","Florida Hospital Bronze POS 50 1635","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$1,455","$260","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1635",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040021","Health First Silver HMO 80 1342","36194FL004",,"FLN001","FLS001","FLF009","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040021-00","Health First Silver HMO 80 1342","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1342",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040021","Health First Silver HMO 80 1342","36194FL004",,"FLN001","FLS001","FLF009","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040021-01","Health First Silver HMO 80 1342","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1342",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040021","Health First Silver HMO 80 1342","36194FL004",,"FLN001","FLS001","FLF009","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040021-02","Health First Silver HMO 80 1342","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1342_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040021","Health First Silver HMO 80 1342","36194FL004",,"FLN001","FLS001","FLF009","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040021-03","Health First Silver HMO 80 1342","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1342",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040021","Health First Silver HMO 80 1342","36194FL004",,"FLN001","FLS001","FLF009","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040021-04","Health First Silver AV73 HMO 80 1343","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$330","$150","$1,270","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1343",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040021","Health First Silver HMO 80 1342","36194FL004",,"FLN001","FLS001","FLF009","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040021-05","Health First Silver AV87 HMO 80 1344","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$890","$150","$700","$270","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1344",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040021","Health First Silver HMO 80 1342","36194FL004",,"FLN001","FLS001","FLF009","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040021-06","Health First Silver AV94 HMO 95 1345","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$250","$150","$250","$190","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1345",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080021","Florida Hospital Silver HMO 80 1636","36194FL008",,"FLN002","FLS002","FLF021","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080021-00","Florida Hospital Silver HMO 80 1636","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1636",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080021","Florida Hospital Silver HMO 80 1636","36194FL008",,"FLN002","FLS002","FLF021","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080021-01","Florida Hospital Silver HMO 80 1636","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1636",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080021","Florida Hospital Silver HMO 80 1636","36194FL008",,"FLN002","FLS002","FLF021","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080021-02","Florida Hospital Silver HMO 80 1636","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1636_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080021","Florida Hospital Silver HMO 80 1636","36194FL008",,"FLN002","FLS002","FLF021","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080021-03","Florida Hospital Silver HMO 80 1636","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1636",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020021","Health First Silver POS 80 1346","36194FL002",,"FLN001","FLS001","FLF009","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020021-05","Health First Silver AV87 POS 80 1348","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$890","$150","$700","$270","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1348",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020021","Health First Silver POS 80 1346","36194FL002",,"FLN001","FLS001","FLF009","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020021-06","Health First Silver AV94 POS 95 1349","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$250","$150","$250","$190","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1349",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060021","Florida Hospital Silver POS 80 1640","36194FL006",,"FLN002","FLS002","FLF021","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060021-00","Florida Hospital Silver POS 80 1640","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1640",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060021","Florida Hospital Silver POS 80 1640","36194FL006",,"FLN002","FLS002","FLF021","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060021-01","Florida Hospital Silver POS 80 1640","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1640",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060021","Florida Hospital Silver POS 80 1640","36194FL006",,"FLN002","FLS002","FLF021","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060021-02","Florida Hospital Silver POS 80 1640","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1640_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060021","Florida Hospital Silver POS 80 1640","36194FL006",,"FLN002","FLS002","FLF021","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060021-03","Florida Hospital Silver POS 80 1640","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$330","$150","$1,410","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1640",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060021","Florida Hospital Silver POS 80 1640","36194FL006",,"FLN002","FLS002","FLF021","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060021-04","Florida Hospital Silver AV73 POS 80 1641","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$330","$150","$1,270","$590","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1641",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060021","Florida Hospital Silver POS 80 1640","36194FL006",,"FLN002","FLS002","FLF021","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060021-05","Florida Hospital Silver AV87 POS 80 1642","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$890","$150","$700","$270","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1642",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080022","Florida Hospital Gold HMO 80 1644","36194FL008",,"FLN002","FLS002","FLF019","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080022-01","Florida Hospital Gold HMO 80 1644","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1644",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080022","Florida Hospital Gold HMO 80 1644","36194FL008",,"FLN002","FLS002","FLF019","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080022-02","Florida Hospital Gold HMO 80 1644","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1644_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080022","Florida Hospital Gold HMO 80 1644","36194FL008",,"FLN002","FLS002","FLF019","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080022-03","Florida Hospital Gold HMO 80 1644","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1644",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020022","Health First Gold POS 80 1351","36194FL002",,"FLN001","FLS001","FLF007","New","POS","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020022-00","Health First Gold POS 80 1351","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1351",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010016","Health First Gold POS 80 5467","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9811",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010016-00","Health First Gold POS 80 5467","Standard Gold Off Exchange Plan",,"0.799205899238586","No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5467",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070005","Florida Hospital Silver HMO 50 5428","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9776",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070005-00","Florida Hospital Silver HMO 50 5428","Standard Silver Off Exchange Plan",,"0.714929103851318","No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5428",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070005","Florida Hospital Silver HMO 50 5428","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9776",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070005-01","Florida Hospital Silver HMO 50 5428","Standard Silver On Exchange Plan",,"0.714929103851318","No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5428",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040016","Health First GYM ACCESS Gold HMO 90 HSA 1328","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9713",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040016-03","Health First GYM ACCESS Gold HMO 90 HSA 1328","Limited Cost Sharing Plan Variation",,"0.805655658245087","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1328",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080016","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1622","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9713",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080016-00","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1622","Standard Gold Off Exchange Plan",,"0.805655658245087","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1622",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080016","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1622","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9713",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080016-01","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1622","Standard Gold On Exchange Plan",,"0.805655658245087","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1622",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010016","Health First Gold POS 80 5467","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9811",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010016-01","Health First Gold POS 80 5467","Standard Gold On Exchange Plan",,"0.799205899238586","No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5467",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040009","Health First GYM ACCESS Silver HMO 70 1307","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040009-03","Health First GYM ACCESS Silver HMO 70 1307","Limited Cost Sharing Plan Variation",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1307",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070017","Florida Hospital Gold HMO 80 5471","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9797",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070017-01","Florida Hospital Gold HMO 80 5471","Standard Gold On Exchange Plan","81.75%","0","No","Yes","No","100%",,"$500","$60","$830","$150","$500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5471",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040009","Health First GYM ACCESS Silver HMO 70 1307","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040009-04","Health First GYM ACCESS Silver AV73 HMO 70 1308","73% AV Level Silver Plan",,"0.737995088100433","No","Yes","No","100%",,"$2,500","$50","$800","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1308",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020022","Health First Gold POS 80 1351","36194FL002",,"FLN001","FLS001","FLF007","New","POS","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020022-01","Health First Gold POS 80 1351","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1351",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020022","Health First Gold POS 80 1351","36194FL002",,"FLN001","FLS001","FLF007","New","POS","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020022-02","Health First Gold POS 80 1351","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1351_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050016","Florida Hospital Gold POS 80 5469","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9811",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050016-00","Florida Hospital Gold POS 80 5469","Standard Gold Off Exchange Plan",,"0.799205899238586","No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5469",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050016","Florida Hospital Gold POS 80 5469","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9811",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050016-01","Florida Hospital Gold POS 80 5469","Standard Gold On Exchange Plan",,"0.799205899238586","No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5469",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020022","Health First Gold POS 80 1351","36194FL002",,"FLN001","FLS001","FLF007","New","POS","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020022-03","Health First Gold POS 80 1351","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1351",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060022","Florida Hospital Gold POS 80 1645","36194FL006",,"FLN002","FLS002","FLF019","New","POS","Gold","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060022-00","Florida Hospital Gold POS 80 1645","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1645",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060022","Florida Hospital Gold POS 80 1645","36194FL006",,"FLN002","FLS002","FLF019","New","POS","Gold","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060022-01","Florida Hospital Gold POS 80 1645","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1645",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060022","Florida Hospital Gold POS 80 1645","36194FL006",,"FLN002","FLS002","FLF019","New","POS","Gold","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060022-02","Florida Hospital Gold POS 80 1645","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1645_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060022","Florida Hospital Gold POS 80 1645","36194FL006",,"FLN002","FLS002","FLF019","New","POS","Gold","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060022-03","Florida Hospital Gold POS 80 1645","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$780","$150","$1,250","$460","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1645",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040004","Health First GYM ACCESS Bronze HMO 70 HSA 1276","36194FL004",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040004-00","Health First GYM ACCESS Bronze HMO 70 HSA 1276","Standard Bronze Off Exchange Plan",,"0.619856595993042","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$5,150","$0","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1276",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030026","Health First Platinum HMO 80 5499","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9836",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030026-00","Health First Platinum HMO 80 5499","Standard Platinum Off Exchange Plan","90.39%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80","$0","$0","$0","$0",,"5","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5499",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030026","Health First Platinum HMO 80 5499","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9836",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030026-01","Health First Platinum HMO 80 5499","Standard Platinum On Exchange Plan","90.39%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80","$0","$0","$0","$0",,"5","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5499",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040004","Health First GYM ACCESS Bronze HMO 70 HSA 1276","36194FL004",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040004-01","Health First GYM ACCESS Bronze HMO 70 HSA 1276","Standard Bronze On Exchange Plan",,"0.619856595993042","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$5,150","$0","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1276",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040004","Health First GYM ACCESS Bronze HMO 70 HSA 1276","36194FL004",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040004-02","Health First GYM ACCESS Bronze HMO 70 1276","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1276_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070026","Florida Hospital Platinum HMO 80 5500","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9836",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070026-00","Florida Hospital Platinum HMO 80 5500","Standard Platinum Off Exchange Plan","90.39%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80","$0","$0","$0","$0",,"5","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5500",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070026","Florida Hospital Platinum HMO 80 5500","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9836",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070026-01","Florida Hospital Platinum HMO 80 5500","Standard Platinum On Exchange Plan","90.39%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80","$0","$0","$0","$0",,"5","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5500",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040004","Health First GYM ACCESS Bronze HMO 70 HSA 1276","36194FL004",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040004-03","Health First GYM ACCESS Bronze HMO 70 HSA 1276","Limited Cost Sharing Plan Variation",,"0.619856595993042","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$5,150","$0","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1276",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080004","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1576","36194FL008",,"FLN002","FLS002","FLF015","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080004-00","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1576","Standard Bronze Off Exchange Plan",,"0.619856595993042","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$5,150","$0","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1576",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080004","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1576","36194FL008",,"FLN002","FLS002","FLF015","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080004-01","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1576","Standard Bronze On Exchange Plan",,"0.619856595993042","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$5,150","$0","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1576",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080004","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1576","36194FL008",,"FLN002","FLS002","FLF015","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080004-02","Florida Hospital GYM ACCESS Bronze HMO 70 1576","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1576_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080004","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1576","36194FL008",,"FLN002","FLS002","FLF015","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080004-03","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1576","Limited Cost Sharing Plan Variation",,"0.619856595993042","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$5,150","$0","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1576",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040016","Health First GYM ACCESS Gold HMO 90 HSA 1328","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9713",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040016-00","Health First GYM ACCESS Gold HMO 90 HSA 1328","Standard Gold Off Exchange Plan",,"0.805655658245087","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1328",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030005","Health First Silver HMO 50 5426","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9776",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030005-00","Health First Silver HMO 50 5426","Standard Silver Off Exchange Plan",,"0.714929103851318","No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5426",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030005","Health First Silver HMO 50 5426","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9776",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030005-01","Health First Silver HMO 50 5426","Standard Silver On Exchange Plan",,"0.714929103851318","No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5426",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040016","Health First GYM ACCESS Gold HMO 90 HSA 1328","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9713",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040016-01","Health First GYM ACCESS Gold HMO 90 HSA 1328","Standard Gold On Exchange Plan",,"0.805655658245087","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1328",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040016","Health First GYM ACCESS Gold HMO 90 HSA 1328","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9713",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040016-02","Health First GYM ACCESS Gold HMO 90 1328","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1328_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080016","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1622","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9713",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080016-02","Florida Hospital GYM ACCESS Gold HMO 90 1622","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1622_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080016","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1622","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9713",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080016-03","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1622","Limited Cost Sharing Plan Variation",,"0.805655658245087","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1622",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010005","Health First Silver POS 50 5427","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9782",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010005-00","Health First Silver POS 50 5427","Standard Silver Off Exchange Plan",,"0.714929103851318","No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5427",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010005","Health First Silver POS 50 5427","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9782",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010005-01","Health First Silver POS 50 5427","Standard Silver On Exchange Plan",,"0.714929103851318","No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5427",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050005","Florida Hospital Silver POS 50 5429","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9782",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050005-00","Florida Hospital Silver POS 50 5429","Standard Silver Off Exchange Plan",,"0.714929103851318","No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5429",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050005","Florida Hospital Silver POS 50 5429","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9782",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050005-01","Florida Hospital Silver POS 50 5429","Standard Silver On Exchange Plan",,"0.714929103851318","No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5429",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030017","Health First Gold HMO 80 5470","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9797",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030017-00","Health First Gold HMO 80 5470","Standard Gold Off Exchange Plan","81.75%","0","No","Yes","No","100%",,"$500","$60","$830","$150","$500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5470",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040009","Health First GYM ACCESS Silver HMO 70 1307","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040009-00","Health First GYM ACCESS Silver HMO 70 1307","Standard Silver Off Exchange Plan",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1307",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040009","Health First GYM ACCESS Silver HMO 70 1307","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040009-01","Health First GYM ACCESS Silver HMO 70 1307","Standard Silver On Exchange Plan",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1307",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030017","Health First Gold HMO 80 5470","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9797",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030017-01","Health First Gold HMO 80 5470","Standard Gold On Exchange Plan","81.75%","0","No","Yes","No","100%",,"$500","$60","$830","$150","$500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5470",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070017","Florida Hospital Gold HMO 80 5471","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9797",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070017-00","Florida Hospital Gold HMO 80 5471","Standard Gold Off Exchange Plan","81.75%","0","No","Yes","No","100%",,"$500","$60","$830","$150","$500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5471",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040009","Health First GYM ACCESS Silver HMO 70 1307","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040009-02","Health First GYM ACCESS Silver HMO 70 1307","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1307_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040009","Health First GYM ACCESS Silver HMO 70 1307","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040009-05","Health First GYM ACCESS Silver AV87 HMO 70 1309","87% AV Level Silver Plan",,"0.875965714454651","No","Yes","No","100%",,"$800","$50","$700","$150","$800","$520","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1309",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040009","Health First GYM ACCESS Silver HMO 70 1307","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040009-06","Health First GYM ACCESS Silver AV94 HMO 70 1310","94% AV Level Silver Plan",,"0.944396913051605","No","Yes","No","100%",,"$0","$50","$600","$150","$0","$350","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1310",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080009","Florida Hospital GYM ACCESS Silver HMO 70 1601","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080009-00","Florida Hospital GYM ACCESS Silver HMO 70 1601","Standard Silver Off Exchange Plan",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1601",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080009","Florida Hospital GYM ACCESS Silver HMO 70 1601","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080009-01","Florida Hospital GYM ACCESS Silver HMO 70 1601","Standard Silver On Exchange Plan",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1601",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080009","Florida Hospital GYM ACCESS Silver HMO 70 1601","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080009-02","Florida Hospital GYM ACCESS Silver HMO 70 1601","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1601_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080009","Florida Hospital GYM ACCESS Silver HMO 70 1601","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080009-03","Florida Hospital GYM ACCESS Silver HMO 70 1601","Limited Cost Sharing Plan Variation",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1601",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080009","Florida Hospital GYM ACCESS Silver HMO 70 1601","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080009-04","Florida Hospital GYM ACCESS Silver AV73 HMO 70 1602","73% AV Level Silver Plan",,"0.737995088100433","No","Yes","No","100%",,"$2,500","$50","$800","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1602",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080009","Florida Hospital GYM ACCESS Silver HMO 70 1601","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080009-05","Florida Hospital GYM ACCESS Silver AV87 HMO 70 1603","87% AV Level Silver Plan",,"0.875965714454651","No","Yes","No","100%",,"$800","$50","$700","$150","$800","$520","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1603",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080009","Florida Hospital GYM ACCESS Silver HMO 70 1601","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9662",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080009-06","Florida Hospital GYM ACCESS Silver AV94 HMO 70 1604","94% AV Level Silver Plan",,"0.944396913051605","No","Yes","No","100%",,"$0","$50","$600","$150","$0","$350","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1604",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030031","Health First Platinum HMO 100 5513","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.984",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030031-00","Health First Platinum HMO 100 5513","Standard Platinum Off Exchange Plan","91.95%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5513",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060009","Florida Hospital GYM ACCESS Silver POS 70 1605","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060009-00","Florida Hospital GYM ACCESS Silver POS 70 1605","Standard Silver Off Exchange Plan",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1605",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060009","Florida Hospital GYM ACCESS Silver POS 70 1605","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060009-01","Florida Hospital GYM ACCESS Silver POS 70 1605","Standard Silver On Exchange Plan",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1605",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030031","Health First Platinum HMO 100 5513","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.984",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030031-01","Health First Platinum HMO 100 5513","Standard Platinum On Exchange Plan","91.95%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5513",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070031","Florida Hospital Platinum HMO 100 5515","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.984",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070031-00","Florida Hospital Platinum HMO 100 5515","Standard Platinum Off Exchange Plan","91.95%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5515",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060009","Florida Hospital GYM ACCESS Silver POS 70 1605","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060009-02","Florida Hospital GYM ACCESS Silver POS 70 1605","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1605_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030006","Health First Silver HMO 50 5430","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030006-00","Health First Silver HMO 50 5430","Standard Silver Off Exchange Plan","71.95%","0.727540373802185","No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5430",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030006","Health First Silver HMO 50 5430","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030006-01","Health First Silver HMO 50 5430","Standard Silver On Exchange Plan","71.95%","0.727540373802185","No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5430",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020008","Health First GYM ACCESS Silver POS 80 1297","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020008-01","Health First GYM ACCESS Silver POS 80 1297","Standard Silver On Exchange Plan","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1297",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020008","Health First GYM ACCESS Silver POS 80 1297","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020008-02","Health First GYM ACCESS Silver POS 80 1297","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1297_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070006","Florida Hospital Silver HMO 50 5432","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070006-00","Florida Hospital Silver HMO 50 5432","Standard Silver Off Exchange Plan","71.95%","0.727540373802185","No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5432",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070006","Florida Hospital Silver HMO 50 5432","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070006-01","Florida Hospital Silver HMO 50 5432","Standard Silver On Exchange Plan","71.95%","0.727540373802185","No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5432",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080015","Florida Hospital GYM ACCESS Gold HMO 70 1621","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9728",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080015-03","Florida Hospital GYM ACCESS Gold HMO 70 1621","Limited Cost Sharing Plan Variation","78.71%","0","No","Yes","No","100%",,"$0","$750","$0","$150","$1,270","$690","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1621",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040010","Health First GYM ACCESS Silver HMO 70 1315","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040010-00","Health First GYM ACCESS Silver HMO 70 1315","Standard Silver Off Exchange Plan",,"0.707021236419678","No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1315",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030008","Health First Silver HMO 50 5437","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030008-00","Health First Silver HMO 50 5437","Standard Silver Off Exchange Plan","71.76%","0.726570188999176","No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5437",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060009","Florida Hospital GYM ACCESS Silver POS 70 1605","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060009-03","Florida Hospital GYM ACCESS Silver POS 70 1605","Limited Cost Sharing Plan Variation",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1605",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070031","Florida Hospital Platinum HMO 100 5515","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.984",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070031-01","Florida Hospital Platinum HMO 100 5515","Standard Platinum On Exchange Plan","91.95%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5515",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060009","Florida Hospital GYM ACCESS Silver POS 70 1605","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060009-04","Florida Hospital GYM ACCESS Silver AV73 POS 70 1606","73% AV Level Silver Plan",,"0.737995088100433","No","Yes","No","100%",,"$2,500","$50","$800","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1606",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060009","Florida Hospital GYM ACCESS Silver POS 70 1605","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060009-05","Florida Hospital GYM ACCESS Silver AV87 POS 70 1607","87% AV Level Silver Plan",,"0.875965714454651","No","Yes","No","100%",,"$800","$50","$700","$150","$800","$520","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1607",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060009","Florida Hospital GYM ACCESS Silver POS 70 1605","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060009-06","Florida Hospital GYM ACCESS Silver AV94 POS 70 1608","94% AV Level Silver Plan",,"0.944396913051605","No","Yes","No","100%",,"$0","$50","$600","$150","$0","$350","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1608",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020009","Health First GYM ACCESS Silver POS 70 1311","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020009-00","Health First GYM ACCESS Silver POS 70 1311","Standard Silver Off Exchange Plan",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1311",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020009","Health First GYM ACCESS Silver POS 70 1311","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020009-01","Health First GYM ACCESS Silver POS 70 1311","Standard Silver On Exchange Plan",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1311",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020009","Health First GYM ACCESS Silver POS 70 1311","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020009-02","Health First GYM ACCESS Silver POS 70 1311","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1311_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020009","Health First GYM ACCESS Silver POS 70 1311","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020009-03","Health First GYM ACCESS Silver POS 70 1311","Limited Cost Sharing Plan Variation",,"0.698739886283875","No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1311",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020009","Health First GYM ACCESS Silver POS 70 1311","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020009-04","Health First GYM ACCESS Silver AV73 POS 70 1312","73% AV Level Silver Plan",,"0.737995088100433","No","Yes","No","100%",,"$2,500","$50","$800","$150","$1,410","$520","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1312",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020009","Health First GYM ACCESS Silver POS 70 1311","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020009-05","Health First GYM ACCESS Silver AV87 POS 70 1313","87% AV Level Silver Plan",,"0.875965714454651","No","Yes","No","100%",,"$800","$50","$700","$150","$800","$520","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1313",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020009","Health First GYM ACCESS Silver POS 70 1311","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020009-06","Health First GYM ACCESS Silver AV94 POS 70 1314","94% AV Level Silver Plan",,"0.944396913051605","No","Yes","No","100%",,"$0","$50","$600","$150","$0","$350","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1314",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010031","Health First Platinum POS 100 5514","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9847",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010031-00","Health First Platinum POS 100 5514","Standard Platinum Off Exchange Plan","91.95%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5514",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040008","Health First GYM ACCESS Silver HMO 80 1293","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040008-00","Health First GYM ACCESS Silver HMO 80 1293","Standard Silver Off Exchange Plan","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1293",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040008","Health First GYM ACCESS Silver HMO 80 1293","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040008-01","Health First GYM ACCESS Silver HMO 80 1293","Standard Silver On Exchange Plan","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1293",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010031","Health First Platinum POS 100 5514","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9847",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010031-01","Health First Platinum POS 100 5514","Standard Platinum On Exchange Plan","91.95%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5514",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050031","Florida Hospital Platinum POS 100 5516","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9847",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050031-00","Florida Hospital Platinum POS 100 5516","Standard Platinum Off Exchange Plan","91.95%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5516",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040008","Health First GYM ACCESS Silver HMO 80 1293","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040008-02","Health First GYM ACCESS Silver HMO 80 1293","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1293_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040008","Health First GYM ACCESS Silver HMO 80 1293","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040008-03","Health First GYM ACCESS Silver HMO 80 1293","Limited Cost Sharing Plan Variation","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1293",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050031","Florida Hospital Platinum POS 100 5516","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9847",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050031-01","Florida Hospital Platinum POS 100 5516","Standard Platinum On Exchange Plan","91.95%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5516",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040008","Health First GYM ACCESS Silver HMO 80 1293","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040008-04","Health First GYM ACCESS Silver AV73 HMO 80 1294","73% AV Level Silver Plan","73.35%","0.732766330242157","No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1294",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040008","Health First GYM ACCESS Silver HMO 80 1293","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040008-05","Health First GYM ACCESS Silver AV87 HMO 80 1295","87% AV Level Silver Plan","87.44%","0.871704518795013","No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1295",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040008","Health First GYM ACCESS Silver HMO 80 1293","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040008-06","Health First GYM ACCESS Silver AV94 HMO 80 1296","94% AV Level Silver Plan","93.55%","0.933497428894043","No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1296",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080008","Florida Hospital GYM ACCESS Silver HMO 80 1593","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080008-00","Florida Hospital GYM ACCESS Silver HMO 80 1593","Standard Silver Off Exchange Plan","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1593",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080008","Florida Hospital GYM ACCESS Silver HMO 80 1593","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080008-01","Florida Hospital GYM ACCESS Silver HMO 80 1593","Standard Silver On Exchange Plan","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1593",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080008","Florida Hospital GYM ACCESS Silver HMO 80 1593","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080008-02","Florida Hospital GYM ACCESS Silver HMO 80 1593","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1593_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080008","Florida Hospital GYM ACCESS Silver HMO 80 1593","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080008-03","Florida Hospital GYM ACCESS Silver HMO 80 1593","Limited Cost Sharing Plan Variation","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1593",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080008","Florida Hospital GYM ACCESS Silver HMO 80 1593","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080008-04","Florida Hospital GYM ACCESS Silver AV73 HMO 80 1594","73% AV Level Silver Plan","73.35%","0.732766330242157","No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1594",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080008","Florida Hospital GYM ACCESS Silver HMO 80 1593","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080008-05","Florida Hospital GYM ACCESS Silver AV87 HMO 80 1595","87% AV Level Silver Plan","87.44%","0.871704518795013","No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1595",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080008","Florida Hospital GYM ACCESS Silver HMO 80 1593","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9656",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080008-06","Florida Hospital GYM ACCESS Silver AV94 HMO 80 1596","94% AV Level Silver Plan","93.55%","0.933497428894043","No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1596",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020008","Health First GYM ACCESS Silver POS 80 1297","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020008-00","Health First GYM ACCESS Silver POS 80 1297","Standard Silver Off Exchange Plan","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1297",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020008","Health First GYM ACCESS Silver POS 80 1297","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020008-03","Health First GYM ACCESS Silver POS 80 1297","Limited Cost Sharing Plan Variation","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1297",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020008","Health First GYM ACCESS Silver POS 80 1297","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020008-04","Health First GYM ACCESS Silver AV73 POS 80 1298","73% AV Level Silver Plan","73.35%","0.732766330242157","No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1298",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020008","Health First GYM ACCESS Silver POS 80 1297","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020008-05","Health First GYM ACCESS Silver AV87 POS 80 1299","87% AV Level Silver Plan","87.44%","0.871704518795013","No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1299",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020008","Health First GYM ACCESS Silver POS 80 1297","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020008-06","Health First GYM ACCESS Silver AV94 POS 80 1306","94% AV Level Silver Plan","93.55%","0.933497428894043","No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1306",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060008","Florida Hospital GYM ACCESS Silver POS 80 1597","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060008-00","Florida Hospital GYM ACCESS Silver POS 80 1597","Standard Silver Off Exchange Plan","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1597",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060008","Florida Hospital GYM ACCESS Silver POS 80 1597","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060008-01","Florida Hospital GYM ACCESS Silver POS 80 1597","Standard Silver On Exchange Plan","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1597",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060008","Florida Hospital GYM ACCESS Silver POS 80 1597","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060008-02","Florida Hospital GYM ACCESS Silver POS 80 1597","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1597_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060008","Florida Hospital GYM ACCESS Silver POS 80 1597","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060008-03","Florida Hospital GYM ACCESS Silver POS 80 1597","Limited Cost Sharing Plan Variation","68.17%","0.678927779197693","No","Yes","No","100%",,"$3,100","$0","$410","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1597",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060008","Florida Hospital GYM ACCESS Silver POS 80 1597","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060008-04","Florida Hospital GYM ACCESS Silver AV73 POS 80 1598","73% AV Level Silver Plan","73.35%","0.732766330242157","No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1598",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060008","Florida Hospital GYM ACCESS Silver POS 80 1597","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060008-05","Florida Hospital GYM ACCESS Silver AV87 POS 80 1599","87% AV Level Silver Plan","87.44%","0.871704518795013","No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1599",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060008","Florida Hospital GYM ACCESS Silver POS 80 1597","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9666",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060008-06","Florida Hospital GYM ACCESS Silver AV94 POS 80 1600","94% AV Level Silver Plan","93.55%","0.933497428894043","No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1600",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040018","Health First GYM ACCESS Catastrophic HMO 1330","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9157",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040018-00","Health First GYM ACCESS Catastrophic HMO 1330","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1330",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030021","Health First Gold HMO 50 5485","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9809",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030021-00","Health First Gold HMO 50 5485","Standard Gold Off Exchange Plan","81.98%","0","No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5485",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030021","Health First Gold HMO 50 5485","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9809",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030021-01","Health First Gold HMO 50 5485","Standard Gold On Exchange Plan","81.98%","0","No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5485",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040018","Health First GYM ACCESS Catastrophic HMO 1330","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9157",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040018-01","Health First GYM ACCESS Catastrophic HMO 1330","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1330",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080018","Florida Hospital GYM ACCESS Catastrophic HMO 1624","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9157",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080018-00","Florida Hospital GYM ACCESS Catastrophic HMO 1624","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1624",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070021","Florida Hospital Gold HMO 50 5487","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9809",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070021-00","Florida Hospital Gold HMO 50 5487","Standard Gold Off Exchange Plan","81.98%","0","No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5487",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070021","Florida Hospital Gold HMO 50 5487","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9809",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070021-01","Florida Hospital Gold HMO 50 5487","Standard Gold On Exchange Plan","81.98%","0","No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5487",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080018","Florida Hospital GYM ACCESS Catastrophic HMO 1624","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9157",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080018-01","Florida Hospital GYM ACCESS Catastrophic HMO 1624","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1624",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020018","Health First GYM ACCESS Catastrophic POS 1331","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9176",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020018-00","Health First GYM ACCESS Catastrophic POS 1331","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1331",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030019","Health First Gold HMO 80 5476","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9807",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030019-00","Health First Gold HMO 80 5476","Standard Gold Off Exchange Plan","79.73%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5476",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030019","Health First Gold HMO 80 5476","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9807",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030019-01","Health First Gold HMO 80 5476","Standard Gold On Exchange Plan","79.73%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5476",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020018","Health First GYM ACCESS Catastrophic POS 1331","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9176",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020018-01","Health First GYM ACCESS Catastrophic POS 1331","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1331",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060018","Florida Hospital GYM ACCESS Catastrophic POS 1625","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9176",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060018-00","Florida Hospital GYM ACCESS Catastrophic POS 1625","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1625",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070019","Florida Hospital Gold HMO 80 5478","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9807",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070019-00","Florida Hospital Gold HMO 80 5478","Standard Gold Off Exchange Plan","79.73%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5478",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070019","Florida Hospital Gold HMO 80 5478","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9807",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070019-01","Florida Hospital Gold HMO 80 5478","Standard Gold On Exchange Plan","79.73%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5478",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060018","Florida Hospital GYM ACCESS Catastrophic POS 1625","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9176",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060018-01","Florida Hospital GYM ACCESS Catastrophic POS 1625","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1625",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040015","Health First GYM ACCESS Gold HMO 70 1327","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9728",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040015-00","Health First GYM ACCESS Gold HMO 70 1327","Standard Gold Off Exchange Plan","78.71%","0","No","Yes","No","100%",,"$0","$750","$0","$150","$1,270","$690","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1327",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040015","Health First GYM ACCESS Gold HMO 70 1327","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9728",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040015-01","Health First GYM ACCESS Gold HMO 70 1327","Standard Gold On Exchange Plan","78.71%","0","No","Yes","No","100%",,"$0","$750","$0","$150","$1,270","$690","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1327",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040015","Health First GYM ACCESS Gold HMO 70 1327","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9728",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040015-02","Health First GYM ACCESS Gold HMO 70 1327","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1327_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040015","Health First GYM ACCESS Gold HMO 70 1327","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9728",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040015-03","Health First GYM ACCESS Gold HMO 70 1327","Limited Cost Sharing Plan Variation","78.71%","0","No","Yes","No","100%",,"$0","$750","$0","$150","$1,270","$690","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1327",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080015","Florida Hospital GYM ACCESS Gold HMO 70 1621","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9728",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080015-00","Florida Hospital GYM ACCESS Gold HMO 70 1621","Standard Gold Off Exchange Plan","78.71%","0","No","Yes","No","100%",,"$0","$750","$0","$150","$1,270","$690","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1621",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080015","Florida Hospital GYM ACCESS Gold HMO 70 1621","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9728",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080015-01","Florida Hospital GYM ACCESS Gold HMO 70 1621","Standard Gold On Exchange Plan","78.71%","0","No","Yes","No","100%",,"$0","$750","$0","$150","$1,270","$690","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1621",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080015","Florida Hospital GYM ACCESS Gold HMO 70 1621","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9728",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080015-02","Florida Hospital GYM ACCESS Gold HMO 70 1621","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1621_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030008","Health First Silver HMO 50 5437","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030008-01","Health First Silver HMO 50 5437","Standard Silver On Exchange Plan","71.76%","0.726570188999176","No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5437",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040010","Health First GYM ACCESS Silver HMO 70 1315","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040010-01","Health First GYM ACCESS Silver HMO 70 1315","Standard Silver On Exchange Plan",,"0.707021236419678","No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1315",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040010","Health First GYM ACCESS Silver HMO 70 1315","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040010-02","Health First GYM ACCESS Silver HMO 70 1315","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1315_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070008","Florida Hospital Silver HMO 50 5438","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070008-00","Florida Hospital Silver HMO 50 5438","Standard Silver Off Exchange Plan","71.76%","0.726570188999176","No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5438",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070008","Florida Hospital Silver HMO 50 5438","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070008-01","Florida Hospital Silver HMO 50 5438","Standard Silver On Exchange Plan","71.76%","0.726570188999176","No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5438",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040010","Health First GYM ACCESS Silver HMO 70 1315","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040010-03","Health First GYM ACCESS Silver HMO 70 1315","Limited Cost Sharing Plan Variation",,"0.707021236419678","No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1315",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040010","Health First GYM ACCESS Silver HMO 70 1315","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040010-04","Health First GYM ACCESS Silver AV73 HMO 70 1316","73% AV Level Silver Plan",,"0.738681077957153","No","Yes","No","100%",,"$1,300","$0","$1,160","$150","$1,300","$80","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1316",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040010","Health First GYM ACCESS Silver HMO 70 1315","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040010-05","Health First GYM ACCESS Silver AV87 HMO 70 1317","87% AV Level Silver Plan",,"0.87673944234848","No","Yes","No","100%",,"$30","$0","$1,540","$150","$30","$80","$720","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1317",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040010","Health First GYM ACCESS Silver HMO 70 1315","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040010-06","Health First GYM ACCESS Silver AV94 HMO 70 1318","94% AV Level Silver Plan",,"0.944549202919006","No","Yes","No","100%",,"$0","$0","$600","$150","$0","$50","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1318",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080010","Florida Hospital GYM ACCESS Silver HMO 70 1609","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080010-00","Florida Hospital GYM ACCESS Silver HMO 70 1609","Standard Silver Off Exchange Plan",,"0.707021236419678","No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1609",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080010","Florida Hospital GYM ACCESS Silver HMO 70 1609","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080010-01","Florida Hospital GYM ACCESS Silver HMO 70 1609","Standard Silver On Exchange Plan",,"0.707021236419678","No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1609",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080010","Florida Hospital GYM ACCESS Silver HMO 70 1609","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080010-02","Florida Hospital GYM ACCESS Silver HMO 70 1609","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1609_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080010","Florida Hospital GYM ACCESS Silver HMO 70 1609","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080010-03","Florida Hospital GYM ACCESS Silver HMO 70 1609","Limited Cost Sharing Plan Variation",,"0.707021236419678","No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1609",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080010","Florida Hospital GYM ACCESS Silver HMO 70 1609","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080010-04","Florida Hospital GYM ACCESS Silver AV73 HMO 70 1610","73% AV Level Silver Plan",,"0.738681077957153","No","Yes","No","100%",,"$1,300","$0","$1,160","$150","$1,300","$80","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1610",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080010","Florida Hospital GYM ACCESS Silver HMO 70 1609","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080010-05","Florida Hospital GYM ACCESS Silver AV87 HMO 70 1611","87% AV Level Silver Plan",,"0.87673944234848","No","Yes","No","100%",,"$30","$0","$1,540","$150","$30","$80","$720","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1611",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080010","Florida Hospital GYM ACCESS Silver HMO 70 1609","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9658",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080010-06","Florida Hospital GYM ACCESS Silver AV94 HMO 70 1612","94% AV Level Silver Plan",,"0.944549202919006","No","Yes","No","100%",,"$0","$0","$600","$150","$0","$50","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1612",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040011","Health First GYM ACCESS Silver HMO 80 HSA 1319","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040011-00","Health First GYM ACCESS Silver HMO 80 HSA 1319","Standard Silver Off Exchange Plan",,"0.697717905044556","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1319",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040011","Health First GYM ACCESS Silver HMO 80 HSA 1319","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040011-01","Health First GYM ACCESS Silver HMO 80 HSA 1319","Standard Silver On Exchange Plan",,"0.697717905044556","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1319",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040011","Health First GYM ACCESS Silver HMO 80 HSA 1319","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040011-02","Health First GYM ACCESS Silver HMO 80 1319","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1319_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040011","Health First GYM ACCESS Silver HMO 80 HSA 1319","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040011-03","Health First GYM ACCESS Silver HMO 80 HSA 1319","Limited Cost Sharing Plan Variation",,"0.697717905044556","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1319",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040011","Health First GYM ACCESS Silver HMO 80 HSA 1319","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040011-04","Health First GYM ACCESS Silver AV73 HMO 80 HSA 1320","73% AV Level Silver Plan",,"0.739629924297333","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1320",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040011","Health First GYM ACCESS Silver HMO 80 HSA 1319","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040011-05","Health First GYM ACCESS Silver AV87 HMO 80 1321","87% AV Level Silver Plan",,"0.876605629920959","Yes","Yes","No","100%",,"$300","$0","$1,100","$150","$300","$0","$990","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1321",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040011","Health First GYM ACCESS Silver HMO 80 HSA 1319","36194FL004",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040011-06","Health First GYM ACCESS Silver AV94 HMO 80 1322","94% AV Level Silver Plan",,"0.934494435787201","Yes","Yes","No","100%",,"$0","$0","$880","$150","$0","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1322",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080011","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080011-00","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","Standard Silver Off Exchange Plan",,"0.697717905044556","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1613",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080011","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080011-01","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","Standard Silver On Exchange Plan",,"0.697717905044556","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1613",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080011","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080011-02","Florida Hospital GYM ACCESS Silver HMO 80 1613","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1613_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080011","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080011-03","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","Limited Cost Sharing Plan Variation",,"0.697717905044556","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1613",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080011","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080011-04","Florida Hospital GYM ACCESS Silver AV73 HMO 80 HSA 1614","73% AV Level Silver Plan",,"0.739629924297333","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1614",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080011","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080011-05","Florida Hospital GYM ACCESS Silver AV87 HMO 80 1615","87% AV Level Silver Plan",,"0.876605629920959","Yes","Yes","No","100%",,"$300","$0","$1,100","$150","$300","$0","$990","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1615",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080011","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1613","36194FL008",,"FLN002","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9659",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080011-06","Florida Hospital GYM ACCESS Silver AV94 HMO 80 1616","94% AV Level Silver Plan",,"0.934494435787201","Yes","Yes","No","100%",,"$0","$0","$880","$150","$0","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1616",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040012","Health First GYM ACCESS Gold HMO 100 1323","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9723",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040012-00","Health First GYM ACCESS Gold HMO 100 1323","Standard Gold Off Exchange Plan",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1323",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010001","Health First Bronze POS 50 5410","36194FL001",,"FLN003","FLS001","FLF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9739",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010001-00","Health First Bronze POS 50 5410","Standard Bronze Off Exchange Plan",,"0.619228422641754","Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2017_sbc_5410",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010001","Health First Bronze POS 50 5410","36194FL001",,"FLN003","FLS001","FLF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9739",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010001-01","Health First Bronze POS 50 5410","Standard Bronze On Exchange Plan",,"0.619228422641754","Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2017_sbc_5410",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030010","Health First Silver HMO 90 HSA 5443","36194FL003",,"FLN003","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9782",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030010-01","Health First Silver HMO 90 HSA 5443","Standard Silver On Exchange Plan",,"0.719767451286316","Yes","Yes","No","100%",,"$2,600","$0","$780","$150","$2,600","$0","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5443",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070010","Florida Hospital Silver HMO 90 HSA 5445","36194FL007",,"FLN004","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9782",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070010-00","Florida Hospital Silver HMO 90 HSA 5445","Standard Silver Off Exchange Plan",,"0.719767451286316","Yes","Yes","No","100%",,"$2,600","$0","$780","$150","$2,600","$0","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5445",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040012","Health First GYM ACCESS Gold HMO 100 1323","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9723",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040012-01","Health First GYM ACCESS Gold HMO 100 1323","Standard Gold On Exchange Plan",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1323",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040012","Health First GYM ACCESS Gold HMO 100 1323","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9723",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040012-02","Health First GYM ACCESS Gold HMO 100 1323","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1323_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050001","Florida Hospital Bronze POS 50 5412","36194FL005",,"FLN004","FLS002","FLF016","New","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9739",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050001-00","Florida Hospital Bronze POS 50 5412","Standard Bronze Off Exchange Plan",,"0.619228422641754","Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2017_sbc_5412",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050001","Florida Hospital Bronze POS 50 5412","36194FL005",,"FLN004","FLS002","FLF016","New","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9739",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050001-01","Florida Hospital Bronze POS 50 5412","Standard Bronze On Exchange Plan",,"0.619228422641754","Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2017_sbc_5412",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040012","Health First GYM ACCESS Gold HMO 100 1323","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9723",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040012-03","Health First GYM ACCESS Gold HMO 100 1323","Limited Cost Sharing Plan Variation",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1323",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080012","Florida Hospital GYM ACCESS Gold HMO 100 1617","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9723",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080012-00","Florida Hospital GYM ACCESS Gold HMO 100 1617","Standard Gold Off Exchange Plan",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1617",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080012","Florida Hospital GYM ACCESS Gold HMO 100 1617","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9723",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080012-01","Florida Hospital GYM ACCESS Gold HMO 100 1617","Standard Gold On Exchange Plan",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1617",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080012","Florida Hospital GYM ACCESS Gold HMO 100 1617","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9723",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080012-02","Florida Hospital GYM ACCESS Gold HMO 100 1617","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1617_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080012","Florida Hospital GYM ACCESS Gold HMO 100 1617","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9723",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080012-03","Florida Hospital GYM ACCESS Gold HMO 100 1617","Limited Cost Sharing Plan Variation",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1617",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020012","Health First GYM ACCESS Gold POS 100 1324","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.973",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020012-00","Health First GYM ACCESS Gold POS 100 1324","Standard Gold Off Exchange Plan",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1324",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030011","Health First Silver HMO 90 HSA 5446","36194FL003",,"FLN003","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9776",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030011-00","Health First Silver HMO 90 HSA 5446","Standard Silver Off Exchange Plan",,"0.69866007566452","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5446",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030011","Health First Silver HMO 90 HSA 5446","36194FL003",,"FLN003","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9776",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030011-01","Health First Silver HMO 90 HSA 5446","Standard Silver On Exchange Plan",,"0.69866007566452","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5446",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020012","Health First GYM ACCESS Gold POS 100 1324","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.973",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020012-01","Health First GYM ACCESS Gold POS 100 1324","Standard Gold On Exchange Plan",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1324",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020012","Health First GYM ACCESS Gold POS 100 1324","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.973",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020012-02","Health First GYM ACCESS Gold POS 100 1324","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1324_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070011","Florida Hospital Silver HMO 90 HSA 5448","36194FL007",,"FLN004","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9776",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070011-00","Florida Hospital Silver HMO 90 HSA 5448","Standard Silver Off Exchange Plan",,"0.69866007566452","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5448",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070011","Florida Hospital Silver HMO 90 HSA 5448","36194FL007",,"FLN004","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9776",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070011-01","Florida Hospital Silver HMO 90 HSA 5448","Standard Silver On Exchange Plan",,"0.69866007566452","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5448",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020012","Health First GYM ACCESS Gold POS 100 1324","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.973",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020012-03","Health First GYM ACCESS Gold POS 100 1324","Limited Cost Sharing Plan Variation",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1324",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060012","Florida Hospital GYM ACCESS Gold POS 100 1618","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.973",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060012-00","Florida Hospital GYM ACCESS Gold POS 100 1618","Standard Gold Off Exchange Plan",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1618",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060012","Florida Hospital GYM ACCESS Gold POS 100 1618","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.973",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060012-01","Florida Hospital GYM ACCESS Gold POS 100 1618","Standard Gold On Exchange Plan",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1618",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060012","Florida Hospital GYM ACCESS Gold POS 100 1618","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.973",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060012-02","Florida Hospital GYM ACCESS Gold POS 100 1618","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1618_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060012","Florida Hospital GYM ACCESS Gold POS 100 1618","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.973",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060012-03","Florida Hospital GYM ACCESS Gold POS 100 1618","Limited Cost Sharing Plan Variation",,"0.802754461765289","No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1618",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010011","Health First Silver POS 90 HSA 5447","36194FL001",,"FLN003","FLS001","FLF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9781",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010011-00","Health First Silver POS 90 HSA 5447","Standard Silver Off Exchange Plan",,"0.69866007566452","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5447",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010011","Health First Silver POS 90 HSA 5447","36194FL001",,"FLN003","FLS001","FLF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9781",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010011-01","Health First Silver POS 90 HSA 5447","Standard Silver On Exchange Plan",,"0.69866007566452","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5447",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050011","Florida Hospital Silver POS 90 HSA 5449","36194FL005",,"FLN004","FLS002","FLF014","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9781",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050011-00","Florida Hospital Silver POS 90 HSA 5449","Standard Silver Off Exchange Plan",,"0.69866007566452","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5449",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050011","Florida Hospital Silver POS 90 HSA 5449","36194FL005",,"FLN004","FLS002","FLF014","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9781",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050011-01","Florida Hospital Silver POS 90 HSA 5449","Standard Silver On Exchange Plan",,"0.69866007566452","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5449",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030010","Health First Silver HMO 90 HSA 5443","36194FL003",,"FLN003","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9782",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030010-00","Health First Silver HMO 90 HSA 5443","Standard Silver Off Exchange Plan",,"0.719767451286316","Yes","Yes","No","100%",,"$2,600","$0","$780","$150","$2,600","$0","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5443",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040014","Health First GYM ACCESS Gold HMO 80 1326","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9721",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040014-00","Health First GYM ACCESS Gold HMO 80 1326","Standard Gold Off Exchange Plan",,"0.79148006439209","No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1326",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040014","Health First GYM ACCESS Gold HMO 80 1326","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9721",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040014-01","Health First GYM ACCESS Gold HMO 80 1326","Standard Gold On Exchange Plan",,"0.79148006439209","No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1326",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040014","Health First GYM ACCESS Gold HMO 80 1326","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9721",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040014-02","Health First GYM ACCESS Gold HMO 80 1326","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1326_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040014","Health First GYM ACCESS Gold HMO 80 1326","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9721",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040014-03","Health First GYM ACCESS Gold HMO 80 1326","Limited Cost Sharing Plan Variation",,"0.79148006439209","No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1326",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070010","Florida Hospital Silver HMO 90 HSA 5445","36194FL007",,"FLN004","FLS002","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9782",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070010-01","Florida Hospital Silver HMO 90 HSA 5445","Standard Silver On Exchange Plan",,"0.719767451286316","Yes","Yes","No","100%",,"$2,600","$0","$780","$150","$2,600","$0","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5445",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080014","Florida Hospital GYM ACCESS Gold HMO 80 1620","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9721",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080014-00","Florida Hospital GYM ACCESS Gold HMO 80 1620","Standard Gold Off Exchange Plan",,"0.79148006439209","No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1620",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080014","Florida Hospital GYM ACCESS Gold HMO 80 1620","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9721",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080014-01","Florida Hospital GYM ACCESS Gold HMO 80 1620","Standard Gold On Exchange Plan",,"0.79148006439209","No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1620",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080014","Florida Hospital GYM ACCESS Gold HMO 80 1620","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9721",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080014-02","Florida Hospital GYM ACCESS Gold HMO 80 1620","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1620_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080014","Florida Hospital GYM ACCESS Gold HMO 80 1620","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9721",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080014-03","Florida Hospital GYM ACCESS Gold HMO 80 1620","Limited Cost Sharing Plan Variation",,"0.79148006439209","No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1620",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040006","Health First GYM ACCESS Silver HMO 100 1285","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040006-00","Health First GYM ACCESS Silver HMO 100 1285","Standard Silver Off Exchange Plan","69.34%","0.679643332958221","No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1285",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030029","Health First Platinum HMO 100 5507","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9837",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030029-00","Health First Platinum HMO 100 5507","Standard Platinum Off Exchange Plan","91.54%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5507",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030029","Health First Platinum HMO 100 5507","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9837",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030029-01","Health First Platinum HMO 100 5507","Standard Platinum On Exchange Plan","91.54%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5507",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040006","Health First GYM ACCESS Silver HMO 100 1285","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040006-01","Health First GYM ACCESS Silver HMO 100 1285","Standard Silver On Exchange Plan","69.34%","0.679643332958221","No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1285",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040006","Health First GYM ACCESS Silver HMO 100 1285","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040006-02","Health First GYM ACCESS Silver HMO 100 1285","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1285_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070029","Florida Hospital Platinum HMO 100 5509","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9837",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070029-00","Florida Hospital Platinum HMO 100 5509","Standard Platinum Off Exchange Plan","91.54%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5509",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070029","Florida Hospital Platinum HMO 100 5509","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9837",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070029-01","Florida Hospital Platinum HMO 100 5509","Standard Platinum On Exchange Plan","91.54%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5509",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040006","Health First GYM ACCESS Silver HMO 100 1285","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040006-03","Health First GYM ACCESS Silver HMO 100 1285","Limited Cost Sharing Plan Variation","69.34%","0.679643332958221","No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1285",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040006","Health First GYM ACCESS Silver HMO 100 1285","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040006-04","Health First GYM ACCESS Silver AV73 HMO 100 1286","73% AV Level Silver Plan","72.50%","0.716208219528198","No","Yes","No","100%",,"$2,900","$0","$0","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1286",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040006","Health First GYM ACCESS Silver HMO 100 1285","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040006-05","Health First GYM ACCESS Silver AV87 HMO 100 1287","87% AV Level Silver Plan","86.78%","0.856330811977386","No","Yes","No","100%",,"$900","$50","$0","$150","$900","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1287",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040006","Health First GYM ACCESS Silver HMO 100 1285","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040006-06","Health First GYM ACCESS Silver AV94 HMO 100 1288","94% AV Level Silver Plan","94.82%","0.939726233482361","No","Yes","No","100%",,"$100","$50","$0","$150","$100","$350","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1288",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080006","Florida Hospital GYM ACCESS Silver HMO 100 1585","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080006-00","Florida Hospital GYM ACCESS Silver HMO 100 1585","Standard Silver Off Exchange Plan","69.34%","0.679643332958221","No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1585",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080006","Florida Hospital GYM ACCESS Silver HMO 100 1585","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080006-01","Florida Hospital GYM ACCESS Silver HMO 100 1585","Standard Silver On Exchange Plan","69.34%","0.679643332958221","No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1585",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080006","Florida Hospital GYM ACCESS Silver HMO 100 1585","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080006-02","Florida Hospital GYM ACCESS Silver HMO 100 1585","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1585_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080006","Florida Hospital GYM ACCESS Silver HMO 100 1585","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080006-03","Florida Hospital GYM ACCESS Silver HMO 100 1585","Limited Cost Sharing Plan Variation","69.34%","0.679643332958221","No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1585",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080006","Florida Hospital GYM ACCESS Silver HMO 100 1585","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080006-04","Florida Hospital GYM ACCESS Silver AV73 HMO 100 1586","73% AV Level Silver Plan","72.50%","0.716208219528198","No","Yes","No","100%",,"$2,900","$0","$0","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1586",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080006","Florida Hospital GYM ACCESS Silver HMO 100 1585","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080006-05","Florida Hospital GYM ACCESS Silver AV87 HMO 100 1587","87% AV Level Silver Plan","86.78%","0.856330811977386","No","Yes","No","100%",,"$900","$50","$0","$150","$900","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1587",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080006","Florida Hospital GYM ACCESS Silver HMO 100 1585","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9671",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080006-06","Florida Hospital GYM ACCESS Silver AV94 HMO 100 1588","94% AV Level Silver Plan","94.82%","0.939726233482361","No","Yes","No","100%",,"$100","$50","$0","$150","$100","$350","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1588",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040005","Health First GYM ACCESS Silver HMO 100 1277","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040005-00","Health First GYM ACCESS Silver HMO 100 1277","Standard Silver Off Exchange Plan","70.16%","0.691754281520844","No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1277",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010029","Health First Platinum POS 100 5508","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9844",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010029-00","Health First Platinum POS 100 5508","Standard Platinum Off Exchange Plan","91.54%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5508",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010029","Health First Platinum POS 100 5508","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9844",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010029-01","Health First Platinum POS 100 5508","Standard Platinum On Exchange Plan","91.54%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5508",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040005","Health First GYM ACCESS Silver HMO 100 1277","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040005-01","Health First GYM ACCESS Silver HMO 100 1277","Standard Silver On Exchange Plan","70.16%","0.691754281520844","No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1277",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040005","Health First GYM ACCESS Silver HMO 100 1277","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040005-02","Health First GYM ACCESS Silver HMO 100 1277","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1277_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040003","Health First GYM ACCESS Bronze HMO 100 HSA 1274","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040003-00","Health First GYM ACCESS Bronze HMO 100 HSA 1274","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1274",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030015","Health First Gold HMO 70 5462","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9807",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030015-00","Health First Gold HMO 70 5462","Standard Gold Off Exchange Plan","81.97%","0","No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5462",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050029","Florida Hospital Platinum POS 100 5510","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9844",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050029-00","Florida Hospital Platinum POS 100 5510","Standard Platinum Off Exchange Plan","91.54%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5510",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040003","Health First GYM ACCESS Bronze HMO 100 HSA 1274","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040003-01","Health First GYM ACCESS Bronze HMO 100 HSA 1274","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1274",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050029","Florida Hospital Platinum POS 100 5510","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9844",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050029-01","Florida Hospital Platinum POS 100 5510","Standard Platinum On Exchange Plan","91.54%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5510",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040005","Health First GYM ACCESS Silver HMO 100 1277","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040005-03","Health First GYM ACCESS Silver HMO 100 1277","Limited Cost Sharing Plan Variation","70.16%","0.691754281520844","No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1277",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040005","Health First GYM ACCESS Silver HMO 100 1277","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040005-04","Health First GYM ACCESS Silver AV73 HMO 100 1278","73% AV Level Silver Plan","73.39%","0.726759612560272","No","Yes","No","100%",,"$3,200","$0","$0","$150","$1,410","$280","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1278",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040005","Health First GYM ACCESS Silver HMO 100 1277","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040005-05","Health First GYM ACCESS Silver AV87 HMO 100 1279","87% AV Level Silver Plan","87.45%","0.885578036308289","No","Yes","No","100%",,"$900","$0","$0","$150","$900","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1279",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040005","Health First GYM ACCESS Silver HMO 100 1277","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040005-06","Health First GYM ACCESS Silver AV94 HMO 100 1280","94% AV Level Silver Plan","94.55%","0.947053194046021","No","Yes","No","100%",,"$150","$0","$0","$150","$150","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1280",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080005","Florida Hospital GYM ACCESS Silver HMO 100 1577","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080005-00","Florida Hospital GYM ACCESS Silver HMO 100 1577","Standard Silver Off Exchange Plan","70.16%","0.691754281520844","No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1577",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080005","Florida Hospital GYM ACCESS Silver HMO 100 1577","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080005-01","Florida Hospital GYM ACCESS Silver HMO 100 1577","Standard Silver On Exchange Plan","70.16%","0.691754281520844","No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1577",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080005","Florida Hospital GYM ACCESS Silver HMO 100 1577","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080005-02","Florida Hospital GYM ACCESS Silver HMO 100 1577","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1577_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080005","Florida Hospital GYM ACCESS Silver HMO 100 1577","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080005-03","Florida Hospital GYM ACCESS Silver HMO 100 1577","Limited Cost Sharing Plan Variation","70.16%","0.691754281520844","No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1577",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080005","Florida Hospital GYM ACCESS Silver HMO 100 1577","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080005-04","Florida Hospital GYM ACCESS Silver AV73 HMO 100 1578","73% AV Level Silver Plan","73.39%","0.726759612560272","No","Yes","No","100%",,"$3,200","$0","$0","$150","$1,410","$280","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1578",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080005","Florida Hospital GYM ACCESS Silver HMO 100 1577","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080005-05","Florida Hospital GYM ACCESS Silver AV87 HMO 100 1579","87% AV Level Silver Plan","87.45%","0.885578036308289","No","Yes","No","100%",,"$900","$0","$0","$150","$900","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1579",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080005","Florida Hospital GYM ACCESS Silver HMO 100 1577","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9669",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080005-06","Florida Hospital GYM ACCESS Silver AV94 HMO 100 1580","94% AV Level Silver Plan","94.55%","0.947053194046021","No","Yes","No","100%",,"$150","$0","$0","$150","$150","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1580",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040007","Health First GYM ACCESS Silver HMO 90 1289","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040007-00","Health First GYM ACCESS Silver HMO 90 1289","Standard Silver Off Exchange Plan","70.93%","0","No","Yes","No","100%",,"$4,000","$50","$50","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1289",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030004","Health First Silver HMO 50 5421","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030004-00","Health First Silver HMO 50 5421","Standard Silver Off Exchange Plan","71.25%","0.721085369586945","No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5421",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030004","Health First Silver HMO 50 5421","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030004-01","Health First Silver HMO 50 5421","Standard Silver On Exchange Plan","71.25%","0.721085369586945","No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5421",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040007","Health First GYM ACCESS Silver HMO 90 1289","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040007-01","Health First GYM ACCESS Silver HMO 90 1289","Standard Silver On Exchange Plan","70.93%","0","No","Yes","No","100%",,"$4,000","$50","$50","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1289",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040007","Health First GYM ACCESS Silver HMO 90 1289","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040007-02","Health First GYM ACCESS Silver HMO 90 1289","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1289_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070004","Florida Hospital Silver HMO 50 5424","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070004-00","Florida Hospital Silver HMO 50 5424","Standard Silver Off Exchange Plan","71.25%","0.721085369586945","No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5424",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070004","Florida Hospital Silver HMO 50 5424","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070004-01","Florida Hospital Silver HMO 50 5424","Standard Silver On Exchange Plan","71.25%","0.721085369586945","No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5424",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040007","Health First GYM ACCESS Silver HMO 90 1289","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040007-03","Health First GYM ACCESS Silver HMO 90 1289","Limited Cost Sharing Plan Variation","70.93%","0","No","Yes","No","100%",,"$4,000","$50","$50","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1289",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040007","Health First GYM ACCESS Silver HMO 90 1289","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040007-04","Health First GYM ACCESS Silver AV73 HMO 90 1290","73% AV Level Silver Plan","74.00%","0","No","Yes","No","100%",,"$2,600","$50","$190","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1290",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040007","Health First GYM ACCESS Silver HMO 90 1289","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040007-05","Health First GYM ACCESS Silver AV87 HMO 90 1291","87% AV Level Silver Plan","87.83%","0","No","Yes","No","100%",,"$350","$50","$410","$150","$350","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1291",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040007","Health First GYM ACCESS Silver HMO 90 1289","36194FL004",,"FLN001","FLS001","FLF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040007-06","Health First GYM ACCESS Silver AV94 HMO 90 1292","94% AV Level Silver Plan","93.45%","0","No","Yes","No","100%",,"$0","$50","$450","$150","$0","$580","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1292",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080007","Florida Hospital GYM ACCESS Silver HMO 90 1589","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080007-00","Florida Hospital GYM ACCESS Silver HMO 90 1589","Standard Silver Off Exchange Plan","70.93%","0","No","Yes","No","100%",,"$4,000","$50","$50","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1589",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080007","Florida Hospital GYM ACCESS Silver HMO 90 1589","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080007-01","Florida Hospital GYM ACCESS Silver HMO 90 1589","Standard Silver On Exchange Plan","70.93%","0","No","Yes","No","100%",,"$4,000","$50","$50","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1589",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080007","Florida Hospital GYM ACCESS Silver HMO 90 1589","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080007-02","Florida Hospital GYM ACCESS Silver HMO 90 1589","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1589_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080007","Florida Hospital GYM ACCESS Silver HMO 90 1589","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080007-03","Florida Hospital GYM ACCESS Silver HMO 90 1589","Limited Cost Sharing Plan Variation","70.93%","0","No","Yes","No","100%",,"$4,000","$50","$50","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1589",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080007","Florida Hospital GYM ACCESS Silver HMO 90 1589","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080007-04","Florida Hospital GYM ACCESS Silver AV73 HMO 90 1590","73% AV Level Silver Plan","74.00%","0","No","Yes","No","100%",,"$2,600","$50","$190","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1590",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080007","Florida Hospital GYM ACCESS Silver HMO 90 1589","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080007-05","Florida Hospital GYM ACCESS Silver AV87 HMO 90 1591","87% AV Level Silver Plan","87.83%","0","No","Yes","No","100%",,"$350","$50","$410","$150","$350","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1591",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080007","Florida Hospital GYM ACCESS Silver HMO 90 1589","36194FL008",,"FLN002","FLS002","FLF023","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9673",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080007-06","Florida Hospital GYM ACCESS Silver AV94 HMO 90 1592","94% AV Level Silver Plan","93.45%","0","No","Yes","No","100%",,"$0","$50","$450","$150","$0","$580","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1592",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030015","Health First Gold HMO 70 5462","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9807",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030015-01","Health First Gold HMO 70 5462","Standard Gold On Exchange Plan","81.97%","0","No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5462",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040003","Health First GYM ACCESS Bronze HMO 100 HSA 1274","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040003-02","Health First GYM ACCESS Bronze HMO 100 1274","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1274_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070015","Florida Hospital Gold HMO 70 5464","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9807",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070015-00","Florida Hospital Gold HMO 70 5464","Standard Gold Off Exchange Plan","81.97%","0","No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5464",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070015","Florida Hospital Gold HMO 70 5464","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9807",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070015-01","Florida Hospital Gold HMO 70 5464","Standard Gold On Exchange Plan","81.97%","0","No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5464",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040003","Health First GYM ACCESS Bronze HMO 100 HSA 1274","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040003-03","Health First GYM ACCESS Bronze HMO 100 HSA 1274","Limited Cost Sharing Plan Variation",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1274",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080003","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1574","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080003-00","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1574","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1574",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080003","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1574","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080003-01","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1574","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1574",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080003","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1574","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080003-02","Florida Hospital GYM ACCESS Bronze HMO 100 1574","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1574_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080003","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1574","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9594",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080003-03","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1574","Limited Cost Sharing Plan Variation",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1574",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020003","Health First GYM ACCESS Bronze POS 100 HSA 1275","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9604",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020003-00","Health First GYM ACCESS Bronze POS 100 HSA 1275","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1275",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020003","Health First GYM ACCESS Bronze POS 100 HSA 1275","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9604",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020003-01","Health First GYM ACCESS Bronze POS 100 HSA 1275","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1275",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020003","Health First GYM ACCESS Bronze POS 100 HSA 1275","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9604",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020003-02","Health First GYM ACCESS Bronze POS 100 1275","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1275_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020003","Health First GYM ACCESS Bronze POS 100 HSA 1275","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9604",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020003-03","Health First GYM ACCESS Bronze POS 100 HSA 1275","Limited Cost Sharing Plan Variation",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2017_sbc_1275",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060003","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1575","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9604",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060003-00","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1575","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1575",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060003","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1575","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9604",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060003-01","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1575","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1575",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060003","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1575","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9604",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060003-02","Florida Hospital GYM ACCESS Bronze POS 100 1575","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1575_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060003","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1575","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9604",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060003-03","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1575","Limited Cost Sharing Plan Variation",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2017_sbc_1575",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030022","Health First Gold HMO 80 5489","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030022-00","Health First Gold HMO 80 5489","Standard Gold Off Exchange Plan",,"0.799098134040833","No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5489",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030022","Health First Gold HMO 80 5489","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030022-01","Health First Gold HMO 80 5489","Standard Gold On Exchange Plan",,"0.799098134040833","No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5489",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070022","Florida Hospital Gold HMO 80 5491","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070022-00","Florida Hospital Gold HMO 80 5491","Standard Gold Off Exchange Plan",,"0.799098134040833","No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5491",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070022","Florida Hospital Gold HMO 80 5491","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070022-01","Florida Hospital Gold HMO 80 5491","Standard Gold On Exchange Plan",,"0.799098134040833","No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5491",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030002","Health First Bronze HMO 90 HSA 5413","36194FL003",,"FLN003","FLS001","FLF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9745",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030002-00","Health First Bronze HMO 90 HSA 5413","Standard Bronze Off Exchange Plan",,"0.619840681552887","Yes","Yes","No","100%",,"$5,170","$0","$1,040","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","per person not applicable","$11600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5413",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030002","Health First Bronze HMO 90 HSA 5413","36194FL003",,"FLN003","FLS001","FLF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9745",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030002-01","Health First Bronze HMO 90 HSA 5413","Standard Bronze On Exchange Plan",,"0.619840681552887","Yes","Yes","No","100%",,"$5,170","$0","$1,040","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","per person not applicable","$11600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5413",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070002","Florida Hospital Bronze HMO 90 HSA 5415","36194FL007",,"FLN004","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9745",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070002-00","Florida Hospital Bronze HMO 90 HSA 5415","Standard Bronze Off Exchange Plan",,"0.619840681552887","Yes","Yes","No","100%",,"$5,170","$0","$1,040","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","per person not applicable","$11600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5415",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070002","Florida Hospital Bronze HMO 90 HSA 5415","36194FL007",,"FLN004","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9745",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070002-01","Florida Hospital Bronze HMO 90 HSA 5415","Standard Bronze On Exchange Plan",,"0.619840681552887","Yes","Yes","No","100%",,"$5,170","$0","$1,040","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","per person not applicable","$11600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5415",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040001","Health First GYM ACCESS Bronze HMO 70 1271","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.962",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040001-00","Health First GYM ACCESS Bronze HMO 70 1271","Standard Bronze Off Exchange Plan","61.99%","0.634928107261658","No","Yes","No","100%",,"$4,650","$0","$0","$150","$1,340","$890","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1271",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030018","Health First Gold HMO 80 5472","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030018-00","Health First Gold HMO 80 5472","Standard Gold Off Exchange Plan","80.80%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5472",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030018","Health First Gold HMO 80 5472","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030018-01","Health First Gold HMO 80 5472","Standard Gold On Exchange Plan","80.80%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5472",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040001","Health First GYM ACCESS Bronze HMO 70 1271","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.962",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040001-01","Health First GYM ACCESS Bronze HMO 70 1271","Standard Bronze On Exchange Plan","61.99%","0.634928107261658","No","Yes","No","100%",,"$4,650","$0","$0","$150","$1,340","$890","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1271",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040001","Health First GYM ACCESS Bronze HMO 70 1271","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.962",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040001-02","Health First GYM ACCESS Bronze HMO 70 1271","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1271_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070018","Florida Hospital Gold HMO 80 5474","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070018-00","Florida Hospital Gold HMO 80 5474","Standard Gold Off Exchange Plan","80.80%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5474",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070018","Florida Hospital Gold HMO 80 5474","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070018-01","Florida Hospital Gold HMO 80 5474","Standard Gold On Exchange Plan","80.80%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5474",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040001","Health First GYM ACCESS Bronze HMO 70 1271","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.962",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040001-03","Health First GYM ACCESS Bronze HMO 70 1271","Limited Cost Sharing Plan Variation","61.99%","0.634928107261658","No","Yes","No","100%",,"$4,650","$0","$0","$150","$1,340","$890","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1271",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080001","Florida Hospital GYM ACCESS Bronze HMO 70 1571","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.962",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080001-00","Florida Hospital GYM ACCESS Bronze HMO 70 1571","Standard Bronze Off Exchange Plan","61.99%","0.634928107261658","No","Yes","No","100%",,"$4,650","$0","$0","$150","$1,340","$890","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1571",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080001","Florida Hospital GYM ACCESS Bronze HMO 70 1571","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.962",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080001-01","Florida Hospital GYM ACCESS Bronze HMO 70 1571","Standard Bronze On Exchange Plan","61.99%","0.634928107261658","No","Yes","No","100%",,"$4,650","$0","$0","$150","$1,340","$890","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1571",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080001","Florida Hospital GYM ACCESS Bronze HMO 70 1571","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.962",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080001-02","Florida Hospital GYM ACCESS Bronze HMO 70 1571","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1571_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080001","Florida Hospital GYM ACCESS Bronze HMO 70 1571","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.962",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080001-03","Florida Hospital GYM ACCESS Bronze HMO 70 1571","Limited Cost Sharing Plan Variation","61.99%","0.634928107261658","No","Yes","No","100%",,"$4,650","$0","$0","$150","$1,340","$890","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1571",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040023","Health First Bronze HMO 100 1352","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040023-00","Health First Bronze HMO 100 1352","Standard Bronze Off Exchange Plan",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1352",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030003","Health First Bronze HMO 100 HSA 5417","36194FL003",,"FLN003","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.974",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030003-00","Health First Bronze HMO 100 HSA 5417","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5417",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030003","Health First Bronze HMO 100 HSA 5417","36194FL003",,"FLN003","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.974",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030003-01","Health First Bronze HMO 100 HSA 5417","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5417",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040023","Health First Bronze HMO 100 1352","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040023-01","Health First Bronze HMO 100 1352","Standard Bronze On Exchange Plan",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1352",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040023","Health First Bronze HMO 100 1352","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040023-02","Health First Bronze HMO 100 1352","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1352_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070003","Florida Hospital Bronze HMO 100 HSA 5419","36194FL007",,"FLN004","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.974",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070003-00","Florida Hospital Bronze HMO 100 HSA 5419","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5419",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070003","Florida Hospital Bronze HMO 100 HSA 5419","36194FL007",,"FLN004","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.974",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070003-01","Florida Hospital Bronze HMO 100 HSA 5419","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5419",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040023","Health First Bronze HMO 100 1352","36194FL004",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040023-03","Health First Bronze HMO 100 1352","Limited Cost Sharing Plan Variation",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1352",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080023","Florida Hospital Bronze HMO 100 1646","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080023-00","Florida Hospital Bronze HMO 100 1646","Standard Bronze Off Exchange Plan",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1646",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080023","Florida Hospital Bronze HMO 100 1646","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080023-01","Florida Hospital Bronze HMO 100 1646","Standard Bronze On Exchange Plan",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1646",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080023","Florida Hospital Bronze HMO 100 1646","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080023-02","Florida Hospital Bronze HMO 100 1646","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1646_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080023","Florida Hospital Bronze HMO 100 1646","36194FL008",,"FLN002","FLS002","FLF013","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080023-03","Florida Hospital Bronze HMO 100 1646","Limited Cost Sharing Plan Variation",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1646",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020023","Health First Bronze POS 100 1353","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020023-00","Health First Bronze POS 100 1353","Standard Bronze Off Exchange Plan",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$15,100","$15100 per person","$30200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1353",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010003","Health First Bronze POS 100 HSA 5418","36194FL001",,"FLN003","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9747",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010003-00","Health First Bronze POS 100 HSA 5418","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5418",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010003","Health First Bronze POS 100 HSA 5418","36194FL001",,"FLN003","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9747",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010003-01","Health First Bronze POS 100 HSA 5418","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5418",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020023","Health First Bronze POS 100 1353","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020023-01","Health First Bronze POS 100 1353","Standard Bronze On Exchange Plan",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$15,100","$15100 per person","$30200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1353",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020023","Health First Bronze POS 100 1353","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020023-02","Health First Bronze POS 100 1353","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1353_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050003","Florida Hospital Bronze POS 100 HSA 5420","36194FL005",,"FLN004","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9747",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050003-00","Florida Hospital Bronze POS 100 HSA 5420","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5420",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050003","Florida Hospital Bronze POS 100 HSA 5420","36194FL005",,"FLN004","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9747",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050003-01","Florida Hospital Bronze POS 100 HSA 5420","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5420",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020023","Health First Bronze POS 100 1353","36194FL002",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020023-03","Health First Bronze POS 100 1353","Limited Cost Sharing Plan Variation",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$15,100","$15100 per person","$30200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2017_sbc_1353",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070023","Florida Hospital Gold HMO 90 5494","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9805",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070023-00","Florida Hospital Gold HMO 90 5494","Standard Gold Off Exchange Plan","81.56%","0","No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5494",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060023","Florida Hospital Bronze POS 100 1647","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060023-00","Florida Hospital Bronze POS 100 1647","Standard Bronze Off Exchange Plan",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$15,100","$15100 per person","$30200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1647",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060023","Florida Hospital Bronze POS 100 1647","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060023-01","Florida Hospital Bronze POS 100 1647","Standard Bronze On Exchange Plan",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$15,100","$15100 per person","$30200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1647",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060023","Florida Hospital Bronze POS 100 1647","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060023-02","Florida Hospital Bronze POS 100 1647","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1647_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060023","Florida Hospital Bronze POS 100 1647","36194FL006",,"FLN002","FLS002","FLF013","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060023-03","Florida Hospital Bronze POS 100 1647","Limited Cost Sharing Plan Variation",,"0.597335398197174","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$15,100","$15100 per person","$30200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2017_sbc_1647",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040024","Health First Silver HMO 80 1354","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040024-00","Health First Silver HMO 80 1354","Standard Silver Off Exchange Plan","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1354",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010009","Health First Silver POS 100 HSA 5440","36194FL001",,"FLN003","FLS001","FLF001","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010009-00","Health First Silver POS 100 HSA 5440","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","per person not applicable","$7200 per group","0.00%",,,,,"$7,200","per person not applicable","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5440",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010009","Health First Silver POS 100 HSA 5440","36194FL001",,"FLN003","FLS001","FLF001","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010009-01","Health First Silver POS 100 HSA 5440","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","per person not applicable","$7200 per group","0.00%",,,,,"$7,200","per person not applicable","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5440",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040024","Health First Silver HMO 80 1354","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040024-01","Health First Silver HMO 80 1354","Standard Silver On Exchange Plan","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1354",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040024","Health First Silver HMO 80 1354","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040024-02","Health First Silver HMO 80 1354","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1354_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050009","Florida Hospital Silver POS 100 HSA 5442","36194FL005",,"FLN004","FLS002","FLF013","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050009-00","Florida Hospital Silver POS 100 HSA 5442","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","per person not applicable","$7200 per group","0.00%",,,,,"$7,200","per person not applicable","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5442",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050009","Florida Hospital Silver POS 100 HSA 5442","36194FL005",,"FLN004","FLS002","FLF013","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050009-01","Florida Hospital Silver POS 100 HSA 5442","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","per person not applicable","$7200 per group","0.00%",,,,,"$7,200","per person not applicable","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5442",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040024","Health First Silver HMO 80 1354","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040024-03","Health First Silver HMO 80 1354","Limited Cost Sharing Plan Variation","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1354",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040024","Health First Silver HMO 80 1354","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040024-04","Health First Silver AV73 HMO 80 1355","73% AV Level Silver Plan","73.35%","0.732766330242157","No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1355",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040024","Health First Silver HMO 80 1354","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040024-05","Health First Silver AV87 HMO 80 1356","87% AV Level Silver Plan","87.44%","0.871704518795013","No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1356",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0040024","Health First Silver HMO 80 1354","36194FL004",,"FLN001","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0040024-06","Health First Silver AV94 HMO 80 1357","94% AV Level Silver Plan","93.55%","0.933497428894043","No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1357",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080024","Florida Hospital Silver HMO 80 1648","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080024-00","Florida Hospital Silver HMO 80 1648","Standard Silver Off Exchange Plan","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1648",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080024","Florida Hospital Silver HMO 80 1648","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080024-01","Florida Hospital Silver HMO 80 1648","Standard Silver On Exchange Plan","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1648",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080024","Florida Hospital Silver HMO 80 1648","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080024-02","Florida Hospital Silver HMO 80 1648","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1648_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080024","Florida Hospital Silver HMO 80 1648","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080024-03","Florida Hospital Silver HMO 80 1648","Limited Cost Sharing Plan Variation","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1648",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080024","Florida Hospital Silver HMO 80 1648","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080024-04","Florida Hospital Silver AV73 HMO 80 1649","73% AV Level Silver Plan","73.35%","0.732766330242157","No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1649",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080024","Florida Hospital Silver HMO 80 1648","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080024-05","Florida Hospital Silver AV87 HMO 80 1650","87% AV Level Silver Plan","87.44%","0.871704518795013","No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1650",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0080024","Florida Hospital Silver HMO 80 1648","36194FL008",,"FLN002","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"No",,"No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0080024-06","Florida Hospital Silver AV94 HMO 80 1651","94% AV Level Silver Plan","93.55%","0.933497428894043","No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1651",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060024","Florida Hospital Silver POS 80 1652","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060024-04","Florida Hospital Silver AV73 POS 80 1653","73% AV Level Silver Plan","73.35%","0.732766330242157","No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1653",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060024","Florida Hospital Silver POS 80 1652","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060024-05","Florida Hospital Silver AV87 POS 80 1654","87% AV Level Silver Plan","87.44%","0.871704518795013","No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1654",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060024","Florida Hospital Silver POS 80 1652","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060024-06","Florida Hospital Silver AV94 POS 80 1655","94% AV Level Silver Plan","93.55%","0.933497428894043","No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1655",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010024","Health First Gold POS 90 HSA 5495","36194FL001",,"FLN003","FLS001","FLF002","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9819",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010024-00","Health First Gold POS 90 HSA 5495","Standard Gold Off Exchange Plan",,"0.812000334262848","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5495",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010024","Health First Gold POS 90 HSA 5495","36194FL001",,"FLN003","FLS001","FLF002","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9819",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010024-01","Health First Gold POS 90 HSA 5495","Standard Gold On Exchange Plan",,"0.812000334262848","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5495",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050024","Florida Hospital Gold POS 90 HSA 5496","36194FL005",,"FLN004","FLS002","FLF014","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9819",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050024-00","Florida Hospital Gold POS 90 HSA 5496","Standard Gold Off Exchange Plan",,"0.812000334262848","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5496",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050024","Florida Hospital Gold POS 90 HSA 5496","36194FL005",,"FLN004","FLS002","FLF014","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9819",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050024-01","Florida Hospital Gold POS 90 HSA 5496","Standard Gold On Exchange Plan",,"0.812000334262848","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5496",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070016","Florida Hospital Gold HMO 80 5468","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9805",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070016-01","Florida Hospital Gold HMO 80 5468","Standard Gold On Exchange Plan",,"0.799205899238586","No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5468",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030001","Health First Bronze HMO 50 5409","36194FL003",,"FLN003","FLS001","FLF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9732",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030001-00","Health First Bronze HMO 50 5409","Standard Bronze Off Exchange Plan",,"0.619228422641754","Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2017_sbc_5409",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030001","Health First Bronze HMO 50 5409","36194FL003",,"FLN003","FLS001","FLF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9732",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030001-01","Health First Bronze HMO 50 5409","Standard Bronze On Exchange Plan",,"0.619228422641754","Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2017_sbc_5409",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020024","Health First Silver POS 80 1358","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020024-00","Health First Silver POS 80 1358","Standard Silver Off Exchange Plan","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1358",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030023","Health First Gold HMO 90 5493","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9805",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030023-00","Health First Gold HMO 90 5493","Standard Gold Off Exchange Plan","81.56%","0","No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5493",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030023","Health First Gold HMO 90 5493","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9805",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030023-01","Health First Gold HMO 90 5493","Standard Gold On Exchange Plan","81.56%","0","No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5493",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020024","Health First Silver POS 80 1358","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020024-01","Health First Silver POS 80 1358","Standard Silver On Exchange Plan","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1358",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020024","Health First Silver POS 80 1358","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020024-02","Health First Silver POS 80 1358","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1358_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070023","Florida Hospital Gold HMO 90 5494","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9805",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070023-01","Florida Hospital Gold HMO 90 5494","Standard Gold On Exchange Plan","81.56%","0","No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5494",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020024","Health First Silver POS 80 1358","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020024-03","Health First Silver POS 80 1358","Limited Cost Sharing Plan Variation","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1358",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020024","Health First Silver POS 80 1358","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020024-04","Health First Silver AV73 POS 80 1359","73% AV Level Silver Plan","73.35%","0.732766330242157","No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1359",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020024","Health First Silver POS 80 1358","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020024-05","Health First Silver AV87 POS 80 1360","87% AV Level Silver Plan","87.44%","0.871704518795013","No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1360",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0020024","Health First Silver POS 80 1358","36194FL002",,"FLN001","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayHFHP.Health-First.org/2017","http://www.myHFHP.org/MP_formulary_2017","36194FL0020024-06","Health First Silver AV94 POS 80 1361","94% AV Level Silver Plan","93.55%","0.933497428894043","No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2017_sbc_1361",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060024","Florida Hospital Silver POS 80 1652","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060024-00","Florida Hospital Silver POS 80 1652","Standard Silver Off Exchange Plan","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1652",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060024","Florida Hospital Silver POS 80 1652","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060024-01","Florida Hospital Silver POS 80 1652","Standard Silver On Exchange Plan","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1652",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060024","Florida Hospital Silver POS 80 1652","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060024-02","Florida Hospital Silver POS 80 1652","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1652_0",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","Individual","No","47-2894653","36194FL0060024","Florida Hospital Silver POS 80 1652","36194FL006",,"FLN002","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://PayFHCA.Health-First.org/2017","http://www.myFHCA.org/FHMP_formulary_2017","36194FL0060024-03","Florida Hospital Silver POS 80 1652","Limited Cost Sharing Plan Variation","68.05%","0.677702009677887","No","Yes","No","100%",,"$2,900","$0","$450","$150","$2,420","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2017_sbc_1652",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030025","Health First Gold HMO 90 HSA 5497","36194FL003",,"FLN003","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030025-00","Health First Gold HMO 90 HSA 5497","Standard Gold Off Exchange Plan",,"0.799173831939697","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5497",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030025","Health First Gold HMO 90 HSA 5497","36194FL003",,"FLN003","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030025-01","Health First Gold HMO 90 HSA 5497","Standard Gold On Exchange Plan",,"0.799173831939697","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5497",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070025","Florida Hospital Gold HMO 90 HSA 5498","36194FL007",,"FLN004","FLS002","FLF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070025-00","Florida Hospital Gold HMO 90 HSA 5498","Standard Gold Off Exchange Plan",,"0.799173831939697","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5498",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070025","Florida Hospital Gold HMO 90 HSA 5498","36194FL007",,"FLN004","FLS002","FLF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070025-01","Florida Hospital Gold HMO 90 HSA 5498","Standard Gold On Exchange Plan",,"0.799173831939697","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2017_sbc_5498",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030030","Health First Platinum HMO 100 5511","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9838",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030030-00","Health First Platinum HMO 100 5511","Standard Platinum Off Exchange Plan","92.00%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5511",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030030","Health First Platinum HMO 100 5511","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9838",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030030-01","Health First Platinum HMO 100 5511","Standard Platinum On Exchange Plan","92.00%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5511",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070030","Florida Hospital Platinum HMO 100 5512","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9838",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070030-00","Florida Hospital Platinum HMO 100 5512","Standard Platinum Off Exchange Plan","92.00%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5512",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070030","Florida Hospital Platinum HMO 100 5512","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9838",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070030-01","Florida Hospital Platinum HMO 100 5512","Standard Platinum On Exchange Plan","92.00%","0","No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5512",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030033","Health First Silver HMO 70 5521","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9774",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030033-00","Health First Silver HMO 70 5521","Standard Silver Off Exchange Plan","69.21%","0","No","Yes","No","100%",,"$0","$1,270","$0","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5521",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030033","Health First Silver HMO 70 5521","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9774",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030033-01","Health First Silver HMO 70 5521","Standard Silver On Exchange Plan","69.21%","0","No","Yes","No","100%",,"$0","$1,270","$0","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5521",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070033","Florida Hospital Silver HMO 70 5522","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9774",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070033-00","Florida Hospital Silver HMO 70 5522","Standard Silver Off Exchange Plan","69.21%","0","No","Yes","No","100%",,"$0","$1,270","$0","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5522",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070033","Florida Hospital Silver HMO 70 5522","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9774",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070033-01","Florida Hospital Silver HMO 70 5522","Standard Silver On Exchange Plan","69.21%","0","No","Yes","No","100%",,"$0","$1,270","$0","$150","$1,270","$710","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5522",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030034","Health First Bronze HMO 50 5523","36194FL003",,"FLN003","FLS001","FLF025","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9743",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030034-00","Health First Bronze HMO 50 5523","Standard Bronze Off Exchange Plan","61.98%","0.621142506599426","No","Yes","No","100%",,"$5,170","$0","$0","$150","$1,725","$235","$0","$80","$0","$0","$0","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,350","$5350 per person","$10700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5523",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030034","Health First Bronze HMO 50 5523","36194FL003",,"FLN003","FLS001","FLF025","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9743",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030034-01","Health First Bronze HMO 50 5523","Standard Bronze On Exchange Plan","61.98%","0.621142506599426","No","Yes","No","100%",,"$5,170","$0","$0","$150","$1,725","$235","$0","$80","$0","$0","$0","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,350","$5350 per person","$10700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5523",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070034","Florida Hospital Bronze HMO 50 5524","36194FL007",,"FLN004","FLS002","FLF026","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9743",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070034-00","Florida Hospital Bronze HMO 50 5524","Standard Bronze Off Exchange Plan","61.98%","0.621142506599426","No","Yes","No","100%",,"$5,170","$0","$0","$150","$1,725","$235","$0","$80","$0","$0","$0","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,350","$5350 per person","$10700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5524",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070034","Florida Hospital Bronze HMO 50 5524","36194FL007",,"FLN004","FLS002","FLF026","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9743",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070034-01","Florida Hospital Bronze HMO 50 5524","Standard Bronze On Exchange Plan","61.98%","0.621142506599426","No","Yes","No","100%",,"$5,170","$0","$0","$150","$1,725","$235","$0","$80","$0","$0","$0","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,350","$5350 per person","$10700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5524",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010007","Health First Silver POS 80 5434","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010007-00","Health First Silver POS 80 5434","Standard Silver Off Exchange Plan","71.09%","0","No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5434",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010007","Health First Silver POS 80 5434","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010007-01","Health First Silver POS 80 5434","Standard Silver On Exchange Plan","71.09%","0","No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5434",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050007","Florida Hospital Silver POS 80 5436","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050007-00","Florida Hospital Silver POS 80 5436","Standard Silver Off Exchange Plan","71.09%","0","No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5436",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050007","Florida Hospital Silver POS 80 5436","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050007-01","Florida Hospital Silver POS 80 5436","Standard Silver On Exchange Plan","71.09%","0","No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5436",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030032","Health First Platinum HMO 80 5517","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030032-00","Health First Platinum HMO 80 5517","Standard Platinum Off Exchange Plan","89.66%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5517",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030032","Health First Platinum HMO 80 5517","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030032-01","Health First Platinum HMO 80 5517","Standard Platinum On Exchange Plan","89.66%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5517",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070032","Florida Hospital Platinum HMO 80 5519","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070032-00","Florida Hospital Platinum HMO 80 5519","Standard Platinum Off Exchange Plan","89.66%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5519",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070032","Florida Hospital Platinum HMO 80 5519","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070032-01","Florida Hospital Platinum HMO 80 5519","Standard Platinum On Exchange Plan","89.66%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5519",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010032","Health First Platinum POS 80 5518","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.984",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010032-00","Health First Platinum POS 80 5518","Standard Platinum Off Exchange Plan","89.66%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5518",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010032","Health First Platinum POS 80 5518","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.984",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010032-01","Health First Platinum POS 80 5518","Standard Platinum On Exchange Plan","89.66%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5518",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050032","Florida Hospital Platinum POS 80 5520","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.984",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050032-00","Florida Hospital Platinum POS 80 5520","Standard Platinum Off Exchange Plan","89.66%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5520",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050032","Florida Hospital Platinum POS 80 5520","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.984",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050032-01","Florida Hospital Platinum POS 80 5520","Standard Platinum On Exchange Plan","89.66%","0","No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5520",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030016","Health First Gold HMO 80 5466","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9805",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030016-00","Health First Gold HMO 80 5466","Standard Gold Off Exchange Plan",,"0.799205899238586","No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5466",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0030016","Health First Gold HMO 80 5466","36194FL003",,"FLN003","FLS001","FLF012","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9805",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0030016-01","Health First Gold HMO 80 5466","Standard Gold On Exchange Plan",,"0.799205899238586","No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5466",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070016","Florida Hospital Gold HMO 80 5468","36194FL007",,"FLN004","FLS002","FLF024","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9805",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070016-00","Florida Hospital Gold HMO 80 5468","Standard Gold Off Exchange Plan",,"0.799205899238586","No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5468",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070001","Florida Hospital Bronze HMO 50 5411","36194FL007",,"FLN004","FLS002","FLF016","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9732",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070001-00","Florida Hospital Bronze HMO 50 5411","Standard Bronze Off Exchange Plan",,"0.619228422641754","Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2017_sbc_5411",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0070001","Florida Hospital Bronze HMO 50 5411","36194FL007",,"FLN004","FLS002","FLF016","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9732",,,"2017-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0070001-01","Florida Hospital Bronze HMO 50 5411","Standard Bronze On Exchange Plan",,"0.619228422641754","Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2017_sbc_5411",
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010002-06","Molina Marketplace Silver 100","94% AV Level Silver Plan",,"0.949759483337402","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010015","Health First Gold POS 70 5463","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9813",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010015-00","Health First Gold POS 70 5463","Standard Gold Off Exchange Plan","81.97%","0","No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5463",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010015","Health First Gold POS 70 5463","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9813",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010015-01","Health First Gold POS 70 5463","Standard Gold On Exchange Plan","81.97%","0","No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5463",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050015","Florida Hospital Gold POS 70 5465","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9813",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050015-00","Florida Hospital Gold POS 70 5465","Standard Gold Off Exchange Plan","81.97%","0","No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5465",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050015","Florida Hospital Gold POS 70 5465","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9813",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050015-01","Florida Hospital Gold POS 70 5465","Standard Gold On Exchange Plan","81.97%","0","No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5465",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010019","Health First Gold POS 80 5477","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9812",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010019-00","Health First Gold POS 80 5477","Standard Gold Off Exchange Plan","79.73%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5477",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0010019","Health First Gold POS 80 5477","36194FL001",,"FLN003","FLS001","FLF012","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9812",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","36194FL0010019-01","Health First Gold POS 80 5477","Standard Gold On Exchange Plan","79.73%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5477",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050019","Florida Hospital Gold POS 80 5479","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9812",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050019-00","Florida Hospital Gold POS 80 5479","Standard Gold Off Exchange Plan","79.73%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5479",
"2017","FL","36194","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","47-2894653","36194FL0050019","Florida Hospital Gold POS 80 5479","36194FL005",,"FLN004","FLS002","FLF024","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9812",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2017","36194FL0050019-01","Florida Hospital Gold POS 80 5479","Standard Gold On Exchange Plan","79.73%","0","No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2017_sbc_5479",
"2017","FL","38897","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","38897FL0010001","TruAssure Basic Adult or Child Dental Plan","38897FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL"
"2017","FL","38897","HIOS","2016-08-18 02:41:03","SHOP (Small Group)","Yes","36-3757528","38897FL0030001","TruAssure Dental Small Group Basic Plan","38897FL003",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL"
"2017","FL","38897","HIOS","2016-08-18 02:41:03","SHOP (Small Group)","Yes","36-3757528","38897FL0040001","TruAssure Dental Small Group Preferred Plan","38897FL004",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL"
"2017","FL","38897","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","38897FL0010001","TruAssure Basic Adult or Child Dental Plan","38897FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL"
"2017","FL","43274","HIOS","2016-08-24 02:30:21","Individual","Yes","14-1917982","43274FL0010001","EssentialSmile Ped 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010001-00","EssentialSmile Ped 221","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2017","FL","43274","HIOS","2016-08-24 02:30:21","Individual","Yes","14-1917982","43274FL0010001","EssentialSmile Ped 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010001-01","EssentialSmile Ped 221","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2017","FL","43274","HIOS","2016-08-24 02:30:21","Individual","Yes","14-1917982","43274FL0010002","EssentialSmile 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010002-00","EssentialSmile 221","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2017","FL","43274","HIOS","2016-08-24 02:30:21","Individual","Yes","14-1917982","43274FL0010002","EssentialSmile 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010002-01","EssentialSmile 221","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2017","FL","43274","HIOS","2016-08-24 02:30:21","Individual","Yes","14-1917982","43274FL0030002","EssentialSmile211","43274FL003",,"FLN002","FLS002",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Only for palliative care where a network provider is not available.","No","http://www.solsticecare.com/pay","","43274FL0030002-00","EssentialSmile211","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2017","FL","43274","HIOS","2016-08-24 02:30:21","Individual","Yes","14-1917982","43274FL0030002","EssentialSmile211","43274FL003",,"FLN002","FLS002",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Only for palliative care where a network provider is not available.","No","http://www.solsticecare.com/pay","","43274FL0030002-01","EssentialSmile211","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2017","FL","48121","HIOS","2016-07-01 08:12:23","Individual","Yes","59-1031071","48121FL0030001","Cigna Dental Pediatric","48121FL003","7730182962","FLN002","FLS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","48121FL0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","FL","48121","HIOS","2016-07-01 08:12:23","Individual","Yes","59-1031071","48121FL0030001","Cigna Dental Pediatric","48121FL003","7730182962","FLN002","FLS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","48121FL0030001-01","Cigna Dental Pediatric","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","FL","48121","HIOS","2016-07-01 08:12:23","Individual","Yes","59-1031071","48121FL0030002","Cigna Dental Family + Pediatric","48121FL003","7730182962","FLN002","FLS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","48121FL0030002-01","Cigna Dental Family + Pediatric","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-family-pediatric-fedvip"
"2017","FL","48129","HIOS","2016-07-19 02:54:01","Individual","Yes","47-0397286","48129FL0080001","Renaissance Individual Dental PPO, EHB Certified","48129FL008",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0080001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","48129","HIOS","2016-07-19 02:54:01","SHOP (Small Group)","Yes","47-0397286","48129FL0100001","Renaissance Group Dental PPO, EHB Certified","48129FL010",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0100001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","48129","HIOS","2016-07-19 02:54:01","SHOP (Small Group)","Yes","47-0397286","48129FL0100002","Renaissance Group Dental PPO, EHB Certified","48129FL010",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0100002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","48129","HIOS","2016-07-19 02:54:01","Individual","Yes","47-0397286","48129FL0080002","Renaissance Individual Dental PPO, EHB Certified","48129FL008",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0080002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","48129","HIOS","2016-07-19 02:54:01","Individual","Yes","47-0397286","48129FL0130001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","48129FL013",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0130001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_EHB_High_2017","http://www.renaissancedental.com/FL_EHB_High_2017"
"2017","FL","48129","HIOS","2016-07-19 02:54:01","Individual","Yes","47-0397286","48129FL0130002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","48129FL013",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0130002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_EHB_Low_2017","http://www.renaissancedental.com/FL_EHB_Low_2017"
"2017","FL","48129","HIOS","2016-07-19 02:54:01","Individual","Yes","47-0397286","48129FL0110001","Renaissance Individual Dental Pediatric-Only, EHB Certified","48129FL011",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0110001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","48129","HIOS","2016-07-19 02:54:01","Individual","Yes","47-0397286","48129FL0110002","Renaissance Individual Dental Pediatric-Only, EHB Certified","48129FL011",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0110002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","FL","48129","HIOS","2016-07-19 02:54:01","Individual","Yes","47-0397286","48129FL0150001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","48129FL015",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0150001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_Ped_High_2017","http://www.renaissancedental.com/FL_Ped_High_2017"
"2017","FL","48129","HIOS","2016-07-19 02:54:01","Individual","Yes","47-0397286","48129FL0150002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","48129FL015",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0150002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_Ped_Low_2017","http://www.renaissancedental.com/FL_Ped_Low_2017"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010001-00","Molina Marketplace Gold","Standard Gold Off Exchange Plan",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010001-01","Molina Marketplace Gold","Standard Gold On Exchange Plan",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010001-02","Molina Marketplace Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010001-03","Molina Marketplace Gold LCS","Limited Cost Sharing Plan Variation",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010002-00","Molina Marketplace Silver 250","Standard Silver Off Exchange Plan",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010002-01","Molina Marketplace Silver 250","Standard Silver On Exchange Plan",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010002-02","Molina Marketplace Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010002-03","Molina Marketplace Silver LCS","Limited Cost Sharing Plan Variation",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010002-04","Molina Marketplace Silver 200","73% AV Level Silver Plan",,"0.739942610263824","No","Yes","No","100%",,"$2,270","$290","$1,340","$150","$2,270","$400","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,275","$2275 per person","$4550 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,275","$2275 per person","$4550 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010002-05","Molina Marketplace Silver 150","87% AV Level Silver Plan",,"0.879904866218567","No","Yes","No","100%",,"$500","$180","$890","$150","$500","$320","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010003-00","Molina Marketplace Bronze","Standard Bronze Off Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010003-01","Molina Marketplace Bronze","Standard Bronze On Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010003-02","Molina Marketplace Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0010003-03","Molina Marketplace Bronze LCS","Limited Cost Sharing Plan Variation",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020001-00","Molina Marketplace Options Silver 250","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020001-01","Molina Marketplace Options Silver 250","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020001-02","Molina Marketplace Options Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020001-03","Molina Marketplace Options Silver LCS","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020001-04","Molina Marketplace Options Silver 200","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020001-05","Molina Marketplace Options Silver 150","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,010","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020001-06","Molina Marketplace Options Silver 100","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020002","Molina Marketplace Options Bronze","54172FL002",,"FLN001","FLS001","FLF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020002-00","Molina Marketplace Options Bronze","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020002","Molina Marketplace Options Bronze","54172FL002",,"FLN001","FLS001","FLF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020002-01","Molina Marketplace Options Bronze","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020002","Molina Marketplace Options Bronze","54172FL002",,"FLN001","FLS001","FLF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020002-02","Molina Marketplace Options Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","54172","HIOS","2016-11-17 02:20:17","Individual","No","26-0155137","54172FL0020002","Molina Marketplace Options Bronze","54172FL002",,"FLN001","FLS001","FLF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2017.pdf","54172FL0020002-03","Molina Marketplace Options Bronze LCS","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1300001","Gym Access IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1300001-00","Gym Access IND Essential Plus Catastrophic HMO 36","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1300001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1300001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1300001","Gym Access IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1300001-01","Gym Access IND Essential Plus Catastrophic HMO 36","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1300001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1300001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1320001","Gym Access IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF004","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1320001-00","Gym Access IND Essential Plus Catastrophic POS 37","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1320001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1320001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1320001","Gym Access IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF004","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1320001-01","Gym Access IND Essential Plus Catastrophic POS 37","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1320001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1320001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL1600001","Gym Access SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1600001-00","Gym Access SMAG Essential Plus Bronze HMO 41","Standard Bronze Off Exchange Plan",,"0.618169844150543","Yes","Yes","No","100%",,"$4,500","$20","$1,660","$150","$2,850","$0","$1,450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL1600001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1600001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL1600001","Gym Access SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1600001-01","Gym Access SMAG Essential Plus Bronze HMO 41","Standard Bronze On Exchange Plan",,"0.618169844150543","Yes","Yes","No","100%",,"$4,500","$20","$1,660","$150","$2,850","$0","$1,450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL1600001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1600001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL1680001","Gym Access SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1680001-00","Gym Access SMAG Essential Plus Bronze POS 42","Standard Bronze Off Exchange Plan",,"0.617856979370117","Yes","Yes","No","100%",,"$4,500","$20","$1,520","$150","$2,850","$0","$1,330","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL1680001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1680001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2190001","Gym Access SMAG Platinum POS 3000","56503FL219","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2190001-00","Gym Access SMAG Platinum POS 3000","Standard Platinum Off Exchange Plan","90.02%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20.00%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2190001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2190001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2560002-06","Gym Access IND Silver POS BC 0941 94%","94% AV Level Silver Plan","94.11%","0","No","Yes","No","100%",,"$0","$350","$0","$150","$0","$450","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2560002-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL2560002-06.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL1680001","Gym Access SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1680001-01","Gym Access SMAG Essential Plus Bronze POS 42","Standard Bronze On Exchange Plan",,"0.617856979370117","Yes","Yes","No","100%",,"$4,500","$20","$1,520","$150","$2,850","$0","$1,330","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL1680001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1680001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2120001","Gym Access SMAG Silver HMO HSA  2000/6450","56503FL212","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2120001-00","Gym Access SMAG Silver HMO HSA  2000/6450","Standard Silver Off Exchange Plan",,"0.717495739459991","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2120001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2120001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2120001","Gym Access SMAG Silver HMO HSA  2000/6450","56503FL212","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2120001-01","Gym Access SMAG Silver HMO HSA  2000/6450","Standard Silver On Exchange Plan",,"0.717495739459991","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2120001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2120001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2130001","Gym Access SMAG Silver POS HSA  2000/6450","56503FL213","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2130001-00","Gym Access SMAG Silver POS HSA  2000/6450","Standard Silver Off Exchange Plan",,"0.717495739459991","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2130001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2130001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2130001","Gym Access SMAG Silver POS HSA  2000/6450","56503FL213","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2130001-01","Gym Access SMAG Silver POS HSA  2000/6450","Standard Silver On Exchange Plan",,"0.717495739459991","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2130001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2130001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2140001","Gym Access SMAG Bronze HMO HSA 5500/6550","56503FL214","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2140001-00","Gym Access SMAG Bronze HMO HSA 5500/6550","Standard Bronze Off Exchange Plan",,"0.619447886943817","Yes","Yes","No","100%",,"$5,500","$10","$530","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2140001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2140001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2140001","Gym Access SMAG Bronze HMO HSA 5500/6550","56503FL214","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2140001-01","Gym Access SMAG Bronze HMO HSA 5500/6550","Standard Bronze On Exchange Plan",,"0.619447886943817","Yes","Yes","No","100%",,"$5,500","$10","$530","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2140001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2140001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2150001","Gym Access SMAG Bronze POS HSA 5500/6550","56503FL215","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2150001-00","Gym Access SMAG Bronze POS HSA 5500/6550","Standard Bronze Off Exchange Plan",,"0.619447886943817","Yes","Yes","No","100%",,"$5,500","$10","$530","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2150001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2150001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2150001","Gym Access SMAG Bronze POS HSA 5500/6550","56503FL215","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2150001-01","Gym Access SMAG Bronze POS HSA 5500/6550","Standard Bronze On Exchange Plan",,"0.619447886943817","Yes","Yes","No","100%",,"$5,500","$10","$530","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2150001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2150001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2160001","Gym Access SMAG Bronze HMO HSA 6000/6550","56503FL216","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2160001-00","Gym Access SMAG Bronze HMO HSA 6000/6550","Standard Bronze Off Exchange Plan",,"0.617185533046722","Yes","Yes","No","100%",,"$6,000","$20","$130","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2160001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2160001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2160001","Gym Access SMAG Bronze HMO HSA 6000/6550","56503FL216","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2160001-01","Gym Access SMAG Bronze HMO HSA 6000/6550","Standard Bronze On Exchange Plan",,"0.617185533046722","Yes","Yes","No","100%",,"$6,000","$20","$130","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2160001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2160001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2170001","Gym Access SMAG Bronze POS HSA 6000/6550","56503FL217","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2170001-00","Gym Access SMAG Bronze POS HSA 6000/6550","Standard Bronze Off Exchange Plan",,"0.617185533046722","Yes","Yes","No","100%",,"$6,000","$20","$130","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2170001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2170001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2170001","Gym Access SMAG Bronze POS HSA 6000/6550","56503FL217","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2170001-01","Gym Access SMAG Bronze POS HSA 6000/6550","Standard Bronze On Exchange Plan",,"0.617185533046722","Yes","Yes","No","100%",,"$6,000","$20","$130","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2017/56503FL2170001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2170001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1380002-00","IND Essential Plus Bronze HMO 41","Standard Bronze Off Exchange Plan",,"0.618169844150543","Yes","Yes","No","100%",,"$4,500","$20","$1,660","$150","$2,850","$0","$1,450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1380002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1380002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1380002-01","IND Essential Plus Bronze HMO 41","Standard Bronze On Exchange Plan",,"0.618169844150543","Yes","Yes","No","100%",,"$4,500","$20","$1,660","$150","$2,850","$0","$1,450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1380002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1380002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1380002-02","IND Essential Plus Bronze HMO 41 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1380002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL1380002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1380002-03","IND Essential Plus Bronze HMO 41 - Limited","Limited Cost Sharing Plan Variation",,"0.618169844150543","Yes","Yes","No","100%",,"$4,500","$20","$1,660","$150","$2,850","$0","$1,450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1380002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL1380002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1460001-00","Gym Access IND Essential Plus Bronze POS 42","Standard Bronze Off Exchange Plan",,"0.617856979370117","Yes","Yes","No","100%",,"$4,500","$20","$1,520","$150","$2,850","$0","$1,330","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1460001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1460001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2300001","Gym Access SMAG Silver HMO 6400","56503FL230","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2300001-00","Gym Access SMAG Silver HMO 6400","Standard Silver Off Exchange Plan",,"0.714932918548584","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2300001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2300001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2300001","Gym Access SMAG Silver HMO 6400","56503FL230","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2300001-01","Gym Access SMAG Silver HMO 6400","Standard Silver On Exchange Plan",,"0.714932918548584","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2300001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2300001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1460001-01","Gym Access IND Essential Plus Bronze POS 42","Standard Bronze On Exchange Plan",,"0.617856979370117","Yes","Yes","No","100%",,"$4,500","$20","$1,520","$150","$2,850","$0","$1,330","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1460001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1460001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1460001-02","Gym Access IND Essential Plus Bronze POS 42 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1460001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL1460001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2290001","Gym Access SMAG Silver HMO 6600","56503FL229","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2290001-00","Gym Access SMAG Silver HMO 6600","Standard Silver Off Exchange Plan",,"0.702070832252502","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2290001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2290001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2290001","Gym Access SMAG Silver HMO 6600","56503FL229","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2290001-01","Gym Access SMAG Silver HMO 6600","Standard Silver On Exchange Plan",,"0.702070832252502","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2290001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2290001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1460001-03","Gym Access IND Essential Plus Bronze POS 42 - Limited","Limited Cost Sharing Plan Variation",,"0.617856979370117","Yes","Yes","No","100%",,"$4,500","$20","$1,520","$150","$2,850","$0","$1,330","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1460001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL1460001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 5500/6550","56503FL224","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2240001-00","Gym Access IND Bronze HMO HSA 5500/6550","Standard Bronze Off Exchange Plan",,"0.619447886943817","Yes","Yes","No","100%",,"$5,500","$10","$530","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2017/56503FL2240001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2240001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 5500/6550","56503FL224","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2240001-01","Gym Access IND Bronze HMO HSA 5500/6550","Standard Bronze On Exchange Plan",,"0.619447886943817","Yes","Yes","No","100%",,"$5,500","$10","$530","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2017/56503FL2240001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2240001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 5500/6550","56503FL224","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2240001-02","Gym Access IND Bronze HMO 5500/6550 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2240001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2240001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 5500/6550","56503FL224","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2240001-03","Gym Access IND Bronze HMO HSA 5500/6550 - Limited","Limited Cost Sharing Plan Variation",,"0.619447886943817","Yes","Yes","No","100%",,"$5,500","$10","$530","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2017/56503FL2240001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2240001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6550","56503FL226","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2260001-00","Gym Access IND Bronze HMO HSA 6000/6550","Standard Bronze Off Exchange Plan",,"0.617185533046722","Yes","Yes","No","100%",,"$6,000","$20","$130","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2017/56503FL2260001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2260001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6550","56503FL226","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2260001-01","Gym Access IND Bronze HMO HSA 6000/6550","Standard Bronze On Exchange Plan",,"0.617185533046722","Yes","Yes","No","100%",,"$6,000","$20","$130","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2017/56503FL2260001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2260001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6550","56503FL226","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2260001-02","Gym Access IND Bronze HMO HSA 6000/6550 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2260001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2260001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6550","56503FL226","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2260001-03","Gym Access IND Bronze HMO HSA 6000/6550 - Limited","Limited Cost Sharing Plan Variation",,"0.617185533046722","Yes","Yes","No","100%",,"$6,000","$20","$130","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2017/56503FL2260001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2260001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2280001","Gym Access SMAG Gold HMO 4500","56503FL228","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2280001-00","Gym Access SMAG Gold HMO 4500","Standard Gold Off Exchange Plan",,"0.809237718582153","No","Yes","No","100%",,"$0","$600","$20","$150","$0","$600","$130","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2280001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2280001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1330001-00","Gym Access IND Essential Plus Silver HMO 53","Standard Silver Off Exchange Plan",,"0.704642355442047","Yes","Yes","No","100%",,"$2,500","$70","$800","$150","$1,270","$520","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1330001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1330001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1330001-01","Gym Access IND Essential Plus Silver HMO 53","Standard Silver On Exchange Plan",,"0.704642355442047","Yes","Yes","No","100%",,"$2,500","$70","$800","$150","$1,270","$520","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1330001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1330001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2280001","Gym Access SMAG Gold HMO 4500","56503FL228","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2280001-01","Gym Access SMAG Gold HMO 4500","Standard Gold On Exchange Plan",,"0.809237718582153","No","Yes","No","100%",,"$0","$600","$20","$150","$0","$600","$130","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2280001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2280001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1330001-02","Gym Access IND Essential Plus Silver HMO 53 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1330001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL1330001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1330001-03","Gym Access IND Essential Plus Silver HMO 53 - Limited","Limited Cost Sharing Plan Variation",,"0.704642355442047","Yes","Yes","No","100%",,"$2,500","$70","$800","$150","$1,270","$520","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1330001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL1330001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2330001","Gym Access SMAG Gold HMO 5500","56503FL233","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2330001-00","Gym Access SMAG Gold HMO 5500","Standard Gold Off Exchange Plan",,"0.792211771011353","Yes","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$620","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2330001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2330001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1330001-04","Gym Access IND Essential Plus Silver HMO 53 73%","73% AV Level Silver Plan",,"0.73940247297287","Yes","Yes","No","100%",,"$2,000","$80","$950","$150","$1,270","$800","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1330001-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL1330001-04.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1330001-05","Gym Access IND Essential Plus Silver HMO 53 87%","87% AV Level Silver Plan",,"0.878068387508392","Yes","Yes","No","100%",,"$400","$50","$1,150","$150","$400","$750","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1330001-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL1330001-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2330001","Gym Access SMAG Gold HMO 5500","56503FL233","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2330001-01","Gym Access SMAG Gold HMO 5500","Standard Gold On Exchange Plan",,"0.792211771011353","Yes","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2330001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2330001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2340001","Gym Access SMAG Gold POS 5500","56503FL234","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2340001-00","Gym Access SMAG Gold POS 5500","Standard Gold Off Exchange Plan",,"0.792211771011353","Yes","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2340001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2340001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1330001-06","Gym Access IND Essential Plus Silver HMO 53 94%","94% AV Level Silver Plan",,"0.936014235019684","Yes","Yes","No","100%",,"$100","$60","$590","$150","$0","$530","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1330001-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL1330001-06.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1410001-00","Gym Access IND Essential Plus Silver POS 54","Standard Silver Off Exchange Plan",,"0.704642355442047","Yes","Yes","No","100%",,"$2,500","$70","$800","$150","$1,270","$520","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1410001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1410001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2340001","Gym Access SMAG Gold POS 5500","56503FL234","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2340001-01","Gym Access SMAG Gold POS 5500","Standard Gold On Exchange Plan",,"0.792211771011353","Yes","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2340001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2340001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1410001-01","Gym Access IND Essential Plus Silver POS 54","Standard Silver On Exchange Plan",,"0.704642355442047","Yes","Yes","No","100%",,"$2,500","$70","$800","$150","$1,270","$520","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1410001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1410001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1410001-02","Gym Access IND Essential Plus Silver POS 54 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1410001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL1410001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1410001-03","Gym Access IND Essential Plus Silver POS 54 - Limited","Limited Cost Sharing Plan Variation",,"0.704642355442047","Yes","Yes","No","100%",,"$2,500","$70","$800","$150","$1,270","$520","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1410001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL1410001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1410001-04","Gym Access IND Essential Plus Silver POS 54 73%","73% AV Level Silver Plan",,"0.73940247297287","Yes","Yes","No","100%",,"$2,000","$80","$950","$150","$1,270","$800","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1410001-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL1410001-04.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1410001-05","Gym Access IND Essential Plus Silver POS 54 87%","87% AV Level Silver Plan",,"0.878068387508392","Yes","Yes","No","100%",,"$400","$50","$1,150","$150","$400","$750","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1410001-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL1410001-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1410001-06","Gym Access IND Essential Plus Silver POS 54 94%","94% AV Level Silver Plan",,"0.936014235019684","Yes","Yes","No","100%",,"$100","$60","$590","$150","$0","$530","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1410001-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL1410001-06.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2040001-00","Gym Access IND Silver HMO 6400","Standard Silver Off Exchange Plan",,"0.714932918548584","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2040001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2040001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2040001-01","Gym Access IND Silver HMO 6400","Standard Silver On Exchange Plan",,"0.714932918548584","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2040001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2040001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2040001-02","Gym Access IND Silver HMO 6400 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2040001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2040001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2040001-03","Gym Access IND Silver HMO 6400 - Limited","Limited Cost Sharing Plan Variation",,"0.714932918548584","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2040001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2040001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2040001-04","Gym Access IND Silver HMO 6400 73%","73% AV Level Silver Plan",,"0.738810896873474","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,200","per person not applicable","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2040001-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL2040001-04.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2040001-05","Gym Access IND Silver HMO 6400 87%","87% AV Level Silver Plan",,"0.877222061157227","No","Yes","No","100%",,"$0","$600","$0","$150","$750","$600","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","per person not applicable","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2040001-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL2040001-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2040001-06","Gym Access IND Silver HMO 6400 94%","94% AV Level Silver Plan",,"0.940260589122772","No","Yes","No","100%",,"$0","$500","$0","$150","$150","$270","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2040001-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL2040001-06.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2060001-00","Gym Access IND Silver HMO 6600","Standard Silver Off Exchange Plan",,"0.702070832252502","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2060001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2060001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2060001-01","Gym Access IND Silver HMO 6600","Standard Silver On Exchange Plan",,"0.702070832252502","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2060001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2060001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2060001-02","Gym Access IND Silver HMO 6600 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2060001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2060001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2060001-03","Gym Access IND Silver HMO 6600 - Limited","Limited Cost Sharing Plan Variation",,"0.702070832252502","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2060001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2060001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2060001-04","Gym Access IND Silver HMO 6600 73%","73% AV Level Silver Plan",,"0.737762868404388","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","per person not applicable","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2060001-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL2060001-04.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2060001-05","Gym Access IND Silver HMO 6600 87%","87% AV Level Silver Plan",,"0.871822595596313","No","Yes","No","100%",,"$820","$40","$770","$150","$1,000","$590","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","per person not applicable","$1300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","per person not applicable","$400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2060001-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL2060001-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2060001-06","Gym Access IND Silver HMO 6600 94%","94% AV Level Silver Plan",,"0.943153858184814","No","Yes","No","100%",,"$150","$40","$340","$150","$200","$250","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2060001-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL2060001-06.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF011","Existing","HMO","Gold","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1390001-00","Gym Access IND Essential Plus Gold HMO 63","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$4,470","$70","$140","$150","$0","$600","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1390001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1390001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF011","Existing","HMO","Gold","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1390001-01","Gym Access IND Essential Plus Gold HMO 63","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$4,470","$70","$140","$150","$0","$600","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1390001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1390001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF011","Existing","HMO","Gold","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1390001-02","Gym Access IND Essential Plus Gold HMO 63 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1390001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL1390001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF011","Existing","HMO","Gold","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1390001-03","Gym Access IND Essential Plus Gold HMO 63 - Limited","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$4,470","$70","$140","$150","$0","$600","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1390001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL1390001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL1620001","Gym Access SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1620001-00","Gym Access SMAG Essential Plus Platinum HMO 65","Standard Platinum Off Exchange Plan","91.47%","0","No","No","No","100%",,"$0","$560","$0","$150","$0","$600","$190","$80","$0","$0","$0","$0",,"5","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2017/56503FL1620001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1620001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1400001-00","Gym Access IND Essential Plus Platinum HMO 65","Standard Platinum Off Exchange Plan","91.47%","0","No","No","No","100%",,"$0","$560","$0","$150","$0","$600","$190","$80","$0","$0","$0","$0",,"5","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL1400001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1400001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1400001-01","Gym Access IND Essential Plus Platinum HMO 65","Standard Platinum On Exchange Plan","91.47%","0","No","No","No","100%",,"$0","$560","$0","$150","$0","$600","$190","$80","$0","$0","$0","$0",,"5","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL1400001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1400001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1990001","Gym Access Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1990001-00","Gym Access Platinum POS 4000","Standard Platinum Off Exchange Plan","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1990001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1990001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1990001","Gym Access Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1990001-01","Gym Access Platinum POS 4000","Standard Platinum On Exchange Plan","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1990001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1990001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2180001","Gym Access SMAG Platinum HMO 3000","56503FL218","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2180001-01","Gym Access SMAG Platinum HMO 3000","Standard Platinum On Exchange Plan","90.02%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2180001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2180001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL1620001","Gym Access SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1620001-01","Gym Access SMAG Essential Plus Platinum HMO 65","Standard Platinum On Exchange Plan","91.47%","0","No","No","No","100%",,"$0","$560","$0","$150","$0","$600","$190","$80","$0","$0","$0","$0",,"5","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2017/56503FL1620001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1620001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2200001","Gym Access SMAG Platinum HMO 4000","56503FL220","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2200001-00","Gym Access SMAG Platinum HMO 4000","Standard Platinum Off Exchange Plan","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2200001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2200001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1400001-02","Gym Access IND Essential Plus Platinum HMO 65 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL1400001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL1400001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1400001-03","Gym Access IND Essential Plus Platinum HMO 65 - Limited","Limited Cost Sharing Plan Variation","91.47%","0","No","No","No","100%",,"$0","$560","$0","$150","$0","$600","$190","$80","$0","$0","$0","$0",,"5","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL1400001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL1400001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2200001","Gym Access SMAG Platinum HMO 4000","56503FL220","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2200001-01","Gym Access SMAG Platinum HMO 4000","Standard Platinum On Exchange Plan","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2200001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2200001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2210001","Gym Access SMAG Platinum POS 4000","56503FL221","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2210001-00","Gym Access SMAG Platinum POS 4000","Standard Platinum Off Exchange Plan","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2210001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2210001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1980001-00","Gym Access IND Platinum HMO 4000","Standard Platinum Off Exchange Plan","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1980001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL1980001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1980001-01","Gym Access IND Platinum HMO 4000","Standard Platinum On Exchange Plan","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1980001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL1980001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2210001","Gym Access SMAG Platinum POS 4000","56503FL221","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2210001-01","Gym Access SMAG Platinum POS 4000","Standard Platinum On Exchange Plan","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2210001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2210001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1980001-02","Gym Access IND Platinum HMO 4000 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1980001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL1980001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1980001-03","Gym Access IND Platinum HMO 4000 - Limited","Limited Cost Sharing Plan Variation","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1980001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL1980001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2180001","Gym Access SMAG Platinum HMO 3000","56503FL218","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2180001-00","Gym Access SMAG Platinum HMO 3000","Standard Platinum Off Exchange Plan","90.02%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2180001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2180001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1990001","Gym Access Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1990001-02","Gym Access Platinum POS 4000 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1990001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL1990001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL1990001","Gym Access Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL1990001-03","Gym Access Platinum POS 4000 - Limited","Limited Cost Sharing Plan Variation","88.79%","0","Yes","Yes","No","100%",,"$0","$560","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL1990001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL1990001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","SHOP (Small Group)","No","26-3238817","56503FL2190001","Gym Access SMAG Platinum POS 3000","56503FL219","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2190001-01","Gym Access SMAG Platinum POS 3000","Standard Platinum On Exchange Plan","90.02%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20.00%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2017/56503FL2190001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2190001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2630002-00","Gym Access IND Platinum HMO BC 1941","Standard Platinum Off Exchange Plan","90.49%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2630002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2630002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2630002-01","Gym Access IND Platinum HMO BC 1941","Standard Platinum On Exchange Plan","90.49%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2630002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2630002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2630002-02","Gym Access IND Platinum HMO BC 1941 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2630002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2630002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2630002-03","Gym Access IND Platinum HMO BC 1941 - Limited","Limited Cost Sharing Plan Variation","90.49%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2630002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2630002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2640002-00","Gym Access IND Platinum POS BC 1941","Standard Platinum Off Exchange Plan","90.49%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2640002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2640002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2640002-01","Gym Access IND Platinum POS BC 1941","Standard Platinum On Exchange Plan","90.49%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2640002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2640002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2640002-02","Gym Access IND Platinum POS BC 1941 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2640002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2640002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2640002-03","Gym Access IND Platinum POS BC 1941 - Limited","Limited Cost Sharing Plan Variation","90.49%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2640002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2640002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2650002-00","Gym Access IND Platinum HMO 91","Standard Platinum Off Exchange Plan","88.99%","0","Yes","Yes","No","100%",,"$0","$580","$0","$150","$250","$550","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2650002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2650002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2650002-01","Gym Access IND Platinum HMO 91","Standard Platinum On Exchange Plan","88.99%","0","Yes","Yes","No","100%",,"$0","$580","$0","$150","$250","$550","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2650002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2650002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2650002-02","Gym Access IND Platinum HMO 91 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2650002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2650002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2650002-03","Gym Access IND Platinum HMO 91 - Limited","Limited Cost Sharing Plan Variation","88.99%","0","Yes","Yes","No","100%",,"$0","$580","$0","$150","$250","$550","$100","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2650002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2650002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2660002-00","Gym Acccess IND Platinum HMO 92","Standard Platinum Off Exchange Plan","88.65%","0","Yes","Yes","No","100%",,"$0","$680","$0","$150","$500","$550","$80","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2660002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2660002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2660002-01","Gym Acccess IND Platinum HMO 92","Standard Platinum On Exchange Plan","88.65%","0","Yes","Yes","No","100%",,"$0","$680","$0","$150","$500","$550","$80","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2660002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2660002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2660002-02","Gym Acccess IND Platinum HMO 92 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2660002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2660002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2660002-03","Gym Acccess IND Platinum HMO 92 - Limited","Limited Cost Sharing Plan Variation","88.65%","0","Yes","Yes","No","100%",,"$0","$680","$0","$150","$500","$550","$80","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2660002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2660002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2090002","IND Gold HMO 4500","56503FL209","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2090002-00","IND Gold HMO 4500","Standard Gold Off Exchange Plan",,"0.809237778186798","No","Yes","No","100%",,"$200","$550","$0","$150","$0","$650","$130","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2090002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2090002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2090002","IND Gold HMO 4500","56503FL209","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2090002-01","IND Gold HMO 4500","Standard Gold On Exchange Plan",,"0.809237778186798","No","Yes","No","100%",,"$200","$550","$0","$150","$0","$650","$130","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2090002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2090002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2090002","IND Gold HMO 4500","56503FL209","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2090002-02","IND Gold HMO 4500 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2090002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2090002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2090002","IND Gold HMO 4500","56503FL209","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2090002-03","IND Gold HMO 4500 - Limited","Limited Cost Sharing Plan Variation",,"0.809237778186798","No","Yes","No","100%",,"$200","$550","$0","$150","$0","$650","$130","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2090002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2090002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2000001-00","Gym Access IND Gold HMO 5500","Standard Gold Off Exchange Plan",,"0.802612125873566","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2000001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2000001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2000001-01","Gym Access IND Gold HMO 5500","Standard Gold On Exchange Plan",,"0.802612125873566","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2000001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2000001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2000001-02","Gym Access IND Gold HMO 5500 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2000001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2000001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2000001-03","Gym Access IND Gold HMO 5500 - Limited","Limited Cost Sharing Plan Variation",,"0.802612125873566","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2000001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2000001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2010001-00","Gym Access IND Gold POS 5500","Standard Gold Off Exchange Plan",,"0.802612125873566","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2010001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2010001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2010001-01","Gym Access IND Gold POS 5500","Standard Gold On Exchange Plan",,"0.802612125873566","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2010001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2010001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2010001-02","Gym Access IND Gold POS 5500 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2010001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2010001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2010001-03","Gym Access IND Gold POS 5500 - Limited","Limited Cost Sharing Plan Variation",,"0.802612125873566","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2010001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2010001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2590002-00","Gym Access IND Gold HMO BC 5651","Standard Gold Off Exchange Plan","81.96%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2590002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2590002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2620002-00","Gym Access IND Platinum POS BC 5841","Standard Platinum Off Exchange Plan",,"0.887459456920624","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2620002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2620002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2620002-01","Gym Access IND Platinum POS BC 5841","Standard Platinum On Exchange Plan",,"0.887459456920624","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2620002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2620002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2620002-02","Gym Access IND Platinum POS BC 5841 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2620002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2620002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2620002-03","Gym Access IND Platinum POS BC 5841 - Limited","Limited Cost Sharing Plan Variation",,"0.887459456920624","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2620002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2620002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2550002-00","Gym Access IND Silver HMO BC 0941","Standard Silver Off Exchange Plan","68.26%","0","No","Yes","No","100%",,"$4,470","$510","$0","$150","$0","$1,040","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2550002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2550002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2590002-01","Gym Access IND Gold HMO BC 5651","Standard Gold On Exchange Plan","81.96%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2590002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2590002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2590002-02","Gym Access IND Gold HMO BC 5651 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2590002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2590002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2590002-03","Gym Access IND Gold HMO BC 5651 - Limited","Limited Cost Sharing Plan Variation","81.96%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2590002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2590002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2600002-00","Gym Access IND Gold POS BC 5651","Standard Gold Off Exchange Plan","81.96%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2600002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2600002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2600002-01","Gym Access IND Gold POS BC 5651","Standard Gold On Exchange Plan","81.96%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2600002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2600002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2600002-02","Gym Access IND Gold POS BC 5651 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2600002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2600002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2600002-03","Gym Access IND Gold POS BC 5651 - Limited","Limited Cost Sharing Plan Variation","81.96%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2600002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2600002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2610001-00","IND Platinum HMO BC 5841","Standard Platinum Off Exchange Plan",,"0.887459456920624","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2610001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2610001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2610001-01","IND Platinum HMO BC 5841","Standard Platinum On Exchange Plan",,"0.887459456920624","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2610001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2610001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2610001-02","IND Platinum HMO BC 5841 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2610001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2610001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2610001-03","IND Platinum HMO BC 5841 - Limited","Limited Cost Sharing Plan Variation",,"0.887459456920624","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2610001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2610001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2550002-01","Gym Access IND Silver HMO BC 0941","Standard Silver On Exchange Plan","68.26%","0","No","Yes","No","100%",,"$4,470","$510","$0","$150","$0","$1,040","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2550002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2550002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2550002-02","Gym Access IND Silver HMO BC 0941 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2550002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2550002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2550002-03","Gym Access IND Silver HMO BC 0941 - Limited","Limited Cost Sharing Plan Variation","68.26%","0","No","Yes","No","100%",,"$4,470","$510","$0","$150","$0","$1,040","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2550002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2550002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2550002-04","Gym Access IND Silver HMO BC 0941 73%","73% AV Level Silver Plan","73.92%","0","No","Yes","No","100%",,"$2,900","$1,040","$0","$150","$0","$690","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2550002-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL2550002-04.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2550002-05","Gym Access IND Silver HMO BC 0941 87%","87% AV Level Silver Plan","87.65%","0","No","Yes","No","100%",,"$0","$470","$0","$150","$0","$500","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2550002-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL2550002-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2550002-06","Gym Access IND Silver HMO BC 0941 94%","94% AV Level Silver Plan","94.11%","0","No","Yes","No","100%",,"$0","$350","$0","$150","$0","$450","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2550002-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL2550002-06.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2560002-00","Gym Access IND Silver POS BC 0941","Standard Silver Off Exchange Plan","68.26%","0","No","Yes","No","100%",,"$4,470","$510","$0","$150","$0","$1,040","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2560002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2560002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2560002-01","Gym Access IND Silver POS BC 0941","Standard Silver On Exchange Plan","68.26%","0","No","Yes","No","100%",,"$4,470","$510","$0","$150","$0","$1,040","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2560002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2560002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2560002-02","Gym Access IND Silver POS BC 0941 - Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2560002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2560002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2560002-03","Gym Access IND Silver POS BC 0941 - Limited","Limited Cost Sharing Plan Variation","68.26%","0","No","Yes","No","100%",,"$4,470","$510","$0","$150","$0","$1,040","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2560002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2560002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2560002-04","Gym Access IND Silver POS BC 0941 73%","73% AV Level Silver Plan","73.92%","0","No","Yes","No","100%",,"$2,900","$1,040","$0","$150","$0","$690","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2560002-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL2560002-04.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2560002-05","Gym Access IND Silver POS BC 0941 87%","87% AV Level Silver Plan","87.65%","0","No","Yes","No","100%",,"$0","$470","$0","$150","$0","$500","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2017/56503FL2560002-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL2560002-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2570001-00","IND Silver HMO BC 7741","Standard Silver Off Exchange Plan",,"0.680048048496246","Yes","Yes","No","100%",,"$4,470","$100","$0","$150","$0","$710","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2570001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2570001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2570001-01","IND Silver HMO BC 7741","Standard Silver On Exchange Plan",,"0.680048048496246","Yes","Yes","No","100%",,"$4,470","$100","$0","$150","$0","$710","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2570001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2570001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2570001-02","IND Silver HMO BC 7741 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2570001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2570001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2570001-03","IND Silver HMO BC 7741 - Limited","Limited Cost Sharing Plan Variation",,"0.680048048496246","Yes","Yes","No","100%",,"$4,470","$100","$0","$150","$0","$710","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2570001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2570001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2570001-04","IND Silver HMO BC 7741 73%","73% AV Level Silver Plan",,"0.724603712558746","Yes","Yes","No","100%",,"$4,470","$100","$0","$150","$0","$620","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2570001-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL2570001-04.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2570001-05","IND Silver HMO BC 7741 87%","87% AV Level Silver Plan",,"0.873428225517273","Yes","Yes","No","100%",,"$0","$30","$1,790","$150","$0","$220","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2570001-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL2570001-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2570001-06","IND Silver HMO BC 7741 94%","94% AV Level Silver Plan",,"0.940895855426788","Yes","Yes","No","100%",,"$0","$10","$940","$150","$0","$170","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2570001-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL2570001-06.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2580002-00","Gym Access IND Silver POS BC 7741","Standard Silver Off Exchange Plan",,"0.680048048496246","Yes","Yes","No","100%",,"$4,470","$100","$0","$150","$0","$710","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2580002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2580002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2580002-01","Gym Access IND Silver POS BC 7741","Standard Silver On Exchange Plan",,"0.680048048496246","Yes","Yes","No","100%",,"$4,470","$100","$0","$150","$0","$710","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2580002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2580002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2580002-02","Gym Access IND Silver POS BC 7741 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2580002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2580002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2580002-03","Gym Access IND Silver POS BC 7741 - Limited","Limited Cost Sharing Plan Variation",,"0.680048048496246","Yes","Yes","No","100%",,"$4,470","$100","$0","$150","$0","$710","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2580002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2580002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2580002-04","Gym Access IND Silver POS BC 7741 73%","73% AV Level Silver Plan",,"0.724603712558746","Yes","Yes","No","100%",,"$4,470","$100","$0","$150","$0","$620","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2580002-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL2580002-04.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2580002-05","Gym Access IND Silver POS BC 7741 87%","87% AV Level Silver Plan",,"0.873428225517273","Yes","Yes","No","100%",,"$0","$30","$1,790","$150","$0","$220","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2580002-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL2580002-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2580002-06","Gym Access IND Silver POS BC 7741 94%","94% AV Level Silver Plan",,"0.940895855426788","Yes","Yes","No","100%",,"$0","$10","$940","$150","$0","$170","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2580002-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL2580002-06.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2530002-00","Gym Access IND Bronze HMO BC 3841","Standard Bronze Off Exchange Plan",,"0.619840621948242","Yes","Yes","No","100%",,"$5,200","$110","$0","$150","$0","$1,220","$70","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2530002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2530002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2530002-01","Gym Access IND Bronze HMO BC 3841","Standard Bronze On Exchange Plan",,"0.619840621948242","Yes","Yes","No","100%",,"$5,200","$110","$0","$150","$0","$1,220","$70","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2530002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2530002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2530002-02","Gym Access IND Bronze HMO BC 3841 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2530002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2530002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2530002-03","Gym Access IND Bronze HMO BC 3841 - Limited","Limited Cost Sharing Plan Variation",,"0.619840621948242","Yes","Yes","No","100%",,"$5,200","$110","$0","$150","$0","$1,220","$70","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2530002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2530002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2540002-00","Gym Access IND Bronze POS BC 3841","Standard Bronze Off Exchange Plan",,"0.619840621948242","Yes","Yes","No","100%",,"$5,200","$110","$0","$150","$0","$1,220","$70","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50.00%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2540002-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2540002-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2540002-01","Gym Access IND Bronze POS BC 3841","Standard Bronze On Exchange Plan",,"0.619840621948242","Yes","Yes","No","100%",,"$5,200","$110","$0","$150","$0","$1,220","$70","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50.00%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2540002-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2540002-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2540002-02","Gym Access IND Bronze POS BC 3841 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2540002-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2540002-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2540002-03","Gym Access IND Bronze POS BC 3841 - Limited","Limited Cost Sharing Plan Variation",,"0.619840621948242","Yes","Yes","No","100%",,"$5,200","$110","$0","$150","$0","$1,220","$70","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50.00%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2540002-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2540002-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2670001","IND Bronze Standardized HMO","56503FL267","7265435496","FLN001","FLS001","FLF006","New","HMO","Bronze","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2670001-00","IND Bronze Standardized HMO","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$4,470","$20","$1,390","$150","$1,270","$1,390","$570","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2670001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2670001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2670001","IND Bronze Standardized HMO","56503FL267","7265435496","FLN001","FLS001","FLF006","New","HMO","Bronze","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2670001-01","IND Bronze Standardized HMO","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$4,470","$20","$1,390","$150","$1,270","$1,390","$570","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2670001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2670001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2670001","IND Bronze Standardized HMO","56503FL267","7265435496","FLN001","FLS001","FLF006","New","HMO","Bronze","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2670001-02","IND Bronze Standardized HMO - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2670001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2670001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2670001","IND Bronze Standardized HMO","56503FL267","7265435496","FLN001","FLS001","FLF006","New","HMO","Bronze","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2670001-03","IND Bronze Standardized HMO - Limited","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$4,470","$20","$1,390","$150","$1,270","$1,390","$570","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2670001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2670001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF010","New","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2680001-00","IND Silver Standardized HMO 1","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$330","$150","$0","$900","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2680001-00.pdf","http://www.fhcp.com/ISOB/2017/56503FL2680001-00.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF010","New","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2680001-01","IND Silver Standardized HMO 1","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$330","$150","$0","$900","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2680001-01.pdf","http://www.fhcp.com/ISOB/2017/56503FL2680001-01.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF010","New","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2680001-02","IND Silver Standardized HMO 1 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2680001-02.pdf","http://www.fhcp.com/ISOB/2017/56503FL2680001-02.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF010","New","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2680001-03","IND Silver Standardized HMO 1 - Limited","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$330","$150","$0","$900","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2680001-03.pdf","http://www.fhcp.com/ISOB/2017/56503FL2680001-03.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF010","New","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2680001-04","IND Silver Standardized HMO 1 73%","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$430","$150","$0","$700","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2680001-04.pdf","http://www.fhcp.com/ISOB/2017/56503FL2680001-04.pdf"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","97725FL0030004","DeltaCare USA Preferred Plan for Families","97725FL003",,"FLN002","FLS002",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0030004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030004-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","97725FL0030001","DeltaCare USA Pediatric Basic Plan","97725FL003",,"FLN002","FLS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0030001-00","DeltaCare USA Pediatric Basic Plan","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030001-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","97725FL0040001","DeltaCare USA Pediatric Basic Plan for Small Businesses","97725FL004",,"FLN002","FLS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0040001-00","DeltaCare USA Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040001-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","97725FL0040002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","97725FL004",,"FLN002","FLS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0040002-00","DeltaCare USA Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040002-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","97725FL0030002","DeltaCare USA Pediatric Preferred Plan","97725FL003",,"FLN002","FLS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0030002-00","DeltaCare USA Pediatric Preferred Plan","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030002-17"
"2017","FL","98534","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","98534FL0240001","Family Basic Dental Plan (Low)","98534FL024",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.91","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0240001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034"
"2017","FL","98534","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","98534FL0240001","Family Basic Dental Plan (Low)","98534FL024",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.91","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0240001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034"
"2017","FL","98534","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","98534FL0250001","Family Enhanced Dental Plan (High)","98534FL025",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0250001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49071"
"2017","FL","98534","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","98534FL0250001","Family Enhanced Dental Plan (High)","98534FL025",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0250001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49071"
"2017","FL","99787","HIOS","2016-08-20 07:40:33","Individual","Yes","75-1233841","99787FL0010001","Dentegra Dental PPO Pediatric Basic Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010001-17"
"2017","FL","99787","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","Yes","75-1233841","99787FL0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","99787FL002",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0020001-17"
"2017","FL","99787","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","Yes","75-1233841","99787FL0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","99787FL002",,"FLN001","FLS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0020008-17"
"2017","FL","99787","HIOS","2016-08-20 07:40:33","Individual","Yes","75-1233841","99787FL0010008","Dentegra Dental PPO Family Preferred Plan","99787FL001",,"FLN001","FLS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010008-17"
"2017","FL","99787","HIOS","2016-08-20 07:40:33","Individual","Yes","75-1233841","99787FL0010007","Dentegra Dental PPO Family Basic Plan","99787FL001",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010007-17"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF010","New","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2680001-05","IND Silver Standardized HMO 1 87%","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$40","$890","$150","$0","$300","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2680001-05.pdf","http://www.fhcp.com/ISOB/2017/56503FL2680001-05.pdf"
"2017","FL","56503","HIOS","2016-09-14 22:21:51","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF010","New","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2017QHPFormularyI_8861_Full_2431.pdf","56503FL2680001-06","IND Silver Standardized HMO 1 94%","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$250","$150","$0","$170","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2017/56503FL2680001-06.pdf","http://www.fhcp.com/ISOB/2017/56503FL2680001-06.pdf"
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110002","Health First Gold PPO 80 5118","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9906",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110002-01","Health First Gold PPO 80 5118","Standard Gold On Exchange Plan",,"0.793184161186218","No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5118",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110013","Health First Silver PPO 50 5318","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9893",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110013-00","Health First Silver PPO 50 5318","Standard Silver Off Exchange Plan","71.25%","0.721085369586945","No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5318",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110013","Health First Silver PPO 50 5318","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9893",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110013-01","Health First Silver PPO 50 5318","Standard Silver On Exchange Plan","71.25%","0.721085369586945","No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5318",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110011","Health First Silver PPO 50 5300","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9892",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110011-00","Health First Silver PPO 50 5300","Standard Silver Off Exchange Plan","71.95%","0.727540373802185","No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5300",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110011","Health First Silver PPO 50 5300","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9892",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110011-01","Health First Silver PPO 50 5300","Standard Silver On Exchange Plan","71.95%","0.727540373802185","No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5300",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110012","Health First Silver PPO 90 HSA 5309","77150FL111",,"FLN001","FLS001","FLF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9894",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110012-00","Health First Silver PPO 90 HSA 5309","Standard Silver Off Exchange Plan",,"0.719767451286316","Yes","Yes","No","100%",,"$2,600","$0","$780","$150","$2,600","$0","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"$5,200","per person not applicable","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5309",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110012","Health First Silver PPO 90 HSA 5309","77150FL111",,"FLN001","FLS001","FLF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9894",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110012-01","Health First Silver PPO 90 HSA 5309","Standard Silver On Exchange Plan",,"0.719767451286316","Yes","Yes","No","100%",,"$2,600","$0","$780","$150","$2,600","$0","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"$5,200","per person not applicable","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2017_sbc_5309",
"2017","FL","59667","HIOS","2016-06-29 04:36:58","Individual","Yes","65-0743731","59667FL0010001","DentaQuest EPO Pediatric High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010001-00","DentaQuest EPO Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","65-0743731","59667FL0020003","DentaQuest EPO Family High","59667FL002","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0020003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","65-0743731","59667FL0020003","DentaQuest EPO Family High","59667FL002","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0020003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","Individual","Yes","65-0743731","59667FL0010001","DentaQuest EPO Pediatric High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010001-01","DentaQuest EPO Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","65-0743731","59667FL0020004","DentaQuest EPO Family Low","59667FL002","7891798028","FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0020004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","65-0743731","59667FL0020004","DentaQuest EPO Family Low","59667FL002","7891798028","FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0020004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","Individual","Yes","65-0743731","59667FL0010003","DentaQuest EPO Family High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","Individual","Yes","65-0743731","59667FL0010003","DentaQuest EPO Family High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","Individual","Yes","65-0743731","59667FL0010004","DentaQuest EPO Family Low","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","59667","HIOS","2016-06-29 04:36:58","Individual","Yes","65-0743731","59667FL0010004","DentaQuest EPO Family Low","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2017","FL","75395","HIOS","2017-03-25 15:17:19","Individual","Yes","20-5898265","75395FL0020001","Kids Choice SADP","75395FL002","7811991943","FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"0.85","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No",,"No","https://argusdental.com/kidschoice/","","75395FL0020001-01","Kids Choice SADP","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://argusdental.com/Kids-Choice-SADP-detail/","https://argusdental.com/Kids-Choice-SADP-detail/"
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110004","Health First Gold PPO 50 5146","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110004-00","Health First Gold PPO 50 5146","Standard Gold Off Exchange Plan","81.13%","0","No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5146",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110004","Health First Gold PPO 50 5146","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110004-01","Health First Gold PPO 50 5146","Standard Gold On Exchange Plan","81.13%","0","No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5146",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110005","Health First Gold PPO 50 5162","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110005-00","Health First Gold PPO 50 5162","Standard Gold Off Exchange Plan","81.96%","0","No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5162",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110005","Health First Gold PPO 50 5162","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110005-01","Health First Gold PPO 50 5162","Standard Gold On Exchange Plan","81.96%","0","No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5162",
"2017","FL","77150","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","45-3131932","77150FL1110002","Health First Gold PPO 80 5118","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9906",,,"2017-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2017","77150FL1110002-00","Health First Gold PPO 80 5118","Standard Gold Off Exchange Plan",,"0.793184161186218","No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2017_sbc_5118",
"2017","FL","85019","HIOS","2016-06-28 02:39:00","Individual","Yes","27-0963551","85019FL0020001","LIBERTY FL Family Value","85019FL002",,"FLN001","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.libertydentalplan.com/ExchangePayment","","85019FL0020001-00","LIBERTY FL Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2017-LDP-FL-IND-Exchange.pdf","https://www.libertydentalplan.com/Resources/Documents/2017-LDP-FL-IND-Exchange.pdf"
"2017","FL","85019","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","27-0963551","85019FL0010001","LIBERTY Dental Plan FL Pediatric Low with Adult Option","85019FL001",,"FLN001","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","85019FL0010001-00","LIBERTY Dental Plan FL Pediatric Low with Adult Option","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2017-LDP-FL-SHOP-Exchange.pdf","https://www.libertydentalplan.com/Resources/Documents/2017-LDP-FL-SHOP-Exchange.pdf"
"2017","FL","85019","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","27-0963551","85019FL0010001","LIBERTY Dental Plan FL Pediatric Low with Adult Option","85019FL001",,"FLN001","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","85019FL0010001-01","LIBERTY Dental Plan FL Pediatric Low with Adult Option","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2017-LDP-FL-SHOP-Exchange.pdf","https://www.libertydentalplan.com/Resources/Documents/2017-LDP-FL-SHOP-Exchange.pdf"
"2017","FL","85019","HIOS","2016-06-28 02:39:00","Individual","Yes","27-0963551","85019FL0020001","LIBERTY FL Family Value","85019FL002",,"FLN001","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.libertydentalplan.com/ExchangePayment","","85019FL0020001-01","LIBERTY FL Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2017-LDP-FL-IND-Exchange.pdf","https://www.libertydentalplan.com/Resources/Documents/2017-LDP-FL-IND-Exchange.pdf"
"2017","FL","93299","HIOS","2016-08-23 02:28:31","Individual","Yes","45-2548158","93299FL0010001","FL Young Smiles","93299FL001",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0010001-00","FL Young Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE"
"2017","FL","93299","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","45-2548158","93299FL0020001","FL Affordable Smiles","93299FL002",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","93299FL0020001-01","FL Affordable Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BROCHURE"
"2017","FL","93299","HIOS","2016-08-23 02:28:31","Individual","Yes","45-2548158","93299FL0010001","FL Young Smiles","93299FL001",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0010001-01","FL Young Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE"
"2017","FL","93299","HIOS","2016-08-23 02:28:31","Individual","Yes","45-2548158","93299FL0010002","FL Family Smiles","93299FL001",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0010002-00","FL Family Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE"
"2017","FL","93299","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","45-2548158","93299FL0020002","FL Affordable Smiles","93299FL002",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","93299FL0020002-00","FL Affordable Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BROCHURE"
"2017","FL","93299","HIOS","2016-08-23 02:28:31","Individual","Yes","45-2548158","93299FL0010002","FL Family Smiles","93299FL001",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0010002-01","FL Family Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","97725FL0010001","Delta Dental PPO Pediatric Basic Plan","97725FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010001-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","97725FL0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020001-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","97725FL0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020002-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","97725FL0010002","Delta Dental PPO Pediatric Preferred Plan","97725FL001",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010002-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","97725FL0010006","Delta Dental PPO Basic Plan for Families","97725FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010006-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","97725FL0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020006-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020006-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","97725FL0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020004-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020004-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","97725FL0010004","Delta Dental PPO Preferred Plan for Families","97725FL001",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010004-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","97725FL0030006","DeltaCare USA Basic Plan for Families","97725FL003",,"FLN002","FLS002",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0030006-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030006-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","97725FL0040006","DeltaCare USA Basic Plan for Families for Small Businesses","97725FL004",,"FLN002","FLS002",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0040006-01","DeltaCare USA Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040006-17"
"2017","FL","97725","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","97725FL0040004","DeltaCare USA Preferred Plan for Families for Small Businesses","97725FL004",,"FLN002","FLS002",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0040004-01","DeltaCare USA Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040004-17"
"2017","FL","99787","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","Yes","75-1233841","99787FL0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","99787FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0020007-17"
"2017","GA","17382","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","57-0523959","17382GA0020001","Group Dental Policy","17382GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","17382GA0020001-00","Group Dental Policy","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","22500","HIOS","2016-08-17 03:19:03","Individual","Yes","36-3757528","22500GA0010001","TruAssure Basic Adult or Child Dental Plan","22500GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","22500GA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA"
"2017","GA","22500","HIOS","2016-08-17 03:19:03","SHOP (Small Group)","Yes","36-3757528","22500GA0030001","TruAssure Dental Small Group Basic Plan","22500GA003",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","22500GA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","22500","HIOS","2016-08-17 03:19:03","SHOP (Small Group)","Yes","36-3757528","22500GA0040001","TruAssure Dental Small Group Preferred Plan","22500GA004",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","22500GA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","22500","HIOS","2016-08-17 03:19:03","Individual","Yes","36-3757528","22500GA0010001","TruAssure Basic Adult or Child Dental Plan","22500GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","22500GA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA"
"2017","GA","22500","HIOS","2016-08-17 03:19:03","Individual","Yes","36-3757528","22500GA0020001","TruAssure Preferred Adult or Child Dental Plan","22500GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/plan-information2?state=GA","","22500GA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA"
"2017","GA","22500","HIOS","2016-08-17 03:19:03","Individual","Yes","36-3757528","22500GA0020001","TruAssure Preferred Adult or Child Dental Plan","22500GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/plan-information2?state=GA","","22500GA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA"
"2017","GA","28167","HIOS","2016-08-19 02:25:56","Individual","Yes","75-1233841","28167GA0010001","Dentegra Dental PPO Pediatric Basic Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010001-17"
"2017","GA","28167","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","75-1233841","28167GA0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","28167GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0020001-17"
"2017","GA","28167","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","75-1233841","28167GA0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","28167GA002",,"GAN001","GAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0020008-17"
"2017","GA","28167","HIOS","2016-08-19 02:25:56","Individual","Yes","75-1233841","28167GA0010008","Dentegra Dental PPO Family Preferred Plan","28167GA001",,"GAN001","GAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010008-17"
"2017","GA","28167","HIOS","2016-08-19 02:25:56","Individual","Yes","75-1233841","28167GA0010007","Dentegra Dental PPO Family Basic Plan","28167GA001",,"GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010007-17"
"2017","GA","28167","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","75-1233841","28167GA0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","28167GA002",,"GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0020007-17"
"2017","GA","37001","HIOS","2016-07-01 08:12:23","Individual","Yes","39-1263473","37001GA0540001","Humana Dental Smart Choice","37001GA054",,"GAN002","GAS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9911","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","37001GA0540001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857010"
"2017","GA","37001","HIOS","2016-07-01 08:12:23","Individual","Yes","39-1263473","37001GA0540001","Humana Dental Smart Choice","37001GA054",,"GAN002","GAS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9911","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","37001GA0540001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857010"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420041","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS007","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420041-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420042","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS008","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420042-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410021","BCBSHP Bronze Pathway X HMO 30 for HSA","49046GA041",,"GAN001","GAS023","GAF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410021-01","BCBSHP Bronze Pathway X HMO 30 for HSA","Standard Bronze On Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G6D","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410021","BCBSHP Bronze Pathway X HMO 30 for HSA","49046GA041",,"GAN001","GAS023","GAF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410021-02","BCBSHP Bronze Pathway X HMO 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G6E","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420036","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS002","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420036-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS023","GAF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-00","BCBSHP Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5D","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS023","GAF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-01","BCBSHP Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420036","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS002","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420036-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420037","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS003","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420037-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS023","GAF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-02","BCBSHP Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G5C","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS023","GAF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-03","BCBSHP Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420037","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS003","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420037-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420038","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS004","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420038-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-00","BCBSHP Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5X","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-01","BCBSHP Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420038","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS004","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420038-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420039","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS005","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420039-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-02","BCBSHP Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G5W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-03","BCBSHP Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420039","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS005","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420039-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420040","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS006","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420040-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-04","BCBSHP Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","73.53%","0.737563371658325","Yes","Yes","Yes","63%","37%","$2,700","$500","$700","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5T","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-05","BCBSHP Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","87.08%","0.871229231357574","Yes","Yes","Yes","63%","37%","$1,150","$0","$10","$0","$1,150","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5U","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420040","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS006","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420040-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420041","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS007","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420041-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-06","BCBSHP Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.47%","0.934762299060822","Yes","Yes","Yes","63%","37%","$500","$0","$10","$0","$500","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5V","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410021","BCBSHP Bronze Pathway X HMO 30 for HSA","49046GA041",,"GAN001","GAS023","GAF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410021-00","BCBSHP Bronze Pathway HMO 30 for HSA","Standard Bronze Off Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G6F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420042","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS008","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420042-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420043","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS009","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420043-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410021","BCBSHP Bronze Pathway X HMO 30 for HSA","49046GA041",,"GAN001","GAS023","GAF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410021-03","BCBSHP Bronze Pathway X HMO 30 for HSA","Limited Cost Sharing Plan Variation","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G6D","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420043","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS009","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420043-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420044","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS010","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420044-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420044","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS010","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420044-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420045","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS011","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420045-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420045","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS011","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420045-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420046","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS012","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420046-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420046","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS012","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420046-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420047","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS013","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420047-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420047","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS013","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420047-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420048","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS014","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420048-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420048","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS014","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420048-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420049","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS015","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420049-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420049","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS015","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420049-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420050","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS016","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420050-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420050","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS016","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420050-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420051","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS017","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420051-00","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420051","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","49046GA042",,"GAN003","GAS017","GAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420051-01","BCBSHP Bronze Pathway X Enhanced POS 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.20%","0.646904766559601","No","Yes","Yes","67%","33%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$61650 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FC3",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420004","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS002","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420004-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410026","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS018","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410026-00","BCBSHP Bronze Pathway Guided Access HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J32","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410026","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS018","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410026-01","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420004","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS002","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420004-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420005","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS003","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420005-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410026","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS018","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410026-02","BCBSHP Bronze Pathway X Guided Access HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J31","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410026","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS018","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410026-03","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420005","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS003","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420005-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420006","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS004","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420006-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410028","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS018","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410028-00","BCBSHP Bronze Pathway Guided Access HMO 30 for HSA","Standard Bronze Off Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J3B","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410028","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS018","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410028-01","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Standard Bronze On Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420006","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS004","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420006-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420007","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS005","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420007-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410028","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS018","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410028-02","BCBSHP Bronze Pathway X Guided Access HMO 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3A","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410028","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS018","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410028-03","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Limited Cost Sharing Plan Variation","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420007","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS005","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420007-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420008","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS006","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420008-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410043","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS019","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410043-00","BCBSHP Bronze Pathway Guided Access HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J32","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410043","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS019","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410043-01","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420008","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS006","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420008-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420009","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS007","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420009-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410043","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS019","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410043-02","BCBSHP Bronze Pathway X Guided Access HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J31","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410043","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS019","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410043-03","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420009","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS007","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420009-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420010","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS008","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420010-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410044","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS020","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410044-00","BCBSHP Bronze Pathway Guided Access HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J32","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410044","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS020","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410044-01","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420010","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS008","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420010-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420011","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS009","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420011-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410044","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS020","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410044-02","BCBSHP Bronze Pathway X Guided Access HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J31","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410044","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS020","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410044-03","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420011","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS009","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420011-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420012","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS010","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420012-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410045","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS021","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410045-00","BCBSHP Bronze Pathway Guided Access HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J32","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410060","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS020","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410060-01","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Standard Bronze On Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420018","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS016","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420018-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420019","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS017","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420019-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410060","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS020","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410060-02","BCBSHP Bronze Pathway X Guided Access HMO 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3A","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-03","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410045","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS021","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410045-01","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420012","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS010","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420012-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420013","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS011","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420013-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-06","BCBSHP Silver Pathway X Guided Access HMO 10 S06","94% AV Level Silver Plan","93.47%","0.934762299060822","Yes","Yes","Yes","63%","37%","$500","$0","$10","$0","$500","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J36","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410054","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS022","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410054-01","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Standard Silver On Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410054","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS022","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410054-02","BCBSHP Silver Pathway X Guided Access HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J37","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420035","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS017","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420035-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420035","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS017","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420035-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410054","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS022","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410054-03","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS023","GAF016","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-03","BCBSHP Silver Pathway X HMO 2000 25","Limited Cost Sharing Plan Variation","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410045","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS021","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410045-02","BCBSHP Bronze Pathway X Guided Access HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J31","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410045","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS021","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410045-03","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420013","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS011","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420013-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420014","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS012","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420014-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410046","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS022","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410046-00","BCBSHP Bronze Pathway Guided Access HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J32","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410046","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS022","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410046-01","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420014","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS012","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420014-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420015","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS013","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420015-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410046","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS022","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410046-02","BCBSHP Bronze Pathway X Guided Access HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J31","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410046","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS022","GAF019","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410046-03","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","63%","37%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420015","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS013","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420015-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420016","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS014","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420016-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410059","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS019","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410059-00","BCBSHP Bronze Pathway Guided Access HMO 30 for HSA","Standard Bronze Off Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J3B","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410059","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS019","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410059-01","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Standard Bronze On Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420016","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS014","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420016-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420017","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS015","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420017-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410059","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS019","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410059-02","BCBSHP Bronze Pathway X Guided Access HMO 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3A","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410059","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS019","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410059-03","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Limited Cost Sharing Plan Variation","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420017","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS015","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420017-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420018","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS016","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420018-00","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410060","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS020","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410060-00","BCBSHP Bronze Pathway Guided Access HMO 30 for HSA","Standard Bronze Off Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J3B","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410060","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS020","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410060-03","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Limited Cost Sharing Plan Variation","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420019","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","49046GA042",,"GAN003","GAS017","GAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420019-01","BCBSHP Gold Pathway X Enhanced POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.31%","0.813415050506592","No","Yes","Yes","67%","33%","$500","$100","$1,300","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBP",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410061","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS021","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410061-00","BCBSHP Bronze Pathway Guided Access HMO 30 for HSA","Standard Bronze Off Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J3B","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410061","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS021","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410061-01","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Standard Bronze On Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410061","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS021","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410061-02","BCBSHP Bronze Pathway X Guided Access HMO 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3A","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410061","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS021","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410061-03","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Limited Cost Sharing Plan Variation","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410062","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS022","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410062-00","BCBSHP Bronze Pathway Guided Access HMO 30 for HSA","Standard Bronze Off Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J3B","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410062","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS022","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410062-01","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Standard Bronze On Exchange Plan","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410062","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS022","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410062-02","BCBSHP Bronze Pathway X Guided Access HMO 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3A","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410062","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","49046GA041",,"GAN002","GAS022","GAF020","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410062-03","BCBSHP Bronze Pathway X Guided Access HMO 30 for HSA","Limited Cost Sharing Plan Variation","61.96%","0.619687616825104","Yes","Yes","Yes","63%","37%","$5,400","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%","$5,400","$5400 per person","$10800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J39","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410027","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS018","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410027-00","BCBSHP Silver Pathway Guided Access HMO 10 for HSA","Standard Silver Off Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J38","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420020","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS002","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420020-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420020","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS002","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420020-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410027","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS018","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410027-01","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Standard Silver On Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410027","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS018","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410027-02","BCBSHP Silver Pathway X Guided Access HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J37","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420021","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS003","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420021-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420021","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS003","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420021-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410027","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS018","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410027-03","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410027","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS018","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410027-04","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA S04","73% AV Level Silver Plan","73.53%","0.737563371658325","Yes","Yes","Yes","63%","37%","$2,700","$500","$700","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J34","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420022","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS004","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420022-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420022","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS004","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420022-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410027","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS018","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410027-05","BCBSHP Silver Pathway X Guided Access HMO 10 S05","87% AV Level Silver Plan","87.08%","0.871229231357574","Yes","Yes","Yes","63%","37%","$1,150","$0","$10","$0","$1,150","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J35","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410027","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS018","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410027-06","BCBSHP Silver Pathway X Guided Access HMO 10 S06","94% AV Level Silver Plan","93.47%","0.934762299060822","Yes","Yes","Yes","63%","37%","$500","$0","$10","$0","$500","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J36","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420023","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS005","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420023-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420023","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS005","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420023-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-00","BCBSHP Silver Pathway Guided Access HMO 10 for HSA","Standard Silver Off Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J38","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-01","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Standard Silver On Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420024","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS006","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420024-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420024","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS006","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420024-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-02","BCBSHP Silver Pathway X Guided Access HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J37","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420025","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS007","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420025-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420025","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS007","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420025-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-04","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA S04","73% AV Level Silver Plan","73.53%","0.737563371658325","Yes","Yes","Yes","63%","37%","$2,700","$500","$700","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J34","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-05","BCBSHP Silver Pathway X Guided Access HMO 10 S05","87% AV Level Silver Plan","87.08%","0.871229231357574","Yes","Yes","Yes","63%","37%","$1,150","$0","$10","$0","$1,150","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J35","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420026","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS008","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420026-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420026","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS008","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420026-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410052","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS020","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410052-00","BCBSHP Silver Pathway Guided Access HMO 10 for HSA","Standard Silver Off Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J38","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420027","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS009","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420027-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420027","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS009","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420027-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410052","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS020","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410052-01","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Standard Silver On Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410052","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS020","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410052-02","BCBSHP Silver Pathway X Guided Access HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J37","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420028","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS010","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420028-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420028","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS010","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420028-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410052","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS020","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410052-03","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410052","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS020","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410052-04","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA S04","73% AV Level Silver Plan","73.53%","0.737563371658325","Yes","Yes","Yes","63%","37%","$2,700","$500","$700","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J34","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420029","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS011","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420029-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420029","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS011","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420029-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410052","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS020","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410052-05","BCBSHP Silver Pathway X Guided Access HMO 10 S05","87% AV Level Silver Plan","87.08%","0.871229231357574","Yes","Yes","Yes","63%","37%","$1,150","$0","$10","$0","$1,150","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J35","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410052","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS020","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410052-06","BCBSHP Silver Pathway X Guided Access HMO 10 S06","94% AV Level Silver Plan","93.47%","0.934762299060822","Yes","Yes","Yes","63%","37%","$500","$0","$10","$0","$500","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J36","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420030","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS012","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420030-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420030","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS012","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420030-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-00","BCBSHP Silver Pathway Guided Access HMO 10 for HSA","Standard Silver Off Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J38","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-01","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Standard Silver On Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420031","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS013","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420031-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420031","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS013","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420031-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-02","BCBSHP Silver Pathway X Guided Access HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J37","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-03","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420032","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS014","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420032-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420032","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS014","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420032-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-04","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA S04","73% AV Level Silver Plan","73.53%","0.737563371658325","Yes","Yes","Yes","63%","37%","$2,700","$500","$700","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J34","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-05","BCBSHP Silver Pathway X Guided Access HMO 10 S05","87% AV Level Silver Plan","87.08%","0.871229231357574","Yes","Yes","Yes","63%","37%","$1,150","$0","$10","$0","$1,150","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J35","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420033","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS015","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420033-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420033","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS015","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420033-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-06","BCBSHP Silver Pathway X Guided Access HMO 10 S06","94% AV Level Silver Plan","93.47%","0.934762299060822","Yes","Yes","Yes","63%","37%","$500","$0","$10","$0","$500","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J36","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS023","GAF016","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-00","BCBSHP Silver Pathway HMO 2000 25","Standard Silver Off Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6Q","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS023","GAF016","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-01","BCBSHP Silver Pathway X HMO 2000 25","Standard Silver On Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS023","GAF016","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-02","BCBSHP Silver Pathway X HMO 2000 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6P","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS023","GAF016","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-04","BCBSHP Silver Pathway X HMO 2000 25 S04","73% AV Level Silver Plan","73.57%","0.739208817481995","Yes","Yes","Yes","63%","37%","$1,750","$1,000","$1,800","$0","$1,750","$200","$700","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS023","GAF016","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-05","BCBSHP Silver Pathway X HMO 2000 25 S05","87% AV Level Silver Plan","87.62%","0.875626981258392","Yes","Yes","Yes","63%","37%","$800","$500","$500","$0","$750","$60","$900","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6M","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS023","GAF016","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-06","BCBSHP Silver Pathway X HMO 2000 25 S06","94% AV Level Silver Plan","94.34%","0.941370785236359","Yes","Yes","Yes","63%","37%","$300","$100","$300","$0","$250","$40","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6N","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410054","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS022","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410054-00","BCBSHP Silver Pathway Guided Access HMO 10 for HSA","Standard Silver Off Exchange Plan","69.72%","0.700645625591278","Yes","Yes","Yes","63%","37%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J38","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420034","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS016","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420034-00","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver Off Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1638390","49046GA0420034","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","49046GA042",,"GAN003","GAS016","GAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.bcbsga.com/GASelectdrugtier5","49046GA0420034-01","BCBSHP Silver Pathway X Enhanced POS 1500 30 5500 Plus","Standard Silver On Exchange Plan","71.96%","0.7400181889534","No","Yes","Yes","67%","33%","$1,500","$100","$1,700","$0","$900","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$16,500","$16500 per person","$49500 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%","$1,500","$1500 per person","$4500 per group","30.00%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","25.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FBV",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410054","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS022","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410054-04","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA S04","73% AV Level Silver Plan","73.53%","0.737563371658325","Yes","Yes","Yes","63%","37%","$2,700","$500","$700","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J34","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410054","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS022","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410054-05","BCBSHP Silver Pathway X Guided Access HMO 10 S05","87% AV Level Silver Plan","87.08%","0.871229231357574","Yes","Yes","Yes","63%","37%","$1,150","$0","$10","$0","$1,150","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J35","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410054","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS022","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410054-06","BCBSHP Silver Pathway X Guided Access HMO 10 S06","94% AV Level Silver Plan","93.47%","0.934762299060822","Yes","Yes","Yes","63%","37%","$500","$0","$10","$0","$500","$0","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J36","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410029","BCBSHP Bronze Pathway X HMO 5850","49046GA041",,"GAN001","GAS023","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410029-00","BCBSHP Bronze Pathway HMO 5850","Standard Bronze Off Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3C","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410029","BCBSHP Bronze Pathway X HMO 5850","49046GA041",,"GAN001","GAS023","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410029-01","BCBSHP Bronze Pathway X HMO 5850","Standard Bronze On Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3D","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410029","BCBSHP Bronze Pathway X HMO 5850","49046GA041",,"GAN001","GAS023","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410029-02","BCBSHP Bronze Pathway X HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3E","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410029","BCBSHP Bronze Pathway X HMO 5850","49046GA041",,"GAN001","GAS023","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410029-03","BCBSHP Bronze Pathway X HMO 5850","Limited Cost Sharing Plan Variation","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3D","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410030","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS018","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410030-00","BCBSHP Bronze Pathway Guided Access HMO 5850","Standard Bronze Off Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410030","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS018","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410030-01","BCBSHP Bronze Pathway X Guided Access HMO 5850","Standard Bronze On Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410030","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS018","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410030-02","BCBSHP Bronze Pathway X Guided Access HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410030","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS018","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410030-03","BCBSHP Bronze Pathway X Guided Access HMO 5850","Limited Cost Sharing Plan Variation","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410075","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS019","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410075-00","BCBSHP Bronze Pathway Guided Access HMO 5850","Standard Bronze Off Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410075","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS019","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410075-01","BCBSHP Bronze Pathway X Guided Access HMO 5850","Standard Bronze On Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410075","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS019","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410075-02","BCBSHP Bronze Pathway X Guided Access HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410075","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS019","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410075-03","BCBSHP Bronze Pathway X Guided Access HMO 5850","Limited Cost Sharing Plan Variation","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410076","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS020","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410076-00","BCBSHP Bronze Pathway Guided Access HMO 5850","Standard Bronze Off Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410076","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS020","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410076-01","BCBSHP Bronze Pathway X Guided Access HMO 5850","Standard Bronze On Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410076","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS020","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410076-02","BCBSHP Bronze Pathway X Guided Access HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410076","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS020","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410076-03","BCBSHP Bronze Pathway X Guided Access HMO 5850","Limited Cost Sharing Plan Variation","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410077","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS021","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410077-00","BCBSHP Bronze Pathway Guided Access HMO 5850","Standard Bronze Off Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410077","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS021","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410077-01","BCBSHP Bronze Pathway X Guided Access HMO 5850","Standard Bronze On Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410077","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS021","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410077-02","BCBSHP Bronze Pathway X Guided Access HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410077","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS021","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410077-03","BCBSHP Bronze Pathway X Guided Access HMO 5850","Limited Cost Sharing Plan Variation","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410078","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS022","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410078-00","BCBSHP Bronze Pathway Guided Access HMO 5850","Standard Bronze Off Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410078","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS022","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410078-01","BCBSHP Bronze Pathway X Guided Access HMO 5850","Standard Bronze On Exchange Plan","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410078","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS022","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410078-02","BCBSHP Bronze Pathway X Guided Access HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410078","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS022","GAF014","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410078-03","BCBSHP Bronze Pathway X Guided Access HMO 5850","Limited Cost Sharing Plan Variation","60.12%","0.600063800811768","Yes","Yes","Yes","63%","37%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410031","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS018","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410031-00","BCBSHP Silver Pathway Guided Access HMO 2000 25","Standard Silver Off Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3P","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410031","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS018","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410031-01","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Standard Silver On Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410031","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS018","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410031-02","BCBSHP Silver Pathway X Guided Access HMO 2000 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3N","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410031","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS018","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410031-03","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Limited Cost Sharing Plan Variation","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410031","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS018","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410031-04","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S04","73% AV Level Silver Plan","73.57%","0.739208817481995","Yes","Yes","Yes","63%","37%","$1,750","$1,000","$1,800","$0","$1,750","$200","$700","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410031","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS018","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410031-05","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S05","87% AV Level Silver Plan","87.62%","0.875626981258392","Yes","Yes","Yes","63%","37%","$800","$500","$500","$0","$750","$60","$900","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410031","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS018","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410031-06","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S06","94% AV Level Silver Plan","94.34%","0.941370785236359","Yes","Yes","Yes","63%","37%","$300","$100","$300","$0","$250","$40","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3M","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS019","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-00","BCBSHP Silver Pathway Guided Access HMO 2000 25","Standard Silver Off Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3P","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS019","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-01","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Standard Silver On Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS019","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-02","BCBSHP Silver Pathway X Guided Access HMO 2000 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3N","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS019","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-03","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Limited Cost Sharing Plan Variation","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS019","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-04","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S04","73% AV Level Silver Plan","73.57%","0.739208817481995","Yes","Yes","Yes","63%","37%","$1,750","$1,000","$1,800","$0","$1,750","$200","$700","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Core Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-02","BCBSHP Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3U","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Core Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-03","BCBSHP Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Core Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-04","BCBSHP Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.03%","0.720967173576355","Yes","Yes","Yes","63%","37%","$3,800","$60","$1,200","$0","$500","$160","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3R","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Core Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-05","BCBSHP Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.19%","0.861789703369141","Yes","Yes","Yes","63%","37%","$1,000","$40","$800","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS019","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-05","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S05","87% AV Level Silver Plan","87.62%","0.875626981258392","Yes","Yes","Yes","63%","37%","$800","$500","$500","$0","$750","$60","$900","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS019","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-06","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S06","94% AV Level Silver Plan","94.34%","0.941370785236359","Yes","Yes","Yes","63%","37%","$300","$100","$300","$0","$250","$40","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3M","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410068","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS020","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410068-00","BCBSHP Silver Pathway Guided Access HMO 2000 25","Standard Silver Off Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3P","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410068","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS020","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410068-01","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Standard Silver On Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410068","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS020","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410068-02","BCBSHP Silver Pathway X Guided Access HMO 2000 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3N","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410068","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS020","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410068-03","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Limited Cost Sharing Plan Variation","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410068","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS020","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410068-04","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S04","73% AV Level Silver Plan","73.57%","0.739208817481995","Yes","Yes","Yes","63%","37%","$1,750","$1,000","$1,800","$0","$1,750","$200","$700","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410068","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS020","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410068-05","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S05","87% AV Level Silver Plan","87.62%","0.875626981258392","Yes","Yes","Yes","63%","37%","$800","$500","$500","$0","$750","$60","$900","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410068","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS020","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410068-06","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S06","94% AV Level Silver Plan","94.34%","0.941370785236359","Yes","Yes","Yes","63%","37%","$300","$100","$300","$0","$250","$40","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3M","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS021","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-00","BCBSHP Silver Pathway Guided Access HMO 2000 25","Standard Silver Off Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3P","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS021","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-01","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Standard Silver On Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS021","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-02","BCBSHP Silver Pathway X Guided Access HMO 2000 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3N","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS021","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-03","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Limited Cost Sharing Plan Variation","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS021","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-04","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S04","73% AV Level Silver Plan","73.57%","0.739208817481995","Yes","Yes","Yes","63%","37%","$1,750","$1,000","$1,800","$0","$1,750","$200","$700","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS021","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-05","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S05","87% AV Level Silver Plan","87.62%","0.875626981258392","Yes","Yes","Yes","63%","37%","$800","$500","$500","$0","$750","$60","$900","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS021","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-06","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S06","94% AV Level Silver Plan","94.34%","0.941370785236359","Yes","Yes","Yes","63%","37%","$300","$100","$300","$0","$250","$40","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3M","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410070","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS022","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410070-00","BCBSHP Silver Pathway Guided Access HMO 2000 25","Standard Silver Off Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3P","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410070","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS022","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410070-01","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Standard Silver On Exchange Plan","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410070","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS022","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410070-02","BCBSHP Silver Pathway X Guided Access HMO 2000 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3N","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS019","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-05","BCBSHP Silver Pathway X Guided Access HMO 3500 S05","87% AV Level Silver Plan","87.43%","0.849429965019226","No","Yes","Yes","63%","37%","$750","$500","$500","$0","$700","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Y","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS019","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-06","BCBSHP Silver Pathway X Guided Access HMO 3500 S06","94% AV Level Silver Plan","94.76%","0.929918110370636","No","Yes","Yes","63%","37%","$250","$40","$300","$0","$250","$1,200","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-02","BCBSHP Silver Core Pathway X Guided Access HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J46",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-03","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-04","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S04","73% AV Level Silver Plan","72.03%","0.720967173576355","Yes","Yes","Yes","63%","37%","$3,800","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J43",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410070","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS022","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410070-03","BCBSHP Silver Pathway X Guided Access HMO 2000 25","Limited Cost Sharing Plan Variation","70.34%","0.70859694480896","Yes","Yes","Yes","63%","37%","$2,000","$1,000","$1,600","$0","$2,000","$200","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410070","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS022","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410070-04","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S04","73% AV Level Silver Plan","73.57%","0.739208817481995","Yes","Yes","Yes","63%","37%","$1,750","$1,000","$1,800","$0","$1,750","$200","$700","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410070","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS022","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410070-05","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S05","87% AV Level Silver Plan","87.62%","0.875626981258392","Yes","Yes","Yes","63%","37%","$800","$500","$500","$0","$750","$60","$900","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410070","BCBSHP Silver Pathway X Guided Access HMO 2000 25","49046GA041",,"GAN002","GAS022","GAF016","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410070-06","BCBSHP Silver Pathway X Guided Access HMO 2000 25 S06","94% AV Level Silver Plan","94.34%","0.941370785236359","Yes","Yes","Yes","63%","37%","$300","$100","$300","$0","$250","$40","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3M","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Core Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-00","BCBSHP Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3V","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Core Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-01","BCBSHP Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Core Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-06","BCBSHP Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.50%","0.934635698795319","Yes","Yes","Yes","63%","37%","$250","$40","$500","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3T","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410033","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS018","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410033-00","BCBSHP Silver Pathway Guided Access HMO 3500","Standard Silver Off Exchange Plan","68.31%","0.703723669052124","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J40","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410033","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS018","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410033-01","BCBSHP Silver Pathway X Guided Access HMO 3500","Standard Silver On Exchange Plan","68.31%","0.694509744644165","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410033","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS018","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410033-02","BCBSHP Silver Pathway X Guided Access HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J41","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410033","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS018","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410033-03","BCBSHP Silver Pathway X Guided Access HMO 3500","Limited Cost Sharing Plan Variation","68.31%","0.694509744644165","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410033","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS018","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410033-04","BCBSHP Silver Pathway X Guided Access HMO 3500 S04","73% AV Level Silver Plan","73.37%","0.731672644615173","No","Yes","Yes","63%","37%","$2,000","$900","$1,600","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3X","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410033","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS018","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410033-05","BCBSHP Silver Pathway X Guided Access HMO 3500 S05","87% AV Level Silver Plan","87.43%","0.847428858280182","No","Yes","Yes","63%","37%","$750","$500","$500","$0","$700","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Y","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410033","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS018","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410033-06","BCBSHP Silver Pathway X Guided Access HMO 3500 S06","94% AV Level Silver Plan","94.76%","0.930182695388794","No","Yes","Yes","63%","37%","$250","$40","$300","$0","$250","$1,200","$70","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS019","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-00","BCBSHP Silver Pathway Guided Access HMO 3500","Standard Silver Off Exchange Plan","68.31%","0.709347307682037","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J40","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410034","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410034-05","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S05","87% AV Level Silver Plan","86.19%","0.861789703369141","Yes","Yes","Yes","63%","37%","$1,000","$40","$800","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J44",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410034","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410034-06","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S06","94% AV Level Silver Plan","93.50%","0.934635698795319","Yes","Yes","Yes","63%","37%","$250","$40","$500","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J45",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-00","BCBSHP Silver Core Pathway Guided Access HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J47",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-01","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-05","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S05","87% AV Level Silver Plan","86.19%","0.861789703369141","Yes","Yes","Yes","63%","37%","$1,000","$40","$800","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J44",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-06","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S06","94% AV Level Silver Plan","93.50%","0.934662640094757","Yes","Yes","Yes","63%","37%","$250","$40","$500","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J45",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410035","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS018","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410035-01","BCBSHP Bronze Pathway X Guided Access HMO 5200","Standard Bronze On Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS019","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-01","BCBSHP Silver Pathway X Guided Access HMO 3500","Standard Silver On Exchange Plan","68.31%","0.709347307682037","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS019","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-02","BCBSHP Silver Pathway X Guided Access HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J41","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS019","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-03","BCBSHP Silver Pathway X Guided Access HMO 3500","Limited Cost Sharing Plan Variation","68.31%","0.709347307682037","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS019","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-04","BCBSHP Silver Pathway X Guided Access HMO 3500 S04","73% AV Level Silver Plan","73.37%","0.743456482887268","No","Yes","Yes","63%","37%","$2,000","$900","$1,600","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3X","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410072","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS020","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410072-00","BCBSHP Silver Pathway Guided Access HMO 3500","Standard Silver Off Exchange Plan","68.31%","0.709347307682037","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J40","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410072","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS020","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410072-01","BCBSHP Silver Pathway X Guided Access HMO 3500","Standard Silver On Exchange Plan","68.31%","0.709347307682037","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410072","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS020","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410072-02","BCBSHP Silver Pathway X Guided Access HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J41","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410072","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS020","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410072-03","BCBSHP Silver Pathway X Guided Access HMO 3500","Limited Cost Sharing Plan Variation","68.31%","0.709347307682037","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410072","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS020","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410072-04","BCBSHP Silver Pathway X Guided Access HMO 3500 S04","73% AV Level Silver Plan","73.37%","0.743456482887268","No","Yes","Yes","63%","37%","$2,000","$900","$1,600","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3X","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410072","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS020","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410072-05","BCBSHP Silver Pathway X Guided Access HMO 3500 S05","87% AV Level Silver Plan","87.43%","0.849429965019226","No","Yes","Yes","63%","37%","$750","$500","$500","$0","$700","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Y","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410072","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS020","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410072-06","BCBSHP Silver Pathway X Guided Access HMO 3500 S06","94% AV Level Silver Plan","94.76%","0.929918110370636","No","Yes","Yes","63%","37%","$250","$40","$300","$0","$250","$1,200","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS021","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-00","BCBSHP Silver Pathway Guided Access HMO 3500","Standard Silver Off Exchange Plan","68.31%","0.709347307682037","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J40","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS021","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-01","BCBSHP Silver Pathway X Guided Access HMO 3500","Standard Silver On Exchange Plan","68.31%","0.709347307682037","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS021","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-02","BCBSHP Silver Pathway X Guided Access HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J41","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS021","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-03","BCBSHP Silver Pathway X Guided Access HMO 3500","Limited Cost Sharing Plan Variation","68.31%",,"No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS021","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-04","BCBSHP Silver Pathway X Guided Access HMO 3500 S04","73% AV Level Silver Plan","73.37%",,"No","Yes","Yes","63%","37%","$2,000","$900","$1,600","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3X","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS021","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-05","BCBSHP Silver Pathway X Guided Access HMO 3500 S05","87% AV Level Silver Plan","87.43%",,"No","Yes","Yes","63%","37%","$750","$500","$500","$0","$700","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Y","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS021","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-06","BCBSHP Silver Pathway X Guided Access HMO 3500 S06","94% AV Level Silver Plan","94.76%",,"No","Yes","Yes","63%","37%","$250","$40","$300","$0","$250","$1,200","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410074","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS022","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410074-00","BCBSHP Silver Pathway Guided Access HMO 3500","Standard Silver Off Exchange Plan","68.31%",,"No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J40","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410074","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS022","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410074-01","BCBSHP Silver Pathway X Guided Access HMO 3500","Standard Silver On Exchange Plan","68.31%",,"No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410074","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS022","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410074-02","BCBSHP Silver Pathway X Guided Access HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J41","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410074","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS022","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410074-03","BCBSHP Silver Pathway X Guided Access HMO 3500","Limited Cost Sharing Plan Variation","68.31%",,"No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410074","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS022","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410074-04","BCBSHP Silver Pathway X Guided Access HMO 3500 S04","73% AV Level Silver Plan","73.37%",,"No","Yes","Yes","63%","37%","$2,000","$900","$1,600","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3X","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410074","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS022","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410074-05","BCBSHP Silver Pathway X Guided Access HMO 3500 S05","87% AV Level Silver Plan","87.43%",,"No","Yes","Yes","63%","37%","$750","$500","$500","$0","$700","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Y","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410074","BCBSHP Silver Pathway X Guided Access HMO 3500","49046GA041",,"GAN002","GAS022","GAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410074-06","BCBSHP Silver Pathway X Guided Access HMO 3500 S06","94% AV Level Silver Plan","94.76%",,"No","Yes","Yes","63%","37%","$250","$40","$300","$0","$250","$1,200","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410034","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410034-00","BCBSHP Silver Core Pathway Guided Access HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J47",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410034","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410034-01","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410034","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410034-02","BCBSHP Silver Core Pathway X Guided Access HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J46",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410034","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410034-03","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410034","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410034-04","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S04","73% AV Level Silver Plan","72.03%","0.720967173576355","Yes","Yes","Yes","63%","37%","$3,800","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J43",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410080","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410080-00","BCBSHP Silver Core Pathway Guided Access HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J47",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200","49046GA041",,"GAN001","GAS023","GAF017","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-02","BCBSHP Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G5J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200","49046GA041",,"GAN001","GAS023","GAF017","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-03","BCBSHP Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500","49046GA041",,"GAN001","GAS023","GAF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-00","BCBSHP Bronze Pathway HMO 5500","Standard Bronze Off Exchange Plan","60.21%","0.614770293235779","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6J","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500","49046GA041",,"GAN001","GAS023","GAF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-01","BCBSHP Bronze Pathway X HMO 5500","Standard Bronze On Exchange Plan","60.21%","0.614770293235779","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500","49046GA041",,"GAN001","GAS023","GAF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-02","BCBSHP Bronze Pathway X HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G6H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410080","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410080-01","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410080","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410080-02","BCBSHP Silver Core Pathway X Guided Access HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J46",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410080","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410080-03","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410080","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410080-04","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S04","73% AV Level Silver Plan","72.03%","0.720967173576355","Yes","Yes","Yes","63%","37%","$3,800","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J43",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410080","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410080-05","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S05","87% AV Level Silver Plan","86.19%","0.861789703369141","Yes","Yes","Yes","63%","37%","$1,000","$40","$800","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J44",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410080","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410080-06","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S06","94% AV Level Silver Plan","93.50%","0.934662640094757","Yes","Yes","Yes","63%","37%","$250","$40","$500","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J45",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-00","BCBSHP Silver Core Pathway Guided Access HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J47",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-01","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-02","BCBSHP Silver Core Pathway X Guided Access HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J46",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-03","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-04","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S04","73% AV Level Silver Plan","72.03%","0.720967173576355","Yes","Yes","Yes","63%","37%","$3,800","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J43",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-05","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S05","87% AV Level Silver Plan","86.19%","0.861789703369141","Yes","Yes","Yes","63%","37%","$1,000","$40","$800","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J44",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-06","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S06","94% AV Level Silver Plan","93.50%","0.934662640094757","Yes","Yes","Yes","63%","37%","$250","$40","$500","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J45",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410082","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410082-00","BCBSHP Silver Core Pathway Guided Access HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J47",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410082","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410082-01","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410082","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410082-02","BCBSHP Silver Core Pathway X Guided Access HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J46",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410082","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410082-03","BCBSHP Silver Core Pathway X Guided Access HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681029617786407","Yes","Yes","Yes","63%","37%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410082","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410082-04","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S04","73% AV Level Silver Plan","72.03%","0.720967173576355","Yes","Yes","Yes","63%","37%","$3,800","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J43",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410082","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410082-05","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S05","87% AV Level Silver Plan","86.19%","0.861789703369141","Yes","Yes","Yes","63%","37%","$1,000","$40","$800","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J44",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410082","BCBSHP Silver Core Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410082-06","BCBSHP Silver Core Pathway X Guided Access HMO 5300 S06","94% AV Level Silver Plan","93.50%","0.934662640094757","Yes","Yes","Yes","63%","37%","$250","$40","$500","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J45",
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200","49046GA041",,"GAN001","GAS023","GAF017","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-00","BCBSHP Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5K","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200","49046GA041",,"GAN001","GAS023","GAF017","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-01","BCBSHP Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500","49046GA041",,"GAN001","GAS023","GAF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-03","BCBSHP Bronze Pathway X HMO 5500","Limited Cost Sharing Plan Variation","60.21%","0.614770293235779","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410035","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS018","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410035-00","BCBSHP Bronze Pathway Guided Access HMO 5200","Standard Bronze Off Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4A","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410035","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS018","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410035-02","BCBSHP Bronze Pathway X Guided Access HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J49","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410035","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS018","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410035-03","BCBSHP Bronze Pathway X Guided Access HMO 5200","Limited Cost Sharing Plan Variation","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410036","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS018","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410036-00","BCBSHP Bronze Pathway Guided Access HMO 5500","Standard Bronze Off Exchange Plan","60.21%","0.614770293235779","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4D","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410036","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS018","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410036-01","BCBSHP Bronze Pathway X Guided Access HMO 5500","Standard Bronze On Exchange Plan","60.21%","0.614770293235779","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410036","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS018","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410036-02","BCBSHP Bronze Pathway X Guided Access HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4C","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410036","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS018","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410036-03","BCBSHP Bronze Pathway X Guided Access HMO 5500","Limited Cost Sharing Plan Variation","60.21%","0.614770293235779","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410047","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS019","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410047-00","BCBSHP Bronze Pathway Guided Access HMO 5200","Standard Bronze Off Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4A","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410047","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS019","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410047-01","BCBSHP Bronze Pathway X Guided Access HMO 5200","Standard Bronze On Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410047","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS019","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410047-02","BCBSHP Bronze Pathway X Guided Access HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J49","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410047","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS019","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410047-03","BCBSHP Bronze Pathway X Guided Access HMO 5200","Limited Cost Sharing Plan Variation","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410048","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS020","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410048-00","BCBSHP Bronze Pathway Guided Access HMO 5200","Standard Bronze Off Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4A","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410048","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS020","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410048-01","BCBSHP Bronze Pathway X Guided Access HMO 5200","Standard Bronze On Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410048","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS020","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410048-02","BCBSHP Bronze Pathway X Guided Access HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J49","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410014","BCBSHP Catastrophic Pathway X HMO 7150","49046GA041",,"GAN001","GAS023","GAF019","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410014-01","BCBSHP Catastrophic Pathway X HMO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$7,150","$0","$0","$0","$4,500","$200","$0","$200",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G59","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410037","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","49046GA041",,"GAN002","GAS018","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410037-00","BCBSHP Catastrophic Pathway Guided Access HMO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410037","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","49046GA041",,"GAN002","GAS018","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410037-01","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4E","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410048","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS020","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410048-03","BCBSHP Bronze Pathway X Guided Access HMO 5200","Limited Cost Sharing Plan Variation","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410050","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS022","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410050-03","BCBSHP Bronze Pathway X Guided Access HMO 5200","Limited Cost Sharing Plan Variation","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410063","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS019","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410063-00","BCBSHP Bronze Pathway Guided Access HMO 5500","Standard Bronze Off Exchange Plan","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4D","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410063","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS019","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410063-01","BCBSHP Bronze Pathway X Guided Access HMO 5500","Standard Bronze On Exchange Plan","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410063","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS019","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410063-02","BCBSHP Bronze Pathway X Guided Access HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4C","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410063","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS019","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410063-03","BCBSHP Bronze Pathway X Guided Access HMO 5500","Limited Cost Sharing Plan Variation","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410064","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS020","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410064-00","BCBSHP Bronze Pathway Guided Access HMO 5500","Standard Bronze Off Exchange Plan","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4D","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410064","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS020","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410064-01","BCBSHP Bronze Pathway X Guided Access HMO 5500","Standard Bronze On Exchange Plan","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410049","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS021","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410049-00","BCBSHP Bronze Pathway Guided Access HMO 5200","Standard Bronze Off Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4A","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410049","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS021","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410049-01","BCBSHP Bronze Pathway X Guided Access HMO 5200","Standard Bronze On Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410049","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS021","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410049-02","BCBSHP Bronze Pathway X Guided Access HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J49","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410049","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS021","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410049-03","BCBSHP Bronze Pathway X Guided Access HMO 5200","Limited Cost Sharing Plan Variation","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410050","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS022","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410050-00","BCBSHP Bronze Pathway Guided Access HMO 5200","Standard Bronze Off Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4A","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410050","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS022","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410050-01","BCBSHP Bronze Pathway X Guided Access HMO 5200","Standard Bronze On Exchange Plan","61.41%","0.631011366844177","Yes","Yes","Yes","63%","37%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410050","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS022","GAF017","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410050-02","BCBSHP Bronze Pathway X Guided Access HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J49","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410064","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS020","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410064-02","BCBSHP Bronze Pathway X Guided Access HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4C","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410064","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS020","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410064-03","BCBSHP Bronze Pathway X Guided Access HMO 5500","Limited Cost Sharing Plan Variation","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410065","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS021","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410065-00","BCBSHP Bronze Pathway Guided Access HMO 5500","Standard Bronze Off Exchange Plan","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4D","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410065","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS021","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410065-01","BCBSHP Bronze Pathway X Guided Access HMO 5500","Standard Bronze On Exchange Plan","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-05","BCBSHP Silver Pathway X HMO 3000 S05","87% AV Level Silver Plan","87.74%","0.887567043304443","Yes","Yes","Yes","63%","37%","$850","$400","$400","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G60","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-06","BCBSHP Silver Pathway X HMO 3000 S06","94% AV Level Silver Plan","94.70%","0.948797941207886","Yes","Yes","Yes","63%","37%","$250","$100","$300","$0","$250","$400","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G61","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500","49046GA041",,"GAN001","GAS023","GAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-00","BCBSHP Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.10%","0.69575971364975","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6V","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500","49046GA041",,"GAN001","GAS023","GAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-01","BCBSHP Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.10%","0.69575971364975","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6R","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410065","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS021","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410065-02","BCBSHP Bronze Pathway X Guided Access HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4C","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410065","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS021","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410065-03","BCBSHP Bronze Pathway X Guided Access HMO 5500","Limited Cost Sharing Plan Variation","60.21%","0.599814295768738","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4C","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410066","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS022","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410066-00","BCBSHP Bronze Pathway Guided Access HMO 5500","Standard Bronze Off Exchange Plan","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410066","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS022","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410066-01","BCBSHP Bronze Pathway X Guided Access HMO 5500","Standard Bronze On Exchange Plan","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4D","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410066","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS022","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410066-02","BCBSHP Bronze Pathway X Guided Access HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410066","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS022","GAF013","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410066-03","BCBSHP Bronze Pathway X Guided Access HMO 5500","Limited Cost Sharing Plan Variation","60.21%","0.614777743816376","Yes","Yes","Yes","63%","37%","$5,500","$0","$700","$0","$4,500","$300","$200","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410014","BCBSHP Catastrophic Pathway X HMO 7150","49046GA041",,"GAN001","GAS023","GAF019","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410014-00","BCBSHP Catastrophic Pathway HMO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$7,150","$0","$0","$0","$4,500","$200","$0","$200",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5A","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410039","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","49046GA041",,"GAN002","GAS019","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410039-00","BCBSHP Catastrophic Pathway Guided Access HMO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410039","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","49046GA041",,"GAN002","GAS019","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410039-01","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4E","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410040","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","49046GA041",,"GAN002","GAS020","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410040-00","BCBSHP Catastrophic Pathway Guided Access HMO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410040","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","49046GA041",,"GAN002","GAS020","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410040-01","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4E","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410041","BCBSHP Catastrophic Pathway x Guided Access HMO 7150","49046GA041",,"GAN002","GAS021","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410041-00","BCBSHP Catastrophic Pathway Guided Access HMO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410041","BCBSHP Catastrophic Pathway x Guided Access HMO 7150","49046GA041",,"GAN002","GAS021","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410041-01","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4E","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410042","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","49046GA041",,"GAN002","GAS022","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410042-00","BCBSHP Catastrophic Pathway Guided Access HMO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4F","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410042","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","49046GA041",,"GAN002","GAS022","GAF019","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410042-01","BCBSHP Catastrophic Pathway X Guided Access HMO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","63%","37%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4E","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-00","BCBSHP Silver Pathway HMO 3000","Standard Silver Off Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G63","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-01","BCBSHP Silver Pathway X HMO 3000","Standard Silver On Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Y","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-02","BCBSHP Silver Pathway X HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G62","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-03","BCBSHP Silver Pathway X HMO 3000","Limited Cost Sharing Plan Variation","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Y","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-04","BCBSHP Silver Pathway X HMO 3000 S04","73% AV Level Silver Plan","73.50%","0.755768358707428","Yes","Yes","Yes","63%","37%","$2,500","$600","$1,200","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Z","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500","49046GA041",,"GAN001","GAS023","GAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-02","BCBSHP Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500","49046GA041",,"GAN001","GAS023","GAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-03","BCBSHP Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.10%","0.69575971364975","No","Yes","Yes","63%","37%","$3,500","$500","$800","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500","49046GA041",,"GAN001","GAS023","GAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-04","BCBSHP Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.08%","0.732461214065552","No","Yes","Yes","63%","37%","$2,000","$900","$1,600","$0","$1,400","$900","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500","49046GA041",,"GAN001","GAS023","GAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-05","BCBSHP Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","86.43%","0.84613972902298","No","Yes","Yes","63%","37%","$750","$500","$500","$0","$700","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6T","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500","49046GA041",,"GAN001","GAS023","GAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-06","BCBSHP Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.47%","0.929208159446716","No","Yes","Yes","63%","37%","$250","$40","$300","$0","$250","$1,200","$70","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6U","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410038","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410038-00","BCBSHP Silver Pathway Guided Access HMO 3000","Standard Silver Off Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4M","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410058","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410058-03","BCBSHP Silver Pathway X Guided Access HMO 3000","Limited Cost Sharing Plan Variation","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410058","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410058-04","BCBSHP Silver Pathway X Guided Access HMO 3000 S04","73% AV Level Silver Plan","73.50%","0.755768358707428","Yes","Yes","Yes","63%","37%","$2,500","$600","$1,200","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410058","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410058-05","BCBSHP Silver Pathway X Guided Access HMO 3000 S05","87% AV Level Silver Plan","87.74%","0.887567043304443","Yes","Yes","Yes","63%","37%","$850","$400","$400","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410058","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410058-06","BCBSHP Silver Pathway X Guided Access HMO 3000 S06","94% AV Level Silver Plan","94.70%","0.948797941207886","Yes","Yes","Yes","63%","37%","$250","$100","$300","$0","$250","$400","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","50491","HIOS","2016-06-26 07:33:26","Individual","Yes","59-1031071","50491GA0030001","Cigna Dental Pediatric","50491GA003","7730182962","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Services","Yes",,"","50491GA0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","GA","55612","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","55612GA0160001","EHB Basic Dental Plan (Low)","55612GA016",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0160001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410038","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410038-01","BCBSHP Silver Pathway X Guided Access HMO 3000","Standard Silver On Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-03","BCBSHP Silver Pathway X Guided Access HMO 3000","Limited Cost Sharing Plan Variation","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410038","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410038-02","BCBSHP Silver Pathway X Guided Access HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410038","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410038-03","BCBSHP Silver Pathway X Guided Access HMO 3000","Limited Cost Sharing Plan Variation","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410038","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410038-04","BCBSHP Silver Pathway X Guided Access HMO 3000 S04","73% AV Level Silver Plan","73.50%","0.755768358707428","Yes","Yes","Yes","63%","37%","$2,500","$600","$1,200","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410038","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410038-05","BCBSHP Silver Pathway X Guided Access HMO 3000 S05","87% AV Level Silver Plan","87.74%","0.887567043304443","Yes","Yes","Yes","63%","37%","$850","$400","$400","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410038","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS018","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410038-06","BCBSHP Silver Pathway X Guided Access HMO 3000 S06","94% AV Level Silver Plan","94.70%","0.948797941207886","Yes","Yes","Yes","63%","37%","$250","$100","$300","$0","$250","$400","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-00","BCBSHP Silver Pathway Guided Access HMO 3000","Standard Silver Off Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4M","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-01","BCBSHP Silver Pathway X Guided Access HMO 3000","Standard Silver On Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-02","BCBSHP Silver Pathway X Guided Access HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-03","BCBSHP Silver Pathway X Guided Access HMO 3000","Limited Cost Sharing Plan Variation","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-04","BCBSHP Silver Pathway X Guided Access HMO 3000 S04","73% AV Level Silver Plan","73.50%","0.755768358707428","Yes","Yes","Yes","63%","37%","$2,500","$600","$1,200","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-05","BCBSHP Silver Pathway X Guided Access HMO 3000 S05","87% AV Level Silver Plan","87.74%","0.887567043304443","Yes","Yes","Yes","63%","37%","$850","$400","$400","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-06","BCBSHP Silver Pathway X Guided Access HMO 3000 S06","94% AV Level Silver Plan","94.70%","0.948797941207886","Yes","Yes","Yes","63%","37%","$250","$100","$300","$0","$250","$400","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410056","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410056-00","BCBSHP Silver Pathway Guided Access HMO 3000","Standard Silver Off Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4M","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410056","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410056-01","BCBSHP Silver Pathway X Guided Access HMO 3000","Standard Silver On Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410056","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410056-02","BCBSHP Silver Pathway X Guided Access HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410056","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410056-03","BCBSHP Silver Pathway X Guided Access HMO 3000","Limited Cost Sharing Plan Variation","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410056","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410056-04","BCBSHP Silver Pathway X Guided Access HMO 3000 S04","73% AV Level Silver Plan","73.50%","0.755768358707428","Yes","Yes","Yes","63%","37%","$2,500","$600","$1,200","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410056","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410056-05","BCBSHP Silver Pathway X Guided Access HMO 3000 S05","87% AV Level Silver Plan","87.74%","0.887567043304443","Yes","Yes","Yes","63%","37%","$850","$400","$400","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410056","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS020","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410056-06","BCBSHP Silver Pathway X Guided Access HMO 3000 S06","94% AV Level Silver Plan","94.70%","0.948797941207886","Yes","Yes","Yes","63%","37%","$250","$100","$300","$0","$250","$400","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-00","BCBSHP Silver Pathway Guided Access HMO 3000","Standard Silver Off Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4M","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-01","BCBSHP Silver Pathway X Guided Access HMO 3000","Standard Silver On Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-02","BCBSHP Silver Pathway X Guided Access HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-04","BCBSHP Silver Pathway X Guided Access HMO 3000 S04","73% AV Level Silver Plan","73.50%","0.755768358707428","Yes","Yes","Yes","63%","37%","$2,500","$600","$1,200","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4H","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-05","BCBSHP Silver Pathway X Guided Access HMO 3000 S05","87% AV Level Silver Plan","87.74%","0.887567043304443","Yes","Yes","Yes","63%","37%","$850","$400","$400","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4J","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-06","BCBSHP Silver Pathway X Guided Access HMO 3000 S06","94% AV Level Silver Plan","94.70%","0.948797941207886","Yes","Yes","Yes","63%","37%","$250","$100","$300","$0","$250","$400","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4K","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410058","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410058-00","BCBSHP Silver Pathway Guided Access HMO 3000","Standard Silver Off Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4M","http://editiondigital.net/view/IU65/2017/OFF_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410058","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410058-01","BCBSHP Silver Pathway X Guided Access HMO 3000","Standard Silver On Exchange Plan","69.13%","0.712847292423248","Yes","Yes","Yes","63%","37%","$3,000","$600","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","HIOS","2017-01-20 09:19:19","Individual","No","58-1638390","49046GA0410058","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS022","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410058-02","BCBSHP Silver Pathway X Guided Access HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4L","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","55612","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","55612GA0180001","Family Basic Dental Plan (Low)","55612GA018",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0180001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49077"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","59-0397210","68806GA0020003","DentaQuest PPO Family High","68806GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0020003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","68806GA0010001","DentaQuest PPO  Pediatric High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","55612","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","55612GA0180001","Family Basic Dental Plan (Low)","55612GA018",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0180001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49077"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-00","Ambetter Balanced Care 1 (2017)","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010002-00.pdf","https://api.centene.com/Brochures/2017/70893GA0010002-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-01","Ambetter Balanced Care 1 (2017)","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010002-01.pdf","https://api.centene.com/Brochures/2017/70893GA0010002-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-02","Ambetter Balanced Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010002-02.pdf","https://api.centene.com/Brochures/2017/70893GA0010002-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-03","Ambetter Balanced Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010002-03.pdf","https://api.centene.com/Brochures/2017/70893GA0010002-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-04","Ambetter Balanced Care 1 (2017)","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010002-04.pdf","https://api.centene.com/Brochures/2017/70893GA0010002-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-05","Ambetter Balanced Care 1 (2017)","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010002-05.pdf","https://api.centene.com/Brochures/2017/70893GA0010002-05.pdf"
"2017","GA","55612","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","55612GA0190001","Family Enhanced Dental Plan (High)","55612GA019",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.88","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0190001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49079"
"2017","GA","55612","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","55612GA0190001","Family Enhanced Dental Plan (High)","55612GA019",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.88","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0190001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49079"
"2017","GA","63411","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","58-0469845","63411GA0480003","BCBSGA Dental Family","63411GA048",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0480003-01","BCBSGA Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215735.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","Individual","Yes","58-0469845","63411GA0510005","BCBSGA Dental Family Value","63411GA051",,"GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0510005-01","BCBSGA Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215737.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","Individual","Yes","58-0469845","63411GA0570005","BCBSGA Dental Family Value","63411GA057",,"GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0570005-00","BCBSGA Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215737.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","58-0469845","63411GA0540003","BCBSGA Dental Family","63411GA054",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0540003-00","BCBSGA Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215735.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","58-0469845","63411GA0480004","BCBSGA Dental Family Enhanced","63411GA048",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.837","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0480004-01","BCBSGA Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215736.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","Individual","Yes","58-0469845","63411GA0510003","BCBSGA Dental Family","63411GA051",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0510003-01","BCBSGA Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215735.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","Individual","Yes","58-0469845","63411GA0570003","BCBSGA Dental Family","63411GA057",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0570003-00","BCBSGA Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215735.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","58-0469845","63411GA0540004","BCBSGA Dental Family Enhanced","63411GA054",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.837","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0540004-00","BCBSGA Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215736.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","Individual","Yes","58-0469845","63411GA0510004","BCBSGA Dental Family Enhanced","63411GA051",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.837","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0510004-01","BCBSGA Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215736.pdf",
"2017","GA","63411","HIOS","2016-06-25 15:13:19","Individual","Yes","58-0469845","63411GA0570004","BCBSGA Dental Family Enhanced","63411GA057",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.837","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0570004-00","BCBSGA Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215736.pdf",
"2017","GA","63940","HIOS","2016-07-28 02:40:10","Individual","Yes","13-5123390","63940GA0210001","Guardian Basics for Families and Individuals","63940GA021",,"GAN002","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","63940GA0210001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","SHOP (Small Group)","Yes","13-5123390","63940GA0140004","Guardian Pediatric Advantage","63940GA014",,"GAN001","GAS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Coverage is provided outside of the Service Area.","Yes",,"","63940GA0140004-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","SHOP (Small Group)","Yes","13-5123390","63940GA0150004","Guardian Pediatric Essentials","63940GA015",,"GAN001","GAS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Coverage is provided outside of the Service Area.","Yes",,"","63940GA0150004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","Individual","Yes","13-5123390","63940GA0210001","Guardian Basics for Families and Individuals","63940GA021",,"GAN002","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","63940GA0210001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","Individual","Yes","13-5123390","63940GA0200002","Guardian Essentials for Families and Individuals","63940GA020",,"GAN002","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","63940GA0200002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","SHOP (Small Group)","Yes","13-5123390","63940GA0170005","Guardian Family Advantage","63940GA017",,"GAN001","GAS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","63940GA0170005-00","Guardian Family Advantage","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","SHOP (Small Group)","Yes","13-5123390","63940GA0190005","Guardian Family Essentials","63940GA019",,"GAN001","GAS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","63940GA0190005-00","Guardian Family Essentials","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","Individual","Yes","13-5123390","63940GA0200002","Guardian Essentials for Families and Individuals","63940GA020",,"GAN002","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","63940GA0200002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","SHOP (Small Group)","Yes","13-5123390","63940GA0170004","Guardian Family Advantage","63940GA017",,"GAN001","GAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","63940GA0170004-01","Guardian Family Advantage","Standard High On Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","GA","63940","HIOS","2016-07-28 02:40:10","SHOP (Small Group)","Yes","13-5123390","63940GA0190004","Guardian Family Essentials","63940GA019",,"GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","63940GA0190004-01","Guardian Family Essentials","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","GA","68687","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","36-0883760","68687GA0030002","EHB High Passive","68687GA003",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68687GA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","GA","68687","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","36-0883760","68687GA0030001","EHB Low Passive","68687GA003",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68687GA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","68806GA0010001","DentaQuest PPO  Pediatric High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","59-0397210","68806GA0020003","DentaQuest PPO Family High","68806GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0020003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-01","Ambetter Balanced Care 10 (2017)","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010005-01.pdf","https://api.centene.com/Brochures/2017/70893GA0010005-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-02","Ambetter Balanced Care 10 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010005-02.pdf","https://api.centene.com/Brochures/2017/70893GA0010005-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-03","Ambetter Balanced Care 10 (2017)","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010005-03.pdf","https://api.centene.com/Brochures/2017/70893GA0010005-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-04","Ambetter Balanced Care 10 (2017)","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010005-04.pdf","https://api.centene.com/Brochures/2017/70893GA0010005-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-05","Ambetter Balanced Care 10 (2017)","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010005-05.pdf","https://api.centene.com/Brochures/2017/70893GA0010005-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-06","Ambetter Balanced Care 10 (2017)","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010005-06.pdf","https://api.centene.com/Brochures/2017/70893GA0010005-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010008","Ambetter Balanced Care 3 (2017)","70893GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010008-00","Ambetter Balanced Care 3 (2017)","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010008-00.pdf","https://api.centene.com/Brochures/2017/70893GA0010008-00.pdf"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","59-0397210","68806GA0020004","DentaQuest PPO Family Low","68806GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0020004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","59-0397210","68806GA0020004","DentaQuest PPO Family Low","68806GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0020004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","68806GA0010003","DentaQuest PPO Family High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","68806GA0010003","DentaQuest PPO Family High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","68806GA0010004","DentaQuest PPO Family Low","68806GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","68806","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","68806GA0010004","DentaQuest PPO Family Low","68806GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2017","GA","69677","HIOS","2016-06-18 03:07:04","SHOP (Small Group)","Yes","47-0098400","69677GA0030002","EHB High Passive","69677GA003",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","69677GA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","GA","69677","HIOS","2016-06-18 03:07:04","SHOP (Small Group)","Yes","47-0098400","69677GA0030001","EHB Low Passive","69677GA003",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","69677GA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010001-00","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/70893GA0010001-00.pdf","https://api.centene.com/Brochures/2017/70893GA0010001-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010001-01","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/70893GA0010001-01.pdf","https://api.centene.com/Brochures/2017/70893GA0010001-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010001-02","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/70893GA0010001-02.pdf","https://api.centene.com/Brochures/2017/70893GA0010001-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010001-03","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/70893GA0010001-03.pdf","https://api.centene.com/Brochures/2017/70893GA0010001-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-06","Ambetter Balanced Care 1 (2017)","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010002-06.pdf","https://api.centene.com/Brochures/2017/70893GA0010002-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2017)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-00","Ambetter Balanced Care 2 (2017)","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010003-00.pdf","https://api.centene.com/Brochures/2017/70893GA0010003-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2017)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-01","Ambetter Balanced Care 2 (2017)","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010003-01.pdf","https://api.centene.com/Brochures/2017/70893GA0010003-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2017)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-02","Ambetter Balanced Care 2 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010003-02.pdf","https://api.centene.com/Brochures/2017/70893GA0010003-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2017)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-03","Ambetter Balanced Care 2 (2017)","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010003-03.pdf","https://api.centene.com/Brochures/2017/70893GA0010003-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2017)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-04","Ambetter Balanced Care 2 (2017)","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010003-04.pdf","https://api.centene.com/Brochures/2017/70893GA0010003-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2017)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-05","Ambetter Balanced Care 2 (2017)","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010003-05.pdf","https://api.centene.com/Brochures/2017/70893GA0010003-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2017)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-06","Ambetter Balanced Care 2 (2017)","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010003-06.pdf","https://api.centene.com/Brochures/2017/70893GA0010003-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2017)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-00","Ambetter Balanced Care 10 (2017)","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010005-00.pdf","https://api.centene.com/Brochures/2017/70893GA0010005-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010008","Ambetter Balanced Care 3 (2017)","70893GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010008-01","Ambetter Balanced Care 3 (2017)","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010008-01.pdf","https://api.centene.com/Brochures/2017/70893GA0010008-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010008","Ambetter Balanced Care 3 (2017)","70893GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010008-02","Ambetter Balanced Care 3 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010008-02.pdf","https://api.centene.com/Brochures/2017/70893GA0010008-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010008","Ambetter Balanced Care 3 (2017)","70893GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010008-03","Ambetter Balanced Care 3 (2017)","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010008-03.pdf","https://api.centene.com/Brochures/2017/70893GA0010008-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010008","Ambetter Balanced Care 3 (2017)","70893GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010008-04","Ambetter Balanced Care 3 (2017)","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010008-04.pdf","https://api.centene.com/Brochures/2017/70893GA0010008-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010008","Ambetter Balanced Care 3 (2017)","70893GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010008-05","Ambetter Balanced Care 3 (2017)","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010008-05.pdf","https://api.centene.com/Brochures/2017/70893GA0010008-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010008","Ambetter Balanced Care 3 (2017)","70893GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010008-06","Ambetter Balanced Care 3 (2017)","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010008-06.pdf","https://api.centene.com/Brochures/2017/70893GA0010008-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2017)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010009-00","Ambetter Balanced Care 4 (2017)","Standard Silver Off Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010009-00.pdf","https://api.centene.com/Brochures/2017/70893GA0010009-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2017)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010009-01","Ambetter Balanced Care 4 (2017)","Standard Silver On Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010009-01.pdf","https://api.centene.com/Brochures/2017/70893GA0010009-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2017)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010009-02","Ambetter Balanced Care 4 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010009-02.pdf","https://api.centene.com/Brochures/2017/70893GA0010009-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2017)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010009-03","Ambetter Balanced Care 4 (2017)","Limited Cost Sharing Plan Variation",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010009-03.pdf","https://api.centene.com/Brochures/2017/70893GA0010009-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2017)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010009-04","Ambetter Balanced Care 4 (2017)","73% AV Level Silver Plan",,"0.732531428337097","Yes","Yes","No","100%",,"$5,200","$40","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010009-04.pdf","https://api.centene.com/Brochures/2017/70893GA0010009-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2017)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010009-05","Ambetter Balanced Care 4 (2017)","87% AV Level Silver Plan",,"0.865934371948242","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010009-05.pdf","https://api.centene.com/Brochures/2017/70893GA0010009-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2017)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010009-06","Ambetter Balanced Care 4 (2017)","94% AV Level Silver Plan",,"0.947982847690582","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010009-06.pdf","https://api.centene.com/Brochures/2017/70893GA0010009-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010010","Ambetter Balanced Care 12 (2017)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010010-00","Ambetter Balanced Care 12 (2017)","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010010-00.pdf","https://api.centene.com/Brochures/2017/70893GA0010010-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010010","Ambetter Balanced Care 12 (2017)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010010-01","Ambetter Balanced Care 12 (2017)","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010010-01.pdf","https://api.centene.com/Brochures/2017/70893GA0010010-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010010","Ambetter Balanced Care 12 (2017)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010010-02","Ambetter Balanced Care 12 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010010-02.pdf","https://api.centene.com/Brochures/2017/70893GA0010010-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010010","Ambetter Balanced Care 12 (2017)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010010-03","Ambetter Balanced Care 12 (2017)","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010010-03.pdf","https://api.centene.com/Brochures/2017/70893GA0010010-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010010","Ambetter Balanced Care 12 (2017)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010010-04","Ambetter Balanced Care 12 (2017)","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$400","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010010-04.pdf","https://api.centene.com/Brochures/2017/70893GA0010010-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010010","Ambetter Balanced Care 12 (2017)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010010-05","Ambetter Balanced Care 12 (2017)","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$900","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010010-05.pdf","https://api.centene.com/Brochures/2017/70893GA0010010-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010010","Ambetter Balanced Care 12 (2017)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010010-06","Ambetter Balanced Care 12 (2017)","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$300","$200","$250","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010010-06.pdf","https://api.centene.com/Brochures/2017/70893GA0010010-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010006-00","Ambetter Essential Care 1 (2017)","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010006-00.pdf","https://api.centene.com/Brochures/2017/70893GA0010006-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010006-01","Ambetter Essential Care 1 (2017)","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010006-01.pdf","https://api.centene.com/Brochures/2017/70893GA0010006-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010006-02","Ambetter Essential Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010006-02.pdf","https://api.centene.com/Brochures/2017/70893GA0010006-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2017)","70893GA001",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010006-03","Ambetter Essential Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0010006-03.pdf","https://api.centene.com/Brochures/2017/70893GA0010006-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9844",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-00","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020001-00.pdf","https://api.centene.com/Brochures/2017/70893GA0020001-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9844",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-01","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020001-01.pdf","https://api.centene.com/Brochures/2017/70893GA0020001-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9844",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-02","Ambetter Balanced Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020001-02.pdf","https://api.centene.com/Brochures/2017/70893GA0020001-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9844",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-03","Ambetter Balanced Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020001-03.pdf","https://api.centene.com/Brochures/2017/70893GA0020001-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9844",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-04","Ambetter Balanced Care 1 (2017) + Vision","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020001-04.pdf","https://api.centene.com/Brochures/2017/70893GA0020001-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9844",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-05","Ambetter Balanced Care 1 (2017) + Vision","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020001-05.pdf","https://api.centene.com/Brochures/2017/70893GA0020001-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9844",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-06","Ambetter Balanced Care 1 (2017) + Vision","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020001-06.pdf","https://api.centene.com/Brochures/2017/70893GA0020001-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-00","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020002-00.pdf","https://api.centene.com/Brochures/2017/70893GA0020002-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-01","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020002-01.pdf","https://api.centene.com/Brochures/2017/70893GA0020002-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-02","Ambetter Balanced Care 2 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020002-02.pdf","https://api.centene.com/Brochures/2017/70893GA0020002-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-03","Ambetter Balanced Care 2 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020002-03.pdf","https://api.centene.com/Brochures/2017/70893GA0020002-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-04","Ambetter Balanced Care 2 (2017) + Vision","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020002-04.pdf","https://api.centene.com/Brochures/2017/70893GA0020002-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-05","Ambetter Balanced Care 2 (2017) + Vision","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020002-05.pdf","https://api.centene.com/Brochures/2017/70893GA0020002-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9852",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-06","Ambetter Balanced Care 2 (2017) + Vision","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020002-06.pdf","https://api.centene.com/Brochures/2017/70893GA0020002-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9843",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-00","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020003-00.pdf","https://api.centene.com/Brochures/2017/70893GA0020003-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9843",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-01","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020003-01.pdf","https://api.centene.com/Brochures/2017/70893GA0020003-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9843",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-02","Ambetter Balanced Care 10 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020003-02.pdf","https://api.centene.com/Brochures/2017/70893GA0020003-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9843",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-03","Ambetter Balanced Care 10 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020003-03.pdf","https://api.centene.com/Brochures/2017/70893GA0020003-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9843",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-04","Ambetter Balanced Care 10 (2017) + Vision","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020003-04.pdf","https://api.centene.com/Brochures/2017/70893GA0020003-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9843",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-05","Ambetter Balanced Care 10 (2017) + Vision","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020003-05.pdf","https://api.centene.com/Brochures/2017/70893GA0020003-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9843",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-06","Ambetter Balanced Care 10 (2017) + Vision","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020003-06.pdf","https://api.centene.com/Brochures/2017/70893GA0020003-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020006","Ambetter Balanced Care 3 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020006-00","Ambetter Balanced Care 3 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020006-00.pdf","https://api.centene.com/Brochures/2017/70893GA0020006-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020006","Ambetter Balanced Care 3 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020006-01","Ambetter Balanced Care 3 (2017) + Vision","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020006-01.pdf","https://api.centene.com/Brochures/2017/70893GA0020006-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020006","Ambetter Balanced Care 3 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020006-02","Ambetter Balanced Care 3 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020006-02.pdf","https://api.centene.com/Brochures/2017/70893GA0020006-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020006","Ambetter Balanced Care 3 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020006-03","Ambetter Balanced Care 3 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020006-03.pdf","https://api.centene.com/Brochures/2017/70893GA0020006-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020006","Ambetter Balanced Care 3 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020006-04","Ambetter Balanced Care 3 (2017) + Vision","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020006-04.pdf","https://api.centene.com/Brochures/2017/70893GA0020006-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020006","Ambetter Balanced Care 3 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020006-05","Ambetter Balanced Care 3 (2017) + Vision","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020006-05.pdf","https://api.centene.com/Brochures/2017/70893GA0020006-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020006","Ambetter Balanced Care 3 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020006-06","Ambetter Balanced Care 3 (2017) + Vision","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020006-06.pdf","https://api.centene.com/Brochures/2017/70893GA0020006-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.983",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020004-00","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020004-00.pdf","https://api.centene.com/Brochures/2017/70893GA0020004-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.983",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020004-01","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020004-01.pdf","https://api.centene.com/Brochures/2017/70893GA0020004-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.983",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020004-02","Ambetter Essential Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020004-02.pdf","https://api.centene.com/Brochures/2017/70893GA0020004-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2017) + Vision","70893GA002",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.983",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020004-03","Ambetter Essential Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0020004-03.pdf","https://api.centene.com/Brochures/2017/70893GA0020004-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9344",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-00","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030001-00.pdf","https://api.centene.com/Brochures/2017/70893GA0030001-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9344",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-01","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030001-01.pdf","https://api.centene.com/Brochures/2017/70893GA0030001-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9344",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-02","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030001-02.pdf","https://api.centene.com/Brochures/2017/70893GA0030001-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9344",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-03","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030001-03.pdf","https://api.centene.com/Brochures/2017/70893GA0030001-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9344",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-04","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030001-04.pdf","https://api.centene.com/Brochures/2017/70893GA0030001-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9344",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-05","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030001-05.pdf","https://api.centene.com/Brochures/2017/70893GA0030001-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9344",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-06","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030001-06.pdf","https://api.centene.com/Brochures/2017/70893GA0030001-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9374",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-00","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030002-00.pdf","https://api.centene.com/Brochures/2017/70893GA0030002-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9374",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-01","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030002-01.pdf","https://api.centene.com/Brochures/2017/70893GA0030002-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9374",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-02","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030002-02.pdf","https://api.centene.com/Brochures/2017/70893GA0030002-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9374",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-03","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030002-03.pdf","https://api.centene.com/Brochures/2017/70893GA0030002-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9374",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-04","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030002-04.pdf","https://api.centene.com/Brochures/2017/70893GA0030002-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9374",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-05","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030002-05.pdf","https://api.centene.com/Brochures/2017/70893GA0030002-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9374",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-06","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030002-06.pdf","https://api.centene.com/Brochures/2017/70893GA0030002-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9338",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-00","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030003-00.pdf","https://api.centene.com/Brochures/2017/70893GA0030003-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9338",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-01","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030003-01.pdf","https://api.centene.com/Brochures/2017/70893GA0030003-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9338",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-02","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030003-02.pdf","https://api.centene.com/Brochures/2017/70893GA0030003-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9338",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-03","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030003-03.pdf","https://api.centene.com/Brochures/2017/70893GA0030003-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9338",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-04","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030003-04.pdf","https://api.centene.com/Brochures/2017/70893GA0030003-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9338",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-05","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030003-05.pdf","https://api.centene.com/Brochures/2017/70893GA0030003-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9338",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-06","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030003-06.pdf","https://api.centene.com/Brochures/2017/70893GA0030003-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9314",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030006-00","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030006-00.pdf","https://api.centene.com/Brochures/2017/70893GA0030006-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9314",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030006-01","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030006-01.pdf","https://api.centene.com/Brochures/2017/70893GA0030006-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9314",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030006-02","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030006-02.pdf","https://api.centene.com/Brochures/2017/70893GA0030006-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9314",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030006-03","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030006-03.pdf","https://api.centene.com/Brochures/2017/70893GA0030006-03.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9314",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030006-04","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030006-04.pdf","https://api.centene.com/Brochures/2017/70893GA0030006-04.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9314",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030006-05","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030006-05.pdf","https://api.centene.com/Brochures/2017/70893GA0030006-05.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9314",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030006-06","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030006-06.pdf","https://api.centene.com/Brochures/2017/70893GA0030006-06.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9287",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030004-00","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030004-00.pdf","https://api.centene.com/Brochures/2017/70893GA0030004-00.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9287",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030004-01","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030004-01.pdf","https://api.centene.com/Brochures/2017/70893GA0030004-01.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9287",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030004-02","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030004-02.pdf","https://api.centene.com/Brochures/2017/70893GA0030004-02.pdf"
"2017","GA","70893","HIOS","2016-10-19 02:44:25","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9287",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030004-03","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/70893GA0030004-03.pdf","https://api.centene.com/Brochures/2017/70893GA0030004-03.pdf"
"2017","GA","73231","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","73231GA0040001","Renaissance Group Dental PPO, EHB Certified","73231GA004",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0040001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","73231","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","73231GA0030001","Renaissance Individual Dental PPO, EHB Certified","73231GA003",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0030001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","73231","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","73231GA0030002","Renaissance Individual Dental PPO, EHB Certified","73231GA003",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0030002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","73231","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","73231GA0040002","Renaissance Group Dental PPO, EHB Certified","73231GA004",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0040002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","73231","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","73231GA0090001","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0090001-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_Group_High_2017","http://www.renaissancedental.com/GA_EHB_Group_High_2017"
"2017","GA","73231","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","73231GA0070001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","73231GA007",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0070001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_High_2017","http://www.renaissancedental.com/GA_EHB_High_2017"
"2017","GA","73231","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","73231GA0070002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","73231GA007",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0070002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_Low_2017","http://www.renaissancedental.com/GA_EHB_Low_2017"
"2017","GA","73231","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","73231GA0090002","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0090002-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_Group_Low_2017","http://www.renaissancedental.com/GA_EHB_Group_Low_2017"
"2017","GA","73231","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","73231GA0090003","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0090003-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_50_50_High_2017","http://www.renaissancedental.com/GA_50_50_High_2017"
"2017","GA","73231","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","73231GA0090004","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0090004-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_50_50_Low_2017","http://www.renaissancedental.com/GA_50_50_Low_2017"
"2017","GA","73231","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","73231GA0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","73231GA006",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","73231","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","73231GA0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","73231GA006",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","GA","73231","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","73231GA0080001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","73231GA008",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0080001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_Ped_High_2017","http://www.renaissancedental.com/GA_Ped_High_2017"
"2017","GA","73231","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","73231GA0080002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","73231GA008",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0080002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_Ped_Low_2017","http://www.renaissancedental.com/GA_Ped_Low_2017"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050048","SimpleCare Gold PPO 50048","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050048-00","SimpleCare Gold PPO 50048-00","Standard Gold Off Exchange Plan",,"0.808989286422729","Yes","Yes","No","100%",,"$1,500","$420","$1,001","$60","$1,500","$1,220","$186","$55","$1,469","$150","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$40,000","$40000 per person","$80000 per group","$45,000","$45000 per person","$90000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,500","$21500 per person","$43000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050048_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050048","SimpleCare Gold PPO 50048","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050048-01","SimpleCare Gold PPO 50048-01","Standard Gold On Exchange Plan",,"0.808989286422729","Yes","Yes","No","100%",,"$1,500","$420","$1,001","$60","$1,500","$1,220","$186","$55","$1,469","$150","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$40,000","$40000 per person","$80000 per group","$45,000","$45000 per person","$90000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,500","$21500 per person","$43000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050048_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040007","SoloCare Silver PPO 40007","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040007-01","SoloCare Silver PPO 40007-01","Standard Silver On Exchange Plan",,"0.707396566867828","Yes","Yes","No","100%",,"$1,750","$630","$4,502","$60","$1,024","$1,475","$838","$55","$897","$180","$734","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","45.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,750","$21750 per person","$43000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040007_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040007","SoloCare Silver PPO 40007","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040007-02","SoloCare Silver PPO 40007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040007_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050050","SimpleCare Gold PPO 50050","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050050-00","SimpleCare Gold PPO 50050-00","Standard Gold Off Exchange Plan",,"0.818583607673645","Yes","Yes","No","100%",,"$2,100","$420","$0","$60","$1,862","$1,220","$0","$55","$1,632","$150","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$40,000","$40000 per person","$80000 per group","$44,000","$44000 per person","$88000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,100","$22100 per person","$44200 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050050_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050052","SimpleCare Gold PPO 50052","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050052-00","SimpleCare Gold PPO 50052-00","Standard Gold Off Exchange Plan",,"0.819018125534058","Yes","Yes","No","100%",,"$2,500","$420","$0","$60","$1,862","$1,220","$0","$55","$1,632","$150","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$40,000","$40000 per person","$80000 per group","$43,000","$43000 per person","$86000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050052_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040026","SoloCare Stdrd Gold PPO 40026","83761GA004",,"GAN001","GAS001","GAF009","New","PPO","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040026-01","SoloCare Stdrd Gold PPO 40026-01","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$4,750","$420","$2,001","$60","$1,489","$960","$372","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$40,000","$40000 per person","$80000 per group","$44,750","$44750 per person","$89500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,250","$21250 per person","$42500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040026_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","78196","HIOS","2016-06-18 03:07:04","SHOP (Small Group)","Yes","93-0242990","78196GA0030002","EHB High Passive","78196GA003",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","78196GA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","GA","78196","HIOS","2016-06-18 03:07:04","SHOP (Small Group)","Yes","93-0242990","78196GA0030001","EHB Low Passive","78196GA003",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","78196GA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83502GA0020003","BESTOne Advantage Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/2017/GA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010007","BESTDental Premium","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Premium_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010007","BESTDental Premium","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Premium_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83502GA0020003","BESTOne Advantage Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/2017/GA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83502GA0020004","BESTOne Plus Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/2017/GA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010008","BESTDental Standard - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Standard-H_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010008","BESTDental Standard - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Standard-H_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83502GA0020004","BESTOne Plus Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/2017/GA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010010","BESTDental Choice - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Standard-L_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010010","BESTDental Choice - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Standard-L_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010009","BESTDental Standard - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Choice-H_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83502GA0020005","BESTOne Plus Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/2017/GA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83502GA0020005","BESTOne Plus Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/2017/GA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010009","BESTDental Standard - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Choice-H_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010011","BESTDental Choice - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Choice-L_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83502GA0020006","BESTOne Basic Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/2017/GA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83502GA0020006","BESTOne Basic Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/2017/GA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010011","BESTDental Choice - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Choice-L_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010012","BESTDental Value","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Value_Plan.pdf"
"2017","GA","83502","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83502GA0010012","BESTDental Value","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/2017/GA_BESTDental_Value_Plan.pdf"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040002","SoloCare Gold PPO 40002","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040002-00","SoloCare Gold PPO 40002-00","Standard Gold Off Exchange Plan",,"0.817946314811707","Yes","Yes","No","100%",,"$1,500","$440","$0","$60","$1,500","$1,375","$0","$55","$1,500","$150","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,500","$21500 per person","$43000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040002_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050040","SimpleCare Platinum PPO 50040","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050040-00","SimpleCare Platinum PPO 50040-00","Standard Platinum Off Exchange Plan",,"0.888858258724213","Yes","Yes","No","100%",,"$500","$1,165","$0","$60","$500","$1,620","$0","$55","$500","$340","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,750","$41750 per person","$83500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,500","$20500 per person","$41000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050040_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050040","SimpleCare Platinum PPO 50040","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050040-01","SimpleCare Platinum PPO 50040-01","Standard Platinum On Exchange Plan",,"0.888858258724213","Yes","Yes","No","100%",,"$500","$1,165","$0","$60","$500","$1,620","$0","$55","$500","$340","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,750","$41750 per person","$83500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,500","$20500 per person","$41000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050040_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040002","SoloCare Gold PPO 40002","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040002-01","SoloCare Gold PPO 40002-01","Standard Gold On Exchange Plan",,"0.817946314811707","Yes","Yes","No","100%",,"$1,500","$440","$0","$60","$1,500","$1,375","$0","$55","$1,500","$150","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,500","$21500 per person","$43000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040002_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040002","SoloCare Gold PPO 40002","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040002-02","SoloCare Gold PPO 40002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040002_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050042","SimpleCare Platinum PPO 50042","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050042-00","SimpleCare Platinum PPO 50042-00","Standard Platinum Off Exchange Plan",,"0.888436675071716","Yes","Yes","No","100%",,"$750","$1,165","$0","$60","$750","$1,620","$0","$55","$750","$240","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,500","$41500 per person","$83000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,750","$20750 per person","$41500 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050042_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050042","SimpleCare Platinum PPO 50042","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050042-01","SimpleCare Platinum PPO 50042-01","Standard Platinum On Exchange Plan",,"0.888436675071716","Yes","Yes","No","100%",,"$750","$1,165","$0","$60","$750","$1,620","$0","$55","$750","$240","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,500","$41500 per person","$83000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,750","$20750 per person","$41500 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050042_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040002","SoloCare Gold PPO 40002","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040002-03","SoloCare Gold PPO 40002-03","Limited Cost Sharing Plan Variation",,"0.817946314811707","Yes","Yes","No","100%",,"$1,500","$440","$0","$60","$1,500","$1,375","$0","$55","$1,500","$150","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,500","$21500 per person","$43000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040002_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040003","SoloCare Gold PPO 40003","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040003-00","SoloCare Gold PPO 40003-00","Standard Gold Off Exchange Plan",,"0.804190039634705","Yes","Yes","No","100%",,"$1,000","$440","$1,001","$60","$1,000","$1,375","$186","$55","$1,000","$150","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040003_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050044","SimpleCare Platinum PPO 50044","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050044-00","SimpleCare Platinum PPO 50044-00","Standard Platinum Off Exchange Plan",,"0.919673621654511","Yes","Yes","No","100%",,"$1,000","$1,165","$0","$60","$1,000","$1,620","$0","$55","$1,000","$240","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,000","$41000 per person","$82000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050044_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050044","SimpleCare Platinum PPO 50044","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050044-01","SimpleCare Platinum PPO 50044-01","Standard Platinum On Exchange Plan",,"0.919673621654511","Yes","Yes","No","100%",,"$1,000","$1,165","$0","$60","$1,000","$1,620","$0","$55","$1,000","$240","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,000","$41000 per person","$82000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050044_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040003","SoloCare Gold PPO 40003","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040003-01","SoloCare Gold PPO 40003-01","Standard Gold On Exchange Plan",,"0.804190039634705","Yes","Yes","No","100%",,"$1,000","$440","$1,001","$60","$1,000","$1,375","$186","$55","$1,000","$150","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040003_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040003","SoloCare Gold PPO 40003","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040003-02","SoloCare Gold PPO 40003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040003_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050046","SimpleCare Gold PPO 50046","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050046-00","SimpleCare Gold PPO 50046-00","Standard Gold Off Exchange Plan",,"0.81618344783783","Yes","Yes","No","100%",,"$1,000","$420","$2,001","$60","$100","$1,220","$372","$55","$1,000","$150","$326","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$40,000","$40000 per person","$80000 per group","$44,000","$44000 per person","$88000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050046_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050050","SimpleCare Gold PPO 50050","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050050-01","SimpleCare Gold PPO 50050-01","Standard Gold On Exchange Plan",,"0.818583607673645","Yes","Yes","No","100%",,"$2,100","$420","$0","$60","$1,862","$1,220","$0","$55","$1,632","$150","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$40,000","$40000 per person","$80000 per group","$44,000","$44000 per person","$88000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,100","$22100 per person","$44200 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050050_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040007","SoloCare Silver PPO 40007","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040007-03","SoloCare Silver PPO 40007-03","Limited Cost Sharing Plan Variation",,"0.707396566867828","Yes","Yes","No","100%",,"$1,750","$630","$4,502","$60","$1,024","$1,475","$838","$55","$897","$180","$734","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","45.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,750","$21750 per person","$43000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040007_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040007","SoloCare Silver PPO 40007","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040007-04","SoloCare Silver PPO 40007-04","73% AV Level Silver Plan",,"0.733973383903503","Yes","Yes","No","100%",,"$1,500","$630","$4,502","$60","$1,024","$1,475","$838","$55","$897","$180","$734","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$40,000","$40000 per person","$80000 per group","$45,700","$45700 per person","$91400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","45.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,500","$21500 per person","$43000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040007_04.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050046","SimpleCare Gold PPO 50046","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050046-01","SimpleCare Gold PPO 50046-01","Standard Gold On Exchange Plan",,"0.81618344783783","Yes","Yes","No","100%",,"$1,000","$420","$2,001","$60","$100","$1,220","$372","$55","$1,000","$150","$326","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$40,000","$40000 per person","$80000 per group","$44,000","$44000 per person","$88000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050046_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040003","SoloCare Gold PPO 40003","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040003-03","SoloCare Gold PPO 40003-03","Limited Cost Sharing Plan Variation",,"0.804190039634705","Yes","Yes","No","100%",,"$1,000","$440","$1,001","$60","$1,000","$1,375","$186","$55","$1,000","$150","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040003_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040007","SoloCare Silver PPO 40007","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040007-00","SoloCare Silver PPO 40007-00","Standard Silver Off Exchange Plan",,"0.707396566867828","Yes","Yes","No","100%",,"$1,750","$630","$4,502","$60","$1,024","$1,475","$838","$55","$897","$180","$734","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","45.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,750","$21750 per person","$43000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040007_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040017-02","SoloCare Silver PPO 40017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040017_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050064","SimpleCare Silver PPO 50064","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050064-00","SimpleCare Silver PPO 50064-00","Standard Silver Off Exchange Plan",,"0.714234471321106","Yes","Yes","No","100%",,"$5,500","$610","$1,001","$60","$1,675","$1,125","$186","$55","$1,469","$180","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,500","$25500 per person","$51000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050064_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050064","SimpleCare Silver PPO 50064","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050064-01","SimpleCare Silver PPO 50064-01","Standard Silver On Exchange Plan",,"0.714234471321106","Yes","Yes","No","100%",,"$5,500","$610","$1,001","$60","$1,675","$1,125","$186","$55","$1,469","$180","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,500","$25500 per person","$51000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050064_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040017-03","SoloCare Silver PPO 40017-03","Limited Cost Sharing Plan Variation",,"0.716718316078186","Yes","Yes","No","100%",,"$4,750","$630","$0","$60","$1,862","$1,475","$0","$55","$1,635","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,750","$24750 per person","$49000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040017_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040017-04","SoloCare Silver PPO 40017-04","73% AV Level Silver Plan",,"0.739329099655151","Yes","Yes","No","100%",,"$4,000","$630","$0","$60","$1,862","$1,475","$0","$55","$1,632","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$40,000","$40000 per person","$80000 per group","$45,700","$45700 per person","$91400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,000","$24000 per person","$48000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040017_04.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040017-05","SoloCare Silver PPO 40017-05","87% AV Level Silver Plan",,"0.864045679569244","Yes","Yes","No","100%",,"$1,000","$630","$0","$60","$1,000","$1,475","$0","$55","$1,000","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$40,000","$40000 per person","$80000 per group","$42,000","$42000 per person","$84000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040017_05.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040017-06","SoloCare Silver PPO 40017-06","94% AV Level Silver Plan",,"0.943554639816284","Yes","Yes","No","100%",,"$250","$630","$0","$60","$250","$1,475","$0","$55","$250","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$40,000","$40000 per person","$80000 per group","$40,500","$40500 per person","$81000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,250","$20250 per person","$40500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040017_06.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040021","SoloCare Bronze PPO 40021","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040021-00","SoloCare Bronze PPO 40021-00","Standard Bronze Off Exchange Plan",,"0.609810709953308","Yes","Yes","No","100%",,"$1,750","$0","$0","$60","$7,150","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,150","$27150 per person","$54300 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040021_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050052","SimpleCare Gold PPO 50052","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050052-01","SimpleCare Gold PPO 50052-01","Standard Gold On Exchange Plan",,"0.819018125534058","Yes","Yes","No","100%",,"$2,500","$420","$0","$60","$1,862","$1,220","$0","$55","$1,632","$150","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$40,000","$40000 per person","$80000 per group","$43,000","$43000 per person","$86000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050052_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040007","SoloCare Silver PPO 40007","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040007-05","SoloCare Silver PPO 40007-05","87% AV Level Silver Plan",,"0.860937833786011","Yes","Yes","No","100%",,"$500","$630","$4,502","$500","$1,475","$898","$55","$500","$180","$734","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,500","$41500 per person","$83000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","45.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,500","$20500 per person","$41000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040007_05.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040007","SoloCare Silver PPO 40007","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040007-06","SoloCare Silver PPO 40007-06","94% AV Level Silver Plan",,"0.938892304897308","Yes","Yes","No","100%",,"$200","$630","$4,502","$60","$200","$1,475","$838","$55","$200","$180","$734","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$40,000","$40000 per person","$80000 per group","$40,400","$40400 per person","$80800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","45.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,200","$20200 per person","$40400 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040007_06.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050054","SimpleCare Gold PPO 50054","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050054-00","SimpleCare Gold PPO 50054-00","Standard Gold Off Exchange Plan",,"0.819049954414368","Yes","Yes","No","100%",,"$3,000","$420","$0","$60","$1,186","$1,220","$0","$55","$1,632","$150","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$40,000","$40000 per person","$80000 per group","$43,000","$43000 per person","$86000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050054_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050054","SimpleCare Gold PPO 50054","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050054-01","SimpleCare Gold PPO 50054-01","Standard Gold On Exchange Plan",,"0.819049954414368","Yes","Yes","No","100%",,"$3,000","$420","$0","$60","$1,186","$1,220","$0","$55","$1,632","$150","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$40,000","$40000 per person","$80000 per group","$43,000","$43000 per person","$86000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050054_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040010-00","SoloCare Silver PPO 40010-00","Standard Silver Off Exchange Plan",,"0.714331030845642","Yes","Yes","No","100%",,"$2,500","$630","$3,002","$60","$1,303","$1,475","$558","$55","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040010_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040010-01","SoloCare Silver PPO 40010-01","Standard Silver On Exchange Plan",,"0.714331030845642","Yes","Yes","No","100%",,"$2,500","$630","$3,002","$60","$1,303","$1,475","$558","$55","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040010_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050056","SimpleCare Silver PPO 50056","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050056-00","SimpleCare Silver PPO 50056-00","Standard Silver Off Exchange Plan",,"0.717050135135651","Yes","Yes","No","100%",,"$3,500","$610","$3,002","$60","$1,303","$1,320","$558","$55","$1,142","$180","$490","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050056_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050056","SimpleCare Silver PPO 50056","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050056-01","SimpleCare Silver PPO 50056-01","Standard Silver On Exchange Plan",,"0.717050135135651","Yes","Yes","No","100%",,"$3,500","$610","$3,002","$60","$1,303","$1,320","$558","$55","$1,142","$180","$490","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050056_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040010-02","SoloCare Silver PPO 40010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040010_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040010-03","SoloCare Silver PPO 40010-03","Limited Cost Sharing Plan Variation",,"0.714331030845642","Yes","Yes","No","100%",,"$2,500","$630","$3,002","$60","$1,303","$1,475","$558","$55","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040010_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050058","SimpleCare Silver PPO 50058","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050058-00","SimpleCare Silver PPO 50058-00","Standard Silver Off Exchange Plan",,"0.712589800357819","Yes","Yes","No","100%",,"$4,000","$610","$3,002","$60","$1,303","$1,320","$558","$55","$1,142","$180","$490","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,000","$24000 per person","$48000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050058_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050058","SimpleCare Silver PPO 50058","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050058-01","SimpleCare Silver PPO 50058-01","Standard Silver On Exchange Plan",,"0.712589800357819","Yes","Yes","No","100%",,"$4,000","$610","$3,002","$60","$1,303","$1,320","$558","$55","$1,142","$180","$490","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,000","$24000 per person","$48000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050058_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040010-04","SoloCare Silver PPO 40010-04","73% AV Level Silver Plan",,"0.739030063152313","Yes","Yes","No","100%",,"$2,100","$630","$3,002","$60","$1,303","$1,475","$558","$55","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$40,000","$40000 per person","$80000 per group","$45,700","$45700 per person","$91400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,100","$22100 per person","$44200 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040010_04.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040010-05","SoloCare Silver PPO 40010-05","87% AV Level Silver Plan",,"0.874338805675507","Yes","Yes","No","100%",,"$500","$630","$3,002","$60","$500","$1,475","$558","$55","$500","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,500","$41500 per person","$83000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,500","$20500 per person","$41000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040010_05.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050060","SimpleCare Silver PPO 50060","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050060-00","SimpleCare Silver PPO 50060-00","Standard Silver Off Exchange Plan",,"0.715682089328766","Yes","Yes","No","100%",,"$4,500","$610","$2,001","$60","$1,489","$1,320","$372","$55","$1,305","$180","$326","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,500","$24500 per person","$49000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050060_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050060","SimpleCare Silver PPO 50060","83761GA005",,"GAN001","GAS001","GAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050060-01","SimpleCare Silver PPO 50060-01","Standard Silver On Exchange Plan",,"0.715682089328766","Yes","Yes","No","100%",,"$4,500","$610","$2,001","$60","$1,489","$1,320","$372","$55","$1,305","$180","$326","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,500","$24500 per person","$49000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050060_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040010-06","SoloCare Silver PPO 40010-06","94% AV Level Silver Plan",,"0.932297706604004","Yes","Yes","No","100%",,"$250","$630","$3,002","$60","$250","$1,475","$558","$55","$250","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$40,000","$40000 per person","$80000 per group","$40,500","$40500 per person","$81000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,250","$20250 per person","$40500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040010_06.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040017-00","SoloCare Silver PPO 40017-00","Standard Silver Off Exchange Plan",,"0.716718316078186","Yes","Yes","No","100%",,"$4,750","$630","$0","$60","$1,862","$1,475","$0","$55","$1,635","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,750","$24750 per person","$49000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040017_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050062","SimpleCare Silver PPO 50062","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050062-00","SimpleCare Silver PPO 50062-00","Standard Silver Off Exchange Plan",,"0.712205052375793","Yes","Yes","No","100%",,"$5,000","$610","$2,001","$60","$1,489","$1,320","$372","$55","$1,305","$180","$326","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050062_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050062","SimpleCare Silver PPO 50062","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050062-01","SimpleCare Silver PPO 50062-01","Standard Silver On Exchange Plan",,"0.712205052375793","Yes","Yes","No","100%",,"$5,000","$610","$2,001","$60","$1,489","$1,320","$372","$55","$1,305","$180","$326","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050062_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040017-01","SoloCare Silver PPO 40017-01","Standard Silver On Exchange Plan",,"0.716718316078186","Yes","Yes","No","100%",,"$4,750","$630","$0","$60","$1,862","$1,475","$0","$55","$1,635","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,750","$24750 per person","$49000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040017_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040021","SoloCare Bronze PPO 40021","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040021-01","SoloCare Bronze PPO 40021-01","Standard Bronze On Exchange Plan",,"0.609810709953308","Yes","Yes","No","100%",,"$1,750","$0","$0","$60","$7,150","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,150","$27150 per person","$54300 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040021_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040021","SoloCare Bronze PPO 40021","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040021-02","SoloCare Bronze PPO 40021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040021_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040021","SoloCare Bronze PPO 40021","83761GA004",,"GAN001","GAS001","GAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040021-03","SoloCare Bronze PPO 40021-03","Limited Cost Sharing Plan Variation",,"0.609810709953308","Yes","Yes","No","100%",,"$1,750","$0","$0","$60","$7,150","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,150","$27150 per person","$54300 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040021_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040026","SoloCare Stdrd Gold PPO 40026","83761GA004",,"GAN001","GAS001","GAF009","New","PPO","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040026-02","SoloCare Stdrd Gold PPO 40026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040026_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040026","SoloCare Stdrd Gold PPO 40026","83761GA004",,"GAN001","GAS001","GAF009","New","PPO","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040026-03","SoloCare Stdrd Gold PPO 40026-03","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$4,750","$420","$2,001","$60","$1,489","$960","$372","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$40,000","$40000 per person","$80000 per group","$44,750","$44750 per person","$89500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,250","$21250 per person","$42500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040026_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040024","SoloCare Stdrd Bronze 40024","83761GA004",,"GAN001","GAS001","GAF007","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040024-00","SoloCare Stdrd Bronze 40024-00","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,200","$230","$6,200","$60","$3,395","$1,445","$2,321","$55","$963","$0","$963","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,500","$26500 per person","$53000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040024_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040032","SoloCare Bronze HDHP 40032","83761GA004",,"GAN001","GAS001","GAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040032-02","SoloCare Bronze HDHP 40032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040032_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040032","SoloCare Bronze HDHP 40032","83761GA004",,"GAN001","GAS001","GAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040032-03","SoloCare Bronze HDHP 40032-03","Limited Cost Sharing Plan Variation",,"0.616105139255524","Yes","Yes","No","100%",,"$5,500","$0","$3,790","$60","$5,029","$0","$2,155","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,550","$46550 per person","$93100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,500","$25500 per person","$51000 per group","Yes",,,"http://www.alliantplans.com/2017/solocare/83761GA0040032_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040022","SoloCare Platinum PPO 40022","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040022-00","SoloCare Platinum PPO 40022-00","Standard Platinum Off Exchange Plan",,"0.908210158348084","Yes","Yes","No","100%",,"$500","$80","$0","$60","$500","$1,245","$0","$55","$500","$75","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,500","$41500 per person","$83000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,500","$20500 per person","$41000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040022_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040022","SoloCare Platinum PPO 40022","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040022-01","SoloCare Platinum PPO 40022-01","Standard Platinum On Exchange Plan",,"0.908210158348084","Yes","Yes","No","100%",,"$500","$80","$0","$60","$500","$1,245","$0","$55","$500","$75","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,500","$41500 per person","$83000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,500","$20500 per person","$41000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040022_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040022","SoloCare Platinum PPO 40022","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040022-02","SoloCare Platinum PPO 40022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040022_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040022","SoloCare Platinum PPO 40022","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040022-03","SoloCare Platinum PPO 40022-03","Limited Cost Sharing Plan Variation",,"0.908210158348084","Yes","Yes","No","100%",,"$500","$80","$0","$60","$500","$1,245","$0","$55","$500","$75","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,500","$41500 per person","$83000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,500","$20500 per person","$41000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040022_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040023","SoloCare Platinum PPO 40023","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040023-00","SoloCare Platinum PPO 40023-00","Standard Platinum Off Exchange Plan",,"0.888423264026642","Yes","Yes","No","100%",,"$750","$80","$0","$60","$750","$1,245","$0","$55","$750","$75","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$40,000","$40000 per person","$80000 per group","$42,000","$42000 per person","$84000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,750","$20750 per person","$41500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040023_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040023","SoloCare Platinum PPO 40023","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040023-01","SoloCare Platinum PPO 40023-01","Standard Platinum On Exchange Plan",,"0.888423264026642","Yes","Yes","No","100%",,"$750","$80","$0","$60","$750","$1,245","$0","$55","$750","$75","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$40,000","$40000 per person","$80000 per group","$42,000","$42000 per person","$84000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,750","$20750 per person","$41500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040023_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040023","SoloCare Platinum PPO 40023","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040023-02","SoloCare Platinum PPO 40023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040023_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040023","SoloCare Platinum PPO 40023","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040023-03","SoloCare Platinum PPO 40023-03","Limited Cost Sharing Plan Variation",,"0.888423264026642","Yes","Yes","No","100%",,"$750","$80","$0","$60","$750","$1,245","$0","$55","$750","$75","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$40,000","$40000 per person","$80000 per group","$42,000","$42000 per person","$84000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,750","$20750 per person","$41500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040023_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040025","SoloCare Stdrd Silver PPO 40025","83761GA004",,"GAN001","GAS001","GAF008","New","PPO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040025-00","SoloCare Stdrd Silver PPO 40025-00","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$630","$2,001","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040025_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050066","SimpleCare Silver PPO 50066","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050066-00","SimpleCare Silver PPO 50066-00","Standard Silver Off Exchange Plan",,"0.712770402431488","Yes","Yes","No","100%",,"$6,000","$610","$1,001","$60","$1,675","$1,125","$186","$55","$1,469","$180","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,000","$26000 per person","$52000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050066_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050066","SimpleCare Silver PPO 50066","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050066-01","SimpleCare Silver PPO 50066-01","Standard Silver On Exchange Plan",,"0.712770402431488","Yes","Yes","No","100%",,"$6,000","$610","$1,001","$60","$1,675","$1,125","$186","$55","$1,469","$180","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,000","$26000 per person","$52000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050066_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040025","SoloCare Stdrd Silver PPO 40025","83761GA004",,"GAN001","GAS001","GAF008","New","PPO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040025-01","SoloCare Stdrd Silver PPO 40025-01","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$630","$2,001","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040025_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040025","SoloCare Stdrd Silver PPO 40025","83761GA004",,"GAN001","GAS001","GAF008","New","PPO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040025-02","SoloCare Stdrd Silver PPO 40025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040025_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050068","SimpleCare Silver PPO 50068","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050068-00","SimpleCare Silver PPO 50068-00","Standard Silver Off Exchange Plan",,"0.710796475410461","Yes","Yes","No","100%",,"$6,500","$610","$1,001","$60","$1,675","$1,125","$186","$55","$1,469","$180","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,500","$26500 per person","$53000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050068_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050068","SimpleCare Silver PPO 50068","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050068-01","SimpleCare Silver PPO 50068-01","Standard Silver On Exchange Plan",,"0.710796475410461","Yes","Yes","No","100%",,"$6,500","$610","$1,001","$60","$1,675","$1,125","$186","$55","$1,469","$180","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,500","$26500 per person","$53000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050068_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040025","SoloCare Stdrd Silver PPO 40025","83761GA004",,"GAN001","GAS001","GAF008","New","PPO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040025-03","SoloCare Stdrd Silver PPO 40025-03","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$630","$2,001","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040025_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040025","SoloCare Stdrd Silver PPO 40025","83761GA004",,"GAN001","GAS001","GAF008","New","PPO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040025-04","SoloCare Stdrd Silver PPO 40025-04","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$610","$3,001","$60","$1,489","$1,330","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$40,000","$40000 per person","$80000 per group","$45,700","$45700 per person","$91400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040025_04.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050070","SimpleCare Silver PPO 50070","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050070-00","SimpleCare Silver PPO 50070-00","Standard Silver Off Exchange Plan",,"0.697663605213165","Yes","Yes","No","100%",,"$7,000","$610","$1,001","$60","$1,675","$1,125","$186","$55","$1,469","$180","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,000","$27000 per person","$54000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050070_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050070","SimpleCare Silver PPO 50070","83761GA005",,"GAN001","GAS001","GAF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050070-01","SimpleCare Silver PPO 50070-01","Standard Silver On Exchange Plan",,"0.697663605213165","Yes","Yes","No","100%",,"$7,000","$610","$1,001","$60","$1,675","$1,125","$186","$55","$1,469","$180","$163","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,000","$27000 per person","$54000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050070_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040025","SoloCare Stdrd Silver PPO 40025","83761GA004",,"GAN001","GAS001","GAF008","New","PPO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040025-05","SoloCare Stdrd Silver PPO 40025-05","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$210","$2,001","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$40,000","$40000 per person","$80000 per group","$42,000","$42000 per person","$84000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,700","$20700 per person","$41400 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040025_05.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040025","SoloCare Stdrd Silver PPO 40025","83761GA004",,"GAN001","GAS001","GAF008","New","PPO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040025-06","SoloCare Stdrd Silver PPO 40025-06","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$107","$500","$60","$250","$228","$93","$55","$250","$45","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$40,000","$40000 per person","$80000 per group","$41,250","$41250 per person","$82500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,250","$20250 per person","$40500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040025_06.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050074","SimpleCare Bronze PPO 50074","83761GA005",,"GAN001","GAS001","GAF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050074-00","SimpleCare Bronze PPO 50074-00","Standard Bronze Off Exchange Plan",,"0.606137335300446","Yes","Yes","No","100%",,"$7,000","$0","$3,790","$60","$5,029","$0","$2,155","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,000","$27000 per person","$54000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050074_00.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","58-2335921","83761GA0050074","SimpleCare Bronze PPO 50074","83761GA005",,"GAN001","GAS001","GAF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0050074-01","SimpleCare Bronze PPO 50074-01","Standard Bronze On Exchange Plan",,"0.606137335300446","Yes","Yes","No","100%",,"$7,000","$0","$3,790","$60","$5,029","$0","$2,155","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,000","$27000 per person","$54000 per group","No","No",,"http://www.alliantplans.com/2017/simplecare/83761GA0050074_01.pdf","http://www.alliantplans.com/2017/brochures/simplecare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040026","SoloCare Stdrd Gold PPO 40026","83761GA004",,"GAN001","GAS001","GAF009","New","PPO","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040026-00","SoloCare Stdrd Gold PPO 40026-00","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$4,750","$420","$2,001","$60","$1,489","$960","$372","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$40,000","$40000 per person","$80000 per group","$44,750","$44750 per person","$89500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,250","$21250 per person","$42500 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040026_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040024","SoloCare Stdrd Bronze 40024","83761GA004",,"GAN001","GAS001","GAF007","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040024-01","SoloCare Stdrd Bronze 40024-01","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,200","$230","$6,200","$60","$3,395","$1,445","$2,321","$55","$963","$0","$963","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,500","$26500 per person","$53000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040024_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040024","SoloCare Stdrd Bronze 40024","83761GA004",,"GAN001","GAS001","GAF007","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040024-02","SoloCare Stdrd Bronze 40024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040024_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040024","SoloCare Stdrd Bronze 40024","83761GA004",,"GAN001","GAS001","GAF007","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040024-03","SoloCare Stdrd Bronze 40024-03","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,200","$230","$6,200","$60","$3,395","$1,445","$2,321","$55","$963","$0","$963","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,500","$26500 per person","$53000 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040024_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040031","SoloCare Bronze HDHP 40031","83761GA004",,"GAN001","GAS001","GAF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040031-00","SoloCare Bronze HDHP 40031-00","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$60","$6,500","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,500","$46500 per person","$93000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,500","$26500 per person","$53000 per group","Yes",,,"http://www.alliantplans.com/2017/solocare/83761GA0040031_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040031","SoloCare Bronze HDHP 40031","83761GA004",,"GAN001","GAS001","GAF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040031-01","SoloCare Bronze HDHP 40031-01","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$60","$6,500","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,500","$46500 per person","$93000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,500","$26500 per person","$53000 per group","Yes",,,"http://www.alliantplans.com/2017/solocare/83761GA0040031_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040031","SoloCare Bronze HDHP 40031","83761GA004",,"GAN001","GAS001","GAF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040031-02","SoloCare Bronze HDHP 40031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2017/solocare/83761GA0040031_02.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040031","SoloCare Bronze HDHP 40031","83761GA004",,"GAN001","GAS001","GAF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040031-03","SoloCare Bronze HDHP 40031-03","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$60","$6,500","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,500","$46500 per person","$93000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,500","$26500 per person","$53000 per group","Yes",,,"http://www.alliantplans.com/2017/solocare/83761GA0040031_03.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040032","SoloCare Bronze HDHP 40032","83761GA004",,"GAN001","GAS001","GAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040032-00","SoloCare Bronze HDHP 40032-00","Standard Bronze Off Exchange Plan",,"0.616105139255524","Yes","Yes","No","100%",,"$5,500","$0","$3,790","$60","$5,029","$0","$2,155","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,550","$46550 per person","$93100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,500","$25500 per person","$51000 per group","Yes",,,"http://www.alliantplans.com/2017/solocare/83761GA0040032_00.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","83761","HIOS","2016-10-19 02:44:25","Individual","No","58-2335921","83761GA0040032","SoloCare Bronze HDHP 40032","83761GA004",,"GAN001","GAS001","GAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.99776280397402",,,"2017-01-01","2017-12-31","No","Coverage is available for emergency situations","Yes","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/AlliantFilesWP/linked/Navitus-EHB-Formulary.pdf","83761GA0040032-01","SoloCare Bronze HDHP 40032-01","Standard Bronze On Exchange Plan",,"0.616105139255524","Yes","Yes","No","100%",,"$5,500","$0","$3,790","$60","$5,029","$0","$2,155","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,550","$46550 per person","$93100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,500","$25500 per person","$51000 per group","Yes",,,"http://www.alliantplans.com/2017/solocare/83761GA0040032_01.pdf","http://www.alliantplans.com/2017/brochures/solocare-2017-brochure/"
"2017","GA","86637","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","86637GA0010002","Delta Dental PPO Pediatric Preferred Plan","86637GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010002-17"
"2017","GA","86637","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","86637GA0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020002-17"
"2017","GA","86637","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","86637GA0010001","Delta Dental PPO Pediatric Basic Plan","86637GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010001-17"
"2017","GA","86637","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","86637GA0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020001-17"
"2017","GA","86637","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","86637GA0010006","Delta Dental PPO Basic Plan for Families","86637GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010006-17"
"2017","GA","86637","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","86637GA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020006-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020006-17"
"2017","GA","86637","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","86637GA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020004-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020004-17"
"2017","GA","86637","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","86637GA0010004","Delta Dental PPO Preferred Plan for Families","86637GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010004-17"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","86681GA0010001","DentaTrust-PPO Pediatric High Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010001-00","DentaTrust-PPO Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","86681GA0020003","DentaSpan Family High Option","86681GA002","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","86681GA0020003","DentaSpan Family High Option","86681GA002","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","86681GA0010001","DentaTrust-PPO Pediatric High Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010001-01","DentaTrust-PPO Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","86681GA0010002","DentaTrust-PPO Pediatric Low Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010002-00","DentaTrust-PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","86681GA0020004","DentaSpan Family Low Option","86681GA002","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","86681GA0020004","DentaSpan Family Low Option","86681GA002","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","86681GA0010002","DentaTrust-PPO Pediatric Low Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010002-01","DentaTrust-PPO Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","86681GA0030003","DentaSpan Dental-Family High Option-Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0030003-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","86681GA0030004","DentaSpan Dental-Family Low Option-Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0030004-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050005-06","KP GA Silver 0/5/94% CSR","94% AV Level Silver Plan","94.98%","0.950637459754944","No","Yes","No","100%",,"$0","$10","$700","$200","$0","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_0_5_94_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 4500/20","89942GA005",,"GAN001","GAS002","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050007-02","KP GA Bronze 4500/20 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_4500_20_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050010","KP GA Catastrophic 7150/0","89942GA005",,"GAN001","GAS002","GAF010","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050010-01","KP GA Catastrophic 7150/0","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,600","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Catastrophic_7150_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710040","Humana Bronze 6550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710040-01","Humana Bronze 6550/Macon HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2844062",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710040","Humana Bronze 6550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710040-02","Humana Bronze 6550/Macon HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2844075",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710040","Humana Bronze 6550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710040-03","Humana Bronze 6550/Macon HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2844101",
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060006","KP GA Bronze 5250/40/40/S4","89942GA006",,"GAN001","GAS001","GAF026","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060006-01","KP GA Bronze 5250/40/40/S4","Standard Bronze On Exchange Plan","61.88%","0.619027256965637","Yes","Yes","No","100%",,"$5,300","$20","$800","$200","$100","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20BRONZE%205250_40_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050014-04","KP GA Silver Std 3000/30/73% CSR","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$100","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_STD_3000_30_73_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060014","KP GA Gold 500/20/25/S4","89942GA006",,"GAN001","GAS001","GAF019","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060014-00","KP GA Gold 500/20/25/S4","Standard Gold Off Exchange Plan","80.86%","0.807829737663269","No","Yes","No","100%",,"$500","$70","$1,200","$200","$0","$1,700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20GOLD%20500_20_25_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710044","Humana Basic 7150/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710044-01","Humana Basic 7150/Savannah HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843607",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710002","Humana Bronze 6550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710002-00","Humana Bronze 6550/Atlanta HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2843919",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610002","Humana Copay Gold 100/1000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF007","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610002-00","Humana Copay Gold 100/1000 National POS - Open Access","Standard Gold Off Exchange Plan","81.65%","0.822226166725159","No","Yes","No","100%",,"$1,000","$0","$3,000","$30","$1,000","$1,200","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861391","http://apps.humana.com/marketing/documents.asp?file=2861469"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610002","Humana Copay Gold 100/1000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF007","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610002-01","Humana Copay Gold 100/1000 National POS - Open Access","Standard Gold On Exchange Plan","81.65%","0.822226166725159","No","Yes","No","100%",,"$1,000","$0","$3,000","$30","$1,000","$1,200","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861391","http://apps.humana.com/marketing/documents.asp?file=2861469"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","86681GA0030001","DentaSpan Pediatric High Option- Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0030001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","86681GA0010003","DentaTrust-PPO Family High Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","86681GA0010003","DentaTrust-PPO Family High Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","86681GA0030002","DentaSpan Pediatric Low Option- Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0030002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","86681GA0010004","DentaTrust-PPO Family Low Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com"
"2017","GA","86681","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","86681GA0010004","DentaTrust-PPO Family Low Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060002","KP GA Gold 0/20/30/S4","89942GA006",,"GAN001","GAS001","GAF018","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060002-00","KP GA Gold 0/20/30/S4","Standard Gold Off Exchange Plan","81.89%","0.823972880840302","No","Yes","No","100%",,"$0","$70","$1,300","$200","$0","$1,500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20GOLD%200_20_30_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050002-00","KP GA Gold 500/20","Standard Gold Off Exchange Plan","80.46%","0.805793941020966","No","Yes","No","100%",,"$500","$2,000","$300","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_500_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050002-01","KP GA Gold 500/20","Standard Gold On Exchange Plan","80.46%","0.805793941020966","No","Yes","No","100%",,"$500","$2,000","$300","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_500_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060002","KP GA Gold 0/20/30/S4","89942GA006",,"GAN001","GAS001","GAF018","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060002-01","KP GA Gold 0/20/30/S4","Standard Gold On Exchange Plan","81.89%","0.823972880840302","No","Yes","No","100%",,"$0","$70","$1,300","$200","$0","$1,500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20GOLD%200_20_30_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050002-02","KP GA Gold 500/20 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_500_20_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050002-03","KP GA Gold 500/20 - AI/LTD","Limited Cost Sharing Plan Variation","80.46%","0.805793941020966","No","Yes","No","100%",,"$500","$2,000","$300","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_500_20_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050003","KP GA Gold Std 1250/20","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Gold","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050003-00","KP GA Gold Std 1250/20","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$20","$1,200","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_STD_1250_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060003","KP GA Gold 1000/20/30/S4","89942GA006",,"GAN001","GAS001","GAF020","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060003-00","KP GA Gold 1000/20/30/S4","Standard Gold Off Exchange Plan","79.69%","0.796100914478302","No","Yes","No","100%",,"$1,000","$70","$900","$200","$0","$1,700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20GOLD%201000_20_30_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060003","KP GA Gold 1000/20/30/S4","89942GA006",,"GAN001","GAS001","GAF020","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060003-01","KP GA Gold 1000/20/30/S4","Standard Gold On Exchange Plan","79.69%","0.796100914478302","No","Yes","No","100%",,"$1,000","$70","$900","$200","$0","$1,700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20GOLD%201000_20_30_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050003","KP GA Gold Std 1250/20","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Gold","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050003-01","KP GA Gold Std 1250/20","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$20","$1,200","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_STD_1250_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050003","KP GA Gold Std 1250/20","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Gold","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050003-02","KP GA Gold Std 1250/20 - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_STD_1250_20_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050003","KP GA Gold Std 1250/20","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Gold","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050003-03","KP GA Gold Std 1250/20 - AI/LTD","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,300","$20","$1,200","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_STD_1250_20_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050012-00","KP GA Gold 1500/20","Standard Gold Off Exchange Plan","78.09%","0.779567122459412","No","Yes","No","100%",,"$1,500","$20","$1,200","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_1500_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060004","KP GA Silver 2500/25/40/S4","89942GA006",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060004-00","KP GA Silver 2500/25/40/S4","Standard Silver Off Exchange Plan","71.01%","0.713000655174255","No","Yes","No","100%",,"$2,500","$20","$1,200","$200","$100","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20SILVER%202500_25_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060004","KP GA Silver 2500/25/40/S4","89942GA006",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060004-01","KP GA Silver 2500/25/40/S4","Standard Silver On Exchange Plan","71.01%","0.713000655174255","No","Yes","No","100%",,"$2,500","$20","$1,200","$200","$100","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20SILVER%202500_25_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050012-01","KP GA Gold 1500/20","Standard Gold On Exchange Plan","78.09%","0.779567122459412","No","Yes","No","100%",,"$1,500","$20","$1,200","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_1500_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050012-02","KP GA Gold 1500/20 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_1500_20_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050012-03","KP GA Gold 1500/20 - AI/LTD","Limited Cost Sharing Plan Variation","78.09%","0.779567122459412","No","Yes","No","100%",,"$1,500","$20","$1,200","$200","$100","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Gold_1500_20_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050004","KP GA Silver 2000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050004-00","KP GA Silver 2000/30","Standard Silver Off Exchange Plan","71.13%","0.709114074707031","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$100","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_2000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060005","KP GA Silver 2000/40/40/S4","89942GA006",,"GAN001","GAS001","GAF021","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060005-00","KP GA Silver 2000/40/40/S4","Standard Silver Off Exchange Plan","70.92%","0.716952860355377","No","Yes","No","100%",,"$2,000","$20","$2,100","$200","$100","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20SILVER%202000_40_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060005","KP GA Silver 2000/40/40/S4","89942GA006",,"GAN001","GAS001","GAF021","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060005-01","KP GA Silver 2000/40/40/S4","Standard Silver On Exchange Plan","70.92%","0.716952860355377","No","Yes","No","100%",,"$2,000","$20","$2,100","$200","$100","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20SILVER%202000_40_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050004","KP GA Silver 2000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050004-01","KP GA Silver 2000/30","Standard Silver On Exchange Plan","71.13%","0.709114074707031","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$100","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_2000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050004","KP GA Silver 2000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050004-02","KP GA Silver 2000/30 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_2000_30_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050004","KP GA Silver 2000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050004-03","KP GA Silver 2000/30 - AI/LTD","Limited Cost Sharing Plan Variation","71.13%","0.709114074707031","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_2000_30_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050004","KP GA Silver 2000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050004-04","KP GA Silver 1700/30/73% CSR","73% AV Level Silver Plan","73.36%","0.737312316894531","No","Yes","No","100%",,"$1,700","$20","$1,700","$200","$100","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_1700_30_73_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050004","KP GA Silver 2000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050004-05","KP GA Silver 0/15/ 87% CSR","87% AV Level Silver Plan","87.89%","0.880057334899902","No","Yes","No","100%",,"$0","$20","$2,200","$200","$0","$1,100","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_0_15_87_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050004","KP GA Silver 2000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050004-06","KP GA Silver 0/5/94% CSR","94% AV Level Silver Plan","94.98%","0.950637459754944","No","Yes","No","100%",,"$0","$10","$700","$200","$0","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_0_5_94_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050005-00","KP GA Silver 3000/30","Standard Silver Off Exchange Plan","68.78%","0.685551166534424","No","Yes","No","100%",,"$3,000","$20","$1,300","$200","$100","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_3000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060006","KP GA Bronze 5250/40/40/S4","89942GA006",,"GAN001","GAS001","GAF026","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060006-00","KP GA Bronze 5250/40/40/S4","Standard Bronze Off Exchange Plan","61.88%","0.619027256965637","Yes","Yes","No","100%",,"$5,300","$20","$800","$200","$100","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20BRONZE%205250_40_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050005-01","KP GA Silver 3000/30","Standard Silver On Exchange Plan","68.78%","0.685551166534424","No","Yes","No","100%",,"$3,000","$20","$1,300","$200","$100","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_3000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050005-02","KP GA Silver 3000/30 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_3000_30_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050005-03","KP GA Silver 3000/30 - AI/LTD","Limited Cost Sharing Plan Variation","68.78%","0.685551166534424","No","Yes","No","100%",,"$3,000","$20","$1,300","$200","$100","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_3000_30_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050005-04","KP GA Silver 1700/30/73% CSR","73% AV Level Silver Plan","73.36%","0.737312316894531","No","Yes","No","100%",,"$1,700","$20","$1,700","$200","$100","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_1700_30_73_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050005-05","KP GA Silver 0/15/ 87% CSR","87% AV Level Silver Plan","87.89%","0.880057334899902","No","Yes","No","100%",,"$0","$20","$2,200","$200","$0","$1,100","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_0_15_87_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050006-00","KP GA Silver 2750/20% HSA","Standard Silver Off Exchange Plan","68.17%","0.679626703262329","Yes","Yes","No","100%",,"$2,800","$20","$900","$200","$1,000","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_2750_20_HSA.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060007","KP GA Silver HDHP/2700/20/S4","89942GA006",,"GAN001","GAS001","GAF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060007-00","KP GA Silver HDHP/2700/20/S4","Standard Silver Off Exchange Plan","69.33%","0.693468868732452","Yes","Yes","No","100%",,"$2,700","$0","$900","$200","$2,700","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/HDHP%20SILVER%202700_20_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060007","KP GA Silver HDHP/2700/20/S4","89942GA006",,"GAN001","GAS001","GAF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060007-01","KP GA Silver HDHP/2700/20/S4","Standard Silver On Exchange Plan","69.33%","0.693468868732452","Yes","Yes","No","100%",,"$2,700","$0","$900","$200","$2,700","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/HDHP%20SILVER%202700_20_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050006-01","KP GA Silver 2750/20% HSA","Standard Silver On Exchange Plan","68.17%","0.679626703262329","Yes","Yes","No","100%",,"$2,800","$20","$900","$200","$1,000","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_2750_20_HSA.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050006-02","KP GA Silver 2750/20% HSA - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_2750_20_HSA_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050006-03","KP GA Silver 2750/20% HSA - AI/LTD","Limited Cost Sharing Plan Variation","68.17%","0.679626703262329","Yes","Yes","No","100%",,"$2,800","$20","$900","$200","$1,000","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_2750_20_HSA_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050006-04","KP GA Silver 1650/20%/73% CSR","73% AV Level Silver Plan","73.69%","0.73658686876297","Yes","Yes","No","100%",,"$1,700","$20","$1,100","$200","$1,000","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_1650_20_73_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050006-05","KP GA Silver 500/10%/87% CSR","87% AV Level Silver Plan","87.72%","0.877065122127533","Yes","Yes","No","100%",,"$500","$20","$700","$200","$500","$700","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_500_10_87_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050006-06","KP GA Silver 100/5%/94% CSR","94% AV Level Silver Plan","94.86%","0.94845724105835","Yes","Yes","No","100%",,"$200","$20","$400","$200","$200","$700","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_100_5_94_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050014-00","KP GA Silver Std 3500/30","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$100","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_STD_3500_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060009","KP GA Bronze HDHP/5000/40/S4","89942GA006",,"GAN001","GAS001","GAF025","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060009-00","KP GA Bronze HDHP/5000/40/S4","Standard Bronze Off Exchange Plan","61.91%","0.619157254695892","Yes","Yes","No","100%",,"$5,000","$0","$900","$200","$5,000","$0","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/HDHP%20BRONZE%205000_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060009","KP GA Bronze HDHP/5000/40/S4","89942GA006",,"GAN001","GAS001","GAF025","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060009-01","KP GA Bronze HDHP/5000/40/S4","Standard Bronze On Exchange Plan","61.91%","0.619157254695892","Yes","Yes","No","100%",,"$5,000","$0","$900","$200","$5,000","$0","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/HDHP%20BRONZE%205000_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050014-01","KP GA Silver Std 3500/30","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$100","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_STD_3500_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050014-02","KP GA Silver Std 3500/30 - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_STD_3500_30_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050014-03","KP GA Silver Std 3500/30 - AI/LTD","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$100","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_STD_3500_30_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050014-05","KP GA Silver Std 700/10/87% CSR","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,300","$200","$100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_STD_700_10_87_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050014-06","KP GA Silver Std 250/5 94% CSR","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$0","$400","$200","$100","$300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Silver_STD_250_5_94_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 4500/20","89942GA005",,"GAN001","GAS002","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050007-00","KP GA Bronze 4500/20","Standard Bronze Off Exchange Plan","61.52%","0.609262228012085","No","Yes","No","100%",,"$4,500","$20","$800","$200","$100","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_4500_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060011","KP GA Silver HRA/2000/40/S4","89942GA006",,"GAN001","GAS001","GAF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060011-00","KP GA Silver HRA/2000/40/S4","Standard Silver Off Exchange Plan","68.44%","0.684503555297852","Yes","Yes","No","100%",,"$2,000","$0","$2,100","$200","$2,000","$0","$1,200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","Yes","$150.00","http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20HRA%20SILVER%202000_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060011","KP GA Silver HRA/2000/40/S4","89942GA006",,"GAN001","GAS001","GAF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060011-01","KP GA Silver HRA/2000/40/S4","Standard Silver On Exchange Plan","68.44%","0.684503555297852","Yes","Yes","No","100%",,"$2,000","$0","$2,100","$200","$2,000","$0","$1,200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","Yes","$150.00","http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20HRA%20SILVER%202000_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 4500/20","89942GA005",,"GAN001","GAS002","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050007-01","KP GA Bronze 4500/20","Standard Bronze On Exchange Plan","61.52%","0.609262228012085","No","Yes","No","100%",,"$4,500","$20","$800","$200","$100","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_4500_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 4500/20","89942GA005",,"GAN001","GAS002","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050007-03","KP GA Bronze 4500/20 - AI/LTD","Limited Cost Sharing Plan Variation","61.52%","0.609262228012085","No","Yes","No","100%",,"$4,500","$20","$800","$200","$100","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_4500_20_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050013","KP GA Bronze 5700/50","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050013-00","KP GA Bronze 5700/50","Standard Bronze Off Exchange Plan","61.80%","0.617507636547089","Yes","Yes","No","100%",,"$5,700","$20","$800","$200","$100","$2,400","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_5700_50.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060012","KP GA Gold 1500/0/20/S4","89942GA006",,"GAN001","GAS001","GAF019","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060012-00","KP GA Gold 1500/0/20/S4","Standard Gold Off Exchange Plan","81.64%","0.82268363237381","No","Yes","No","100%",,"$1,500","$20","$0","$200","$0","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20GOLD%201500_0_20_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060012","KP GA Gold 1500/0/20/S4","89942GA006",,"GAN001","GAS001","GAF019","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060012-01","KP GA Gold 1500/0/20/S4","Standard Gold On Exchange Plan","81.64%","0.82268363237381","No","Yes","No","100%",,"$1,500","$20","$0","$200","$0","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20GOLD%201500_0_20_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050013","KP GA Bronze 5700/50","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050013-01","KP GA Bronze 5700/50","Standard Bronze On Exchange Plan","61.80%","0.617507636547089","Yes","Yes","No","100%",,"$5,700","$20","$800","$200","$100","$2,400","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_5700_50.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050013","KP GA Bronze 5700/50","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050013-02","KP GA Bronze 5700/50 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_5700_50_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050013","KP GA Bronze 5700/50","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050013-03","KP GA Bronze 5700/50 - AI/LTD","Limited Cost Sharing Plan Variation","61.80%","0.617507636547089","Yes","Yes","No","100%",,"$5,700","$20","$800","$200","$100","$2,400","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_5700_50_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS002","GAF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050009-00","KP GA Bronze 6200/40%/HSA  .","Standard Bronze Off Exchange Plan","61.06%","0.612152397632599","Yes","Yes","No","100%",,"$6,200","$0","$400","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_6200_40_HSA.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060013","KP GA Silver 3000/20/40/S4","89942GA006",,"GAN001","GAS001","GAF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060013-00","KP GA Silver 3000/20/40/S4","Standard Silver Off Exchange Plan","70.55%","0.704686462879181","No","Yes","No","100%",,"$3,000","$70","$700","$200","$0","$1,800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20SILVER%203000_20_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060013","KP GA Silver 3000/20/40/S4","89942GA006",,"GAN001","GAS001","GAF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060013-01","KP GA Silver 3000/20/40/S4","Standard Silver On Exchange Plan","70.55%","0.704686462879181","No","Yes","No","100%",,"$3,000","$70","$700","$200","$0","$1,800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20SILVER%203000_20_40_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS002","GAF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050009-01","KP GA Bronze 6200/40%/HSA  .","Standard Bronze On Exchange Plan","61.06%","0.612152397632599","Yes","Yes","No","100%",,"$6,200","$0","$400","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_6200_40_HSA.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS002","GAF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050009-02","KP GA Bronze 6200/40%/HSA - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_6200_40_HSA_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS002","GAF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050009-03","KP GA Bronze 6200/40%/HSA - AI/LTD","Limited Cost Sharing Plan Variation","61.06%","0.612152397632599","Yes","Yes","No","100%",,"$6,200","$0","$400","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_6200_40_HSA_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050015","KP GA Bronze Std 6650/45","89942GA005",,"GAN001","GAS002","GAF009","Existing","HMO","Bronze","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050015-00","KP GA Bronze Std 6650/45","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$20","$300","$200","$500","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_STD_6650_45.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060014","KP GA Gold 500/20/25/S4","89942GA006",,"GAN001","GAS001","GAF019","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060014-01","KP GA Gold 500/20/25/S4","Standard Gold On Exchange Plan","80.86%","0.807829737663269","No","Yes","No","100%",,"$500","$70","$1,200","$200","$0","$1,700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20GOLD%20500_20_25_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050015","KP GA Bronze Std 6650/45","89942GA005",,"GAN001","GAS002","GAF009","Existing","HMO","Bronze","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050015-01","KP GA Bronze Std 6650/45","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$20","$300","$200","$500","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_STD_6650_45.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050015","KP GA Bronze Std 6650/45","89942GA005",,"GAN001","GAS002","GAF009","Existing","HMO","Bronze","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050015-02","KP GA Bronze Std 6650/45 - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_STD_6650_45_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050015","KP GA Bronze Std 6650/45","89942GA005",,"GAN001","GAS002","GAF009","Existing","HMO","Bronze","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050015-03","KP GA Bronze Std 6650/45 - AI/LTD","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,700","$20","$300","$200","$500","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Bronze_STD_6650_45_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","Individual","No","58-1592076","89942GA0050010","KP GA Catastrophic 7150/0","89942GA005",,"GAN001","GAS002","GAF010","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.989492123963126",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0050010-00","KP GA Catastrophic 7150/0","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,600","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2017-ON-Exchange/KP_GA_Catastrophic_7150_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/ga2017planbrochure.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060015","KP GA Bronze 6000/40/50/S4","89942GA006",,"GAN001","GAS001","GAF027","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060015-00","KP GA Bronze 6000/40/50/S4","Standard Bronze Off Exchange Plan","61.13%","0.611361265182495","Yes","Yes","No","100%",,"$6,000","$20","$500","$200","$100","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20BRONZE%206000_40_50_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060015","KP GA Bronze 6000/40/50/S4","89942GA006",,"GAN001","GAS001","GAF027","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060015-01","KP GA Bronze 6000/40/50/S4","Standard Bronze On Exchange Plan","61.13%","0.611361265182495","Yes","Yes","No","100%",,"$6,000","$20","$500","$200","$100","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/KP%20BRONZE%206000_40_50_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060016","KP GA Bronze HDHP/6550/0/S4","89942GA006",,"GAN001","GAS001","GAF028","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060016-00","KP GA Bronze HDHP/6550/0/S4","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/HDHP%20BRONZE%206550_0_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","89942","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","58-1592076","89942GA0060016","KP GA Bronze HDHP/6550/0/S4","89942GA006",,"GAN001","GAS001","GAF028","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9694",,,"2017-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_20175tierformulary_2016.04.pdf","89942GA0060016-01","KP GA Bronze HDHP/6550/0/S4","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2017-ON-Exchange/HDHP%20BRONZE%206550_0_S4.pdf","http://account.kp.org/static/bcssp/pdfs/shared/ga/2017/KP_GA_SB_Plan_Guide_Booklet_2017.pdf"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710001","Humana Basic 7150/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710001-00","Humana Basic 7150/Atlanta HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843503",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610046","Humana Simplicity Gold 003/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF005","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610046-00","Humana Simplicity Gold 003/100 National POS - Open Access","Standard Gold Off Exchange Plan","79.53%","0","No","Yes","No","100%",,"$0","$1,300","$0","$30","$0","$2,000","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861352","http://apps.humana.com/marketing/documents.asp?file=2861430"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610046","Humana Simplicity Gold 003/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF005","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610046-01","Humana Simplicity Gold 003/100 National POS - Open Access","Standard Gold On Exchange Plan","79.53%","0","No","Yes","No","100%",,"$0","$1,300","$0","$30","$0","$2,000","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861352","http://apps.humana.com/marketing/documents.asp?file=2861430"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710001","Humana Basic 7150/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710001-01","Humana Basic 7150/Atlanta HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843503",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710015","Humana Basic 7150/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710015-00","Humana Basic 7150/Columbus GA HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843529",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610047","Humana Simplicity Gold 004/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF005","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610047-00","Humana Simplicity Gold 004/100 National POS - Open Access","Standard Gold Off Exchange Plan","78.40%","0","No","Yes","No","100%",,"$0","$1,500","$0","$30","$0","$2,000","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861365","http://apps.humana.com/marketing/documents.asp?file=2861443"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610047","Humana Simplicity Gold 004/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF005","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610047-01","Humana Simplicity Gold 004/100 National POS - Open Access","Standard Gold On Exchange Plan","78.40%","0","No","Yes","No","100%",,"$0","$1,500","$0","$30","$0","$2,000","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861365","http://apps.humana.com/marketing/documents.asp?file=2861443"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710015","Humana Basic 7150/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710015-01","Humana Basic 7150/Columbus GA HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843529",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710039","Humana Basic 7150/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710039-00","Humana Basic 7150/Macon HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843581",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610048","Humana Simplicity Silver 006/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610048-00","Humana Simplicity Silver 006/100 National POS - Open Access","Standard Silver Off Exchange Plan","71.73%","0","No","Yes","No","100%",,"$0","$2,400","$0","$30","$0","$2,300","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861378","http://apps.humana.com/marketing/documents.asp?file=2861456"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610048","Humana Simplicity Silver 006/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610048-01","Humana Simplicity Silver 006/100 National POS - Open Access","Standard Silver On Exchange Plan","71.73%","0","No","Yes","No","100%",,"$0","$2,400","$0","$30","$0","$2,300","$0","$20","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861378","http://apps.humana.com/marketing/documents.asp?file=2861456"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710039","Humana Basic 7150/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710039-01","Humana Basic 7150/Macon HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843581",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710044","Humana Basic 7150/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710044-00","Humana Basic 7150/Savannah HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843607",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710002","Humana Bronze 6550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710002-01","Humana Bronze 6550/Atlanta HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2843919",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710002","Humana Bronze 6550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710002-02","Humana Bronze 6550/Atlanta HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843932",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610011","Humana Copay Silver 80/2000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF008","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610011-00","Humana Copay Silver 80/2000 National POS - Open Access","Standard Silver Off Exchange Plan","71.59%","0.721341729164124","No","Yes","No","100%",,"$2,000","$20","$2,000","$30","$2,000","$1,200","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861404","http://apps.humana.com/marketing/documents.asp?file=2861482"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610011","Humana Copay Silver 80/2000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF008","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-Rx4-EHB","93332GA0610011-01","Humana Copay Silver 80/2000 National POS - Open Access","Standard Silver On Exchange Plan","71.59%","0.721341729164124","No","Yes","No","100%",,"$2,000","$20","$2,000","$30","$2,000","$1,200","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2861404","http://apps.humana.com/marketing/documents.asp?file=2861482"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710002","Humana Bronze 6550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710002-03","Humana Bronze 6550/Atlanta HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843945",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710016","Humana Bronze 6550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710016-00","Humana Bronze 6550/Columbus GA HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2843971",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710016","Humana Bronze 6550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710016-01","Humana Bronze 6550/Columbus GA HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2843971",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710016","Humana Bronze 6550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710016-02","Humana Bronze 6550/Columbus GA HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843984",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710016","Humana Bronze 6550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710016-03","Humana Bronze 6550/Columbus GA HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2843997",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710040","Humana Bronze 6550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710040-00","Humana Bronze 6550/Macon HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2844062",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710045","Humana Bronze 6550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710045-00","Humana Bronze 6550/Savannah HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2844127",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710045","Humana Bronze 6550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710045-01","Humana Bronze 6550/Savannah HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2844127",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710045","Humana Bronze 6550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710045-02","Humana Bronze 6550/Savannah HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2844140",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710045","Humana Bronze 6550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","93332GA0710045-03","Humana Bronze 6550/Savannah HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2844153",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710003","Humana Bronze 6150/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710003-00","Humana Bronze 6150/Atlanta HMOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843633",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610037","Humana EHDHP Bronze 80/5500 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF009","Existing","POS","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-HDHP-EHB","93332GA0610037-00","Humana EHDHP Bronze 80/5500 National POS - Open Access","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$1,100","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://apps.humana.com/marketing/documents.asp?file=2861417","http://apps.humana.com/marketing/documents.asp?file=2861495"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","SHOP (Small Group)","No","58-2209549","93332GA0610037","Humana EHDHP Bronze 80/5500 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF009","Existing","POS","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Excludes coverage other than ER care from foreign providers","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"https://www.humana.com/2017-HDHP-EHB","93332GA0610037-01","Humana EHDHP Bronze 80/5500 National POS - Open Access","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$1,100","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://apps.humana.com/marketing/documents.asp?file=2861417","http://apps.humana.com/marketing/documents.asp?file=2861495"
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710003","Humana Bronze 6150/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710003-01","Humana Bronze 6150/Atlanta HMOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843633",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710003","Humana Bronze 6150/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710003-02","Humana Bronze 6150/Atlanta HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843646",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710003","Humana Bronze 6150/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710003-03","Humana Bronze 6150/Atlanta HMOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843659",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710017","Humana Bronze 6150/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710017-00","Humana Bronze 6150/Columbus GA HMOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843685",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710017","Humana Bronze 6150/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710017-01","Humana Bronze 6150/Columbus GA HMOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843685",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710017","Humana Bronze 6150/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710017-02","Humana Bronze 6150/Columbus GA HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843698",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710017","Humana Bronze 6150/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710017-03","Humana Bronze 6150/Columbus GA HMOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843724",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710054","Humana Bronze 6150/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710054-00","Humana Bronze 6150/Macon HMOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843815",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710054","Humana Bronze 6150/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710054-01","Humana Bronze 6150/Macon HMOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843815",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710054","Humana Bronze 6150/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710054-02","Humana Bronze 6150/Macon HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843828",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710054","Humana Bronze 6150/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710054-03","Humana Bronze 6150/Macon HMOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843841",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710055","Humana Bronze 6150/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710055-00","Humana Bronze 6150/Savannah HMOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843867",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710055","Humana Bronze 6150/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710055-01","Humana Bronze 6150/Savannah HMOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843867",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710055","Humana Bronze 6150/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710055-02","Humana Bronze 6150/Savannah HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843880",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710055","Humana Bronze 6150/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710055-03","Humana Bronze 6150/Savannah HMOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2843893",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710004","Humana Silver 3550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710004-00","Humana Silver 3550/Atlanta HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844374",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710004","Humana Silver 3550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710004-01","Humana Silver 3550/Atlanta HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844374",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710004","Humana Silver 3550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710004-02","Humana Silver 3550/Atlanta HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844387",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710004","Humana Silver 3550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710004-03","Humana Silver 3550/Atlanta HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844400",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710046","Humana Silver 3550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710046-02","Humana Silver 3550/Savannah HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844699",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710046","Humana Silver 3550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710046-03","Humana Silver 3550/Savannah HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844712",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710046","Humana Silver 3550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710046-04","Humana Silver 3000/Savannah HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844361",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710046","Humana Silver 3550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710046-05","Humana Silver 900/Savannah HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844790",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710046","Humana Silver 3550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710046-06","Humana Silver 250/Savannah HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844296",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700021","Anthem Bronze Pathway X 5300","17575IN070",,"INN001","INS001","INF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700021-00","Anthem Bronze Pathway X 5300","Standard Bronze Off Exchange Plan","61.98%","0.622411668300629","Yes","Yes","Yes","66%","34%","$5,300","$0","$400","$0","$4,500","$300","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","20.00%","$5,300","$5300 per person","$10600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J7B","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","35-0781558","17575IN0830003","Anthem Dental Family","17575IN083",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0830003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214300.pdf",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710004","Humana Silver 3550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710004-04","Humana Silver 3000/Atlanta HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844309",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710004","Humana Silver 3550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710004-05","Humana Silver 900/Atlanta HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844738",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710004","Humana Silver 3550/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710004-06","Humana Silver 250/Atlanta HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844218",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710018","Humana Silver 3550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710018-00","Humana Silver 3550/Columbus GA HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844426",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710018","Humana Silver 3550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710018-01","Humana Silver 3550/Columbus GA HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844426",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710018","Humana Silver 3550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710018-02","Humana Silver 3550/Columbus GA HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844439",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710018","Humana Silver 3550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710018-03","Humana Silver 3550/Columbus GA HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844452",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710018","Humana Silver 3550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710018-04","Humana Silver 3000/Columbus GA HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844322",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710018","Humana Silver 3550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710018-05","Humana Silver 900/Columbus GA HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844751",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710018","Humana Silver 3550/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710018-06","Humana Silver 250/Columbus GA HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844231",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710020","Humana Gold 1250/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710020-00","Humana Gold 1250/Columbus GA HMOx","Standard Gold Off Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844179",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710020","Humana Gold 1250/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710020-01","Humana Gold 1250/Columbus GA HMOx","Standard Gold On Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844179",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710020","Humana Gold 1250/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710020-02","Humana Gold 1250/Columbus GA HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844192",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710020","Humana Gold 1250/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710020-03","Humana Gold 1250/Columbus GA HMOx","Limited Cost Sharing Plan Variation",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844205",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710041","Humana Silver 3550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710041-00","Humana Silver 3550/Macon HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844634",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710041","Humana Silver 3550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710041-01","Humana Silver 3550/Macon HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844634",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710041","Humana Silver 3550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710041-02","Humana Silver 3550/Macon HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844647",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710041","Humana Silver 3550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710041-03","Humana Silver 3550/Macon HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844660",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710041","Humana Silver 3550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710041-04","Humana Silver 3000/Macon HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844348",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710041","Humana Silver 3550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710041-05","Humana Silver 900/Macon HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844777",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710041","Humana Silver 3550/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710041-06","Humana Silver 250/Macon HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844270",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710046","Humana Silver 3550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710046-00","Humana Silver 3550/Savannah HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844686",
"2017","GA","93332","HIOS","2017-04-20 07:50:26","Individual","No","58-2209549","93332GA0710046","Humana Silver 3550/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","93332GA0710046-01","Humana Silver 3550/Savannah HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2844686",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0720009","Anthem Silver Blue Preferred X HMO 2000 30 5500 Plus","17575IN072",,"INN003","INS001","INF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9961",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/INSelectdrugtier5","17575IN0720009-00","Anthem Silver Blue Preferred X HMO 2000 30 5500 Plus","Standard Silver Off Exchange Plan","70.37%","0.729918777942657","No","Yes","No","100%",,"$2,000","$80","$1,500","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GC9",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","Yes","35-0781558","17575IN0860005","Anthem Dental Family Value","17575IN086",,"INN005","INS019",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0860005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214302.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","Yes","35-0781558","17575IN0920005","Anthem Dental Family Value","17575IN092",,"INN005","INS019",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0920005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214302.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0720009","Anthem Silver Blue Preferred X HMO 2000 30 5500 Plus","17575IN072",,"INN003","INS001","INF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9961",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/INSelectdrugtier5","17575IN0720009-01","Anthem Silver Blue Preferred X HMO 2000 30 5500 Plus","Standard Silver On Exchange Plan","70.37%","0.729918777942657","No","Yes","No","100%",,"$2,000","$80","$1,500","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GC9",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","35-0781558","17575IN0890003","Anthem Dental Family","17575IN089",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0890003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214300.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700021","Anthem Bronze Pathway X 5300","17575IN070",,"INN001","INS001","INF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700021-01","Anthem Bronze Pathway X 5300","Standard Bronze On Exchange Plan","61.98%","0.622411668300629","Yes","Yes","Yes","66%","34%","$5,300","$0","$400","$0","$4,500","$300","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","20.00%","$5,300","$5300 per person","$10600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEX","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700021","Anthem Bronze Pathway X 5300","17575IN070",,"INN001","INS001","INF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700021-02","Anthem Bronze Pathway X 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFW","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0720008","Anthem Silver Blue Preferred X HMO 3000 20 4500 Plus","17575IN072",,"INN003","INS001","INF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9961",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/INSelectdrugtier5","17575IN0720008-00","Anthem Silver Blue Preferred X HMO 3000 20 4500 Plus","Standard Silver Off Exchange Plan","70.07%","0.716135144233704","No","Yes","No","100%",,"$3,000","$80","$800","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GC7",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0720008","Anthem Silver Blue Preferred X HMO 3000 20 4500 Plus","17575IN072",,"INN003","INS001","INF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9961",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/INSelectdrugtier5","17575IN0720008-01","Anthem Silver Blue Preferred X HMO 3000 20 4500 Plus","Standard Silver On Exchange Plan","70.07%","0.716135144233704","No","Yes","No","100%",,"$3,000","$80","$800","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GC7",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700021","Anthem Bronze Pathway X 5300","17575IN070",,"INN001","INS001","INF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700021-03","Anthem Bronze Pathway X 5300","Limited Cost Sharing Plan Variation","61.98%","0.622411668300629","Yes","Yes","Yes","66%","34%","$5,300","$0","$400","$0","$4,500","$300","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","20.00%","$5,300","$5300 per person","$10600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEX","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700023","Anthem Bronze Pathway X 6500","17575IN070",,"INN001","INS001","INF015","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700023-00","Anthem Bronze Pathway X 6500","Standard Bronze Off Exchange Plan","61.78%","0.622593522071838","Yes","Yes","Yes","66%","34%","$6,500","$100","$200","$0","$0","$0","$0","$0","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%","$6,500","$6500 per person","$13000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J77","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700023","Anthem Bronze Pathway X 6500","17575IN070",,"INN001","INS001","INF015","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700023-01","Anthem Bronze Pathway X 6500","Standard Bronze On Exchange Plan","61.78%","0.622593522071838","Yes","Yes","Yes","66%","34%","$6,500","$100","$200","$0","$0","$0","$0","$0","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%","$6,500","$6500 per person","$13000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GET","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700023","Anthem Bronze Pathway X 6500","17575IN070",,"INN001","INS001","INF015","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700023-02","Anthem Bronze Pathway X 6500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFS","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700023","Anthem Bronze Pathway X 6500","17575IN070",,"INN001","INS001","INF015","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700023-03","Anthem Bronze Pathway X 6500","Limited Cost Sharing Plan Variation","61.78%","0.622593522071838","Yes","Yes","Yes","66%","34%","$6,500","$100","$200","$0","$0","$0","$0","$0","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%","$6,500","$6500 per person","$13000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GET","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700024","Anthem Bronze Pathway X 0 for HSA","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700024-00","Anthem Bronze Pathway X 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","66%","34%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J76","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","35-0781558","17575IN0830004","Anthem Dental Family Enhanced","17575IN083",,"INN005","INS019",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.834","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0830004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214301.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0720012","Anthem Gold Blue Preferred X HMO 1000 10 7100 Plus","17575IN072",,"INN003","INS001","INF032","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/INSelectdrugtier5","17575IN0720012-00","Anthem Gold Blue Preferred X HMO 1000 10 7100 Plus","Standard Gold Off Exchange Plan","78.50%","0.777085959911346","No","Yes","No","100%",,"$1,000","$80","$600","$0","$700","$1,500","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GCA",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","Yes","35-0781558","17575IN0860003","Anthem Dental Family","17575IN086",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0860003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214300.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","Yes","35-0781558","17575IN0920003","Anthem Dental Family","17575IN092",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0920003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214300.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0720012","Anthem Gold Blue Preferred X HMO 1000 10 7100 Plus","17575IN072",,"INN003","INS001","INF032","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/INSelectdrugtier5","17575IN0720012-01","Anthem Gold Blue Preferred X HMO 1000 10 7100 Plus","Standard Gold On Exchange Plan","78.50%","0.777085959911346","No","Yes","No","100%",,"$1,000","$80","$600","$0","$700","$1,500","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GCA",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","35-0781558","17575IN0890004","Anthem Dental Family Enhanced","17575IN089",,"INN005","INS019",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.834","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0890004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214301.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700024","Anthem Bronze Pathway X 0 for HSA","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700024-01","Anthem Bronze Pathway X 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","66%","34%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GES","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700024","Anthem Bronze Pathway X 0 for HSA","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700024-02","Anthem Bronze Pathway X 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFR","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700024","Anthem Bronze Pathway X 0 for HSA","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700024-03","Anthem Bronze Pathway X 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","66%","34%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GES","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700025","Anthem Bronze Pathway X 20 for HSA","17575IN070",,"INN001","INS001","INF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700025-00","Anthem Bronze Pathway X 20 for HSA","Standard Bronze Off Exchange Plan","61.86%","0.621139526367188","Yes","Yes","Yes","66%","34%","$5,200","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J7A","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700025","Anthem Bronze Pathway X 20 for HSA","17575IN070",,"INN001","INS001","INF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700025-01","Anthem Bronze Pathway X 20 for HSA","Standard Bronze On Exchange Plan","61.86%","0.621139526367188","Yes","Yes","Yes","66%","34%","$5,200","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GEW","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700025","Anthem Bronze Pathway X 20 for HSA","17575IN070",,"INN001","INS001","INF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700025-02","Anthem Bronze Pathway X 20 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFV","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700025","Anthem Bronze Pathway X 20 for HSA","17575IN070",,"INN001","INS001","INF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700025-03","Anthem Bronze Pathway X 20 for HSA","Limited Cost Sharing Plan Variation","61.86%","0.621139526367188","Yes","Yes","Yes","66%","34%","$5,200","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GEW","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-00","Anthem Silver Pathway X 3500","Standard Silver Off Exchange Plan","71.99%","0.721218407154083","Yes","Yes","Yes","66%","34%","$3,500","$600","$500","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","$6,150","$6150 per person","$12300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J7C","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-01","Anthem Silver Pathway X 3500","Standard Silver On Exchange Plan","71.99%","0.721218407154083","Yes","Yes","Yes","66%","34%","$3,500","$600","$500","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","$6,150","$6150 per person","$12300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEY","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-02","Anthem Silver Pathway X 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFX","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-03","Anthem Silver Pathway X 3500","Limited Cost Sharing Plan Variation","71.99%","0.721218407154083","Yes","Yes","Yes","66%","34%","$3,500","$600","$500","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","$6,150","$6150 per person","$12300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEY","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-04","Anthem Silver Pathway X 3500 S04","73% AV Level Silver Plan","74.00%","0.741224825382233","Yes","Yes","Yes","66%","34%","$3,450","$600","$600","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group","0.00%","$3,450","$3450 per person","$6900 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEZ","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-05","Anthem Silver Pathway X 3500 S05","87% AV Level Silver Plan","87.94%","0.880411982536316","Yes","Yes","Yes","66%","34%","$1,000","$500","$600","$0","$500","$1,300","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","$2,150","$2150 per person","$4300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%","$1,000","$1000 per person","$2000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF0","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-06","Anthem Silver Pathway X 3500 S06","94% AV Level Silver Plan","94.90%","0.949286282062531","Yes","Yes","Yes","66%","34%","$250","$200","$600","$0","$250","$800","$20","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$1050 per person","$2100 per group","$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%","$250","$250 per person","$500 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF1","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-00","Anthem Silver Pathway X for HSA","Standard Silver Off Exchange Plan","71.27%","0.715524971485138","Yes","Yes","Yes","66%","34%","$3,000","$500","$1,000","$0","$3,000","$0","$200","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J7D","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-01","Anthem Silver Pathway X for HSA","Standard Silver On Exchange Plan","71.27%","0.715524971485138","Yes","Yes","Yes","66%","34%","$3,000","$500","$1,000","$0","$3,000","$0","$200","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GF2","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-02","Anthem Silver Pathway X AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFY","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-03","Anthem Silver Pathway X for HSA","Limited Cost Sharing Plan Variation","71.27%","0.715524971485138","Yes","Yes","Yes","66%","34%","$3,000","$500","$1,000","$0","$3,000","$0","$200","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GF2","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-04","Anthem Silver Pathway X for HSA S04","73% AV Level Silver Plan","73.32%","0.735077619552612","Yes","Yes","Yes","66%","34%","$2,700","$500","$800","$0","$2,700","$0","$300","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GF3","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-05","Anthem Silver Pathway X S05","87% AV Level Silver Plan","86.40%","0.863974511623383","Yes","Yes","Yes","66%","34%","$1,350","$0","$0","$0","$1,350","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%","$1,350","$1350 per person","$2700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF4","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-06","Anthem Silver Pathway X S06","94% AV Level Silver Plan","93.26%","0.932620525360107","Yes","Yes","Yes","66%","34%","$600","$0","$0","$0","$600","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%","$600","$600 per person","$1200 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF5","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700031","Anthem Bronze Pathway X 5850","17575IN070",,"INN001","INS001","INF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700031-00","Anthem Bronze Pathway X 5850","Standard Bronze Off Exchange Plan","60.13%","0.600088536739349","Yes","Yes","Yes","66%","34%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAM","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700031","Anthem Bronze Pathway X 5850","17575IN070",,"INN001","INS001","INF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700031-01","Anthem Bronze Pathway X 5850","Standard Bronze On Exchange Plan","60.13%","0.600088536739349","Yes","Yes","Yes","66%","34%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAB","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700031","Anthem Bronze Pathway X 5850","17575IN070",,"INN001","INS001","INF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700031-02","Anthem Bronze Pathway X 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XAC","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700031","Anthem Bronze Pathway X 5850","17575IN070",,"INN001","INS001","INF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700031-03","Anthem Bronze Pathway X 5850","Limited Cost Sharing Plan Variation","60.13%","0.600088536739349","Yes","Yes","Yes","66%","34%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAB","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700032","Anthem Bronze Pathway X 4950","17575IN070",,"INN001","INS001","INF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700032-00","Anthem Bronze Pathway X 4950","Standard Bronze Off Exchange Plan","60.43%","0.600557208061218","Yes","Yes","Yes","66%","34%","$4,950","$200","$1,100","$0","$4,950","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAN","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700032","Anthem Bronze Pathway X 4950","17575IN070",,"INN001","INS001","INF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700032-01","Anthem Bronze Pathway X 4950","Standard Bronze On Exchange Plan","60.43%","0.600557208061218","Yes","Yes","Yes","66%","34%","$4,950","$200","$1,100","$0","$4,950","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAE","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700032","Anthem Bronze Pathway X 4950","17575IN070",,"INN001","INS001","INF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700032-02","Anthem Bronze Pathway X 4950 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XAF","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700032","Anthem Bronze Pathway X 4950","17575IN070",,"INN001","INS001","INF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700032-03","Anthem Bronze Pathway X 4950","Limited Cost Sharing Plan Variation","60.43%","0.600557208061218","Yes","Yes","Yes","66%","34%","$4,950","$200","$1,100","$0","$4,950","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAE","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700033","Anthem Bronze Pathway X 7150","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700033-00","Anthem Bronze Pathway X 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","66%","34%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAP","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700033","Anthem Bronze Pathway X 7150","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700033-01","Anthem Bronze Pathway X 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","66%","34%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAG","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700033","Anthem Bronze Pathway X 7150","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700033-02","Anthem Bronze Pathway X 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XAH","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700033","Anthem Bronze Pathway X 7150","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700033-03","Anthem Bronze Pathway X 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","66%","34%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAG","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4350","17575IN070",,"INN001","INS001","INF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-00","Anthem Silver Pathway X 4350","Standard Silver Off Exchange Plan","68.03%","0.683347642421722","No","Yes","Yes","66%","34%","$4,350","$600","$700","$0","$1,400","$1,100","$30","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$4350 per person","$8700 per group","30.00%","$4,350","$4350 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAK","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0720010","Anthem Bronze Blue Preferred X HMO 6000 30 7150 Plus","17575IN072",,"INN003","INS001","INF032","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/INSelectdrugtier5","17575IN0720010-00","Anthem Bronze Blue Preferred X HMO 6000 30 7150 Plus","Standard Bronze Off Exchange Plan","60.27%","0.629184126853943","No","Yes","No","100%",,"$6,000","$80","$300","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GCN",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","Yes","35-0781558","17575IN0860004","Anthem Dental Family Enhanced","17575IN086",,"INN005","INS019",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.834","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0860004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214301.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","Yes","35-0781558","17575IN0920004","Anthem Dental Family Enhanced","17575IN092",,"INN005","INS019",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.834","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0920004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214301.pdf",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0720010","Anthem Bronze Blue Preferred X HMO 6000 30 7150 Plus","17575IN072",,"INN003","INS001","INF032","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/INSelectdrugtier5","17575IN0720010-01","Anthem Bronze Blue Preferred X HMO 6000 30 7150 Plus","Standard Bronze On Exchange Plan","60.27%","0.629184126853943","No","Yes","No","100%",,"$6,000","$80","$300","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GCN",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4350","17575IN070",,"INN001","INS001","INF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-01","Anthem Silver Pathway X 4350","Standard Silver On Exchange Plan","68.03%","0.683347642421722","No","Yes","Yes","66%","34%","$4,350","$600","$700","$0","$1,400","$1,100","$30","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$4350 per person","$8700 per group","30.00%","$4,350","$4350 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA2","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4350","17575IN070",,"INN001","INS001","INF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-02","Anthem Silver Pathway X 4350 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA6","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4350","17575IN070",,"INN001","INS001","INF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-03","Anthem Silver Pathway X 4350","Limited Cost Sharing Plan Variation","68.03%","0.683347642421722","No","Yes","Yes","66%","34%","$4,350","$600","$700","$0","$1,400","$1,100","$30","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$4350 per person","$8700 per group","30.00%","$4,350","$4350 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA2","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4350","17575IN070",,"INN001","INS001","INF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-04","Anthem Silver Pathway X 4350 S04","73% AV Level Silver Plan","72.16%","0.716780304908752","No","Yes","Yes","66%","34%","$3,200","$500","$1,000","$0","$1,400","$1,100","$30","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","30.00%","$3,200","$3200 per person","$6400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA3","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4350","17575IN070",,"INN001","INS001","INF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-05","Anthem Silver Pathway X 4350 S05","87% AV Level Silver Plan","86.27%","0.830511212348938","No","Yes","Yes","66%","34%","$1,000","$400","$400","$0","$700","$1,400","$30","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","50.00%","$300","$300 per person","$600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA4","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4350","17575IN070",,"INN001","INS001","INF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-06","Anthem Silver Pathway X 4350 S06","94% AV Level Silver Plan","93.10%","0.917965054512024","No","Yes","Yes","66%","34%","$250","$200","$400","$0","$250","$1,200","$90","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%","$250","$250 per person","$500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50.00%","$100","$100 per person","$200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA5","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700035","Anthem Silver Core Pathway X 5300","17575IN070",,"INN001","INS001","INF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700035-00","Anthem Silver Core Pathway X 5300","Standard Silver Off Exchange Plan","68.40%","0.684484124183655","Yes","Yes","Yes","66%","34%","$5,300","$60","$500","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EQJ","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700035","Anthem Silver Core Pathway X 5300","17575IN070",,"INN001","INS001","INF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700035-01","Anthem Silver Core Pathway X 5300","Standard Silver On Exchange Plan","68.40%","0.684484124183655","Yes","Yes","Yes","66%","34%","$5,300","$60","$500","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EQD","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700035","Anthem Silver Core Pathway X 5300","17575IN070",,"INN001","INS001","INF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700035-02","Anthem Silver Core Pathway X 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EQE","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700035","Anthem Silver Core Pathway X 5300","17575IN070",,"INN001","INS001","INF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700035-03","Anthem Silver Core Pathway X 5300","Limited Cost Sharing Plan Variation","68.40%","0.684484124183655","Yes","Yes","Yes","66%","34%","$5,300","$60","$500","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EQD","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700035","Anthem Silver Core Pathway X 5300","17575IN070",,"INN001","INS001","INF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700035-04","Anthem Silver Core Pathway X 5300 S04","73% AV Level Silver Plan","72.11%","0.722282707691193","Yes","Yes","Yes","66%","34%","$3,450","$600","$1,100","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group","25.00%","$3,450","$3450 per person","$6900 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EQF","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700035","Anthem Silver Core Pathway X 5300","17575IN070",,"INN001","INS001","INF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700035-05","Anthem Silver Core Pathway X 5300 S05","87% AV Level Silver Plan","86.08%","0.859809637069702","Yes","Yes","Yes","66%","34%","$950","$500","$500","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","25.00%","$950","$950 per person","$1900 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EQG","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700035","Anthem Silver Core Pathway X 5300","17575IN070",,"INN001","INS001","INF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700035-06","Anthem Silver Core Pathway X 5300 S06","94% AV Level Silver Plan","93.06%","0.929147779941559","Yes","Yes","Yes","66%","34%","$250","$200","$400","$0","$250","$600","$10","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EQH","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-00","Anthem Silver Pathway X 2500","Standard Silver Off Exchange Plan","71.50%","0.721490085124969","Yes","Yes","Yes","66%","34%","$2,500","$600","$1,200","$0","$500","$1,900","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J7E","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0730003","Anthem Bronze Blue Preferred X POS 6000 30 7150 Plus","17575IN073",,"INN003","INS001","INF023","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/INSelectdrugtier5","17575IN0730003-00","Anthem Bronze Blue Preferred X POS 6000 30 7150 Plus","Standard Bronze Off Exchange Plan","60.27%","0.629184126853943","No","Yes","No","100%",,"$6,000","$80","$300","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","30.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GCP",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","No","35-0781558","17575IN0730003","Anthem Bronze Blue Preferred X POS 6000 30 7150 Plus","17575IN073",,"INN003","INS001","INF023","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/INSelectdrugtier5","17575IN0730003-01","Anthem Bronze Blue Preferred X POS 6000 30 7150 Plus","Standard Bronze On Exchange Plan","60.27%","0.629184126853943","No","Yes","No","100%",,"$6,000","$80","$300","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","30.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GCP",
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-01","Anthem Silver Pathway X 2500","Standard Silver On Exchange Plan","71.50%","0.721490085124969","Yes","Yes","Yes","66%","34%","$2,500","$600","$1,200","$0","$500","$1,900","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF6","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-02","Anthem Silver Pathway X 2500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFZ","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-03","Anthem Silver Pathway X 2500","Limited Cost Sharing Plan Variation","71.50%","0.721490085124969","Yes","Yes","Yes","66%","34%","$2,500","$600","$1,200","$0","$500","$1,900","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF6","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-04","Anthem Silver Pathway X 2500 S04","73% AV Level Silver Plan","73.95%","0.744235157966614","Yes","Yes","Yes","66%","34%","$2,500","$600","$1,200","$0","$500","$1,700","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF7","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-05","Anthem Silver Pathway X 2500 S05","87% AV Level Silver Plan","87.92%","0.880326569080353","Yes","Yes","Yes","66%","34%","$750","$500","$700","$0","$500","$1,300","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%","$750","$750 per person","$1500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF8","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-06","Anthem Silver Pathway X 2500 S06","94% AV Level Silver Plan","94.95%","0.948931455612183","Yes","Yes","Yes","66%","34%","$200","$200","$400","$0","$200","$500","$10","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF9","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700029","Anthem Catastrophic Pathway X 7150","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700029-00","Anthem Catastrophic Pathway 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","66%","34%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GER","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0700029","Anthem Catastrophic Pathway X 7150","17575IN070",,"INN001","INS001","INF013","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700029-01","Anthem Catastrophic Pathway X 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","66%","34%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEQ","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0760002","Anthem Bronze Pathway X POS 5000","17575IN076",,"INN001","INS001","INF007","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0760002-00","Anthem Bronze Pathway X POS 5000","Standard Bronze Off Exchange Plan","61.68%","0.618916511535645","Yes","Yes","Yes","66%","34%","$0","$5,000","$0","$900","$4,500","$300","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$30,000","$30000 per person","$60000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J79","http://editiondigital.net/view/IU65/2017/OFF_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0760002","Anthem Bronze Pathway X POS 5000","17575IN076",,"INN001","INS001","INF007","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0760002-01","Anthem Bronze Pathway X POS 5000","Standard Bronze On Exchange Plan","61.68%","0.618916511535645","Yes","Yes","Yes","66%","34%","$0","$5,000","$0","$900","$4,500","$300","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$30,000","$30000 per person","$60000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEV","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0760002","Anthem Bronze Pathway X POS 5000","17575IN076",,"INN001","INS001","INF007","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0760002-02","Anthem Bronze Pathway X POS 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFU","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","HIOS","2016-08-19 02:25:56","Individual","No","35-0781558","17575IN0760002","Anthem Bronze Pathway X POS 5000","17575IN076",,"INN001","INS001","INF007","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0760002-03","Anthem Bronze Pathway X POS 5000","Limited Cost Sharing Plan Variation","61.68%","0.618916511535645","Yes","Yes","Yes","66%","34%","$0","$5,000","$0","$900","$4,500","$300","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$30,000","$30000 per person","$60000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEV","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","28856","HIOS","2016-06-25 15:13:19","Individual","Yes","35-1545647","28856IN0160001","Delta Dental Individual PPO, EHB Certified","28856IN016",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0160001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0190001","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0190001-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0190002","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0190002-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","Individual","Yes","35-1545647","28856IN0160002","Delta Dental Individual PPO, EHB Certified","28856IN016",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0160002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010008","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010008-01","CareSource Hoosier Choice Silver","Standard Silver On Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010008","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010008-02","CareSource Hoosier Choice Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silverzero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","28856","HIOS","2016-06-25 15:13:19","Individual","Yes","35-1545647","28856IN0220001","Delta Dental Individual PPO, EHB Certified (Exchange)","28856IN022",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0220001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_High_2017","http://www.deltadentalin.com/IN_EHB_High_2017"
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0190003","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0190003-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0190004","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0190004-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","Individual","Yes","35-1545647","28856IN0230002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","28856IN023",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0230002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_Ped_Low_2017","http://www.deltadentalin.com/IN_Ped_Low_2017"
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0180004","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0180004-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","Individual","Yes","35-1545647","28856IN0220002","Delta Dental Individual PPO, EHB Certified (Exchange)","28856IN022",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0220002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_Low_2017","http://www.deltadentalin.com/IN_EHB_Low_2017"
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0240001","Delta Dental Group PPO, EHB Certified (Exchange)","28856IN024",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0240001-01","Delta Dental Group PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_Group_High_2017","http://www.deltadentalin.com/IN_EHB_Group_High_2017"
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0240002","Delta Dental Group PPO, EHB Certified (Exchange)","28856IN024",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0240002-01","Delta Dental Group PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_Group_Low_2017","http://www.deltadentalin.com/IN_EHB_Group_Low_2017"
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0180001","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0180001-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","Individual","Yes","35-1545647","28856IN0170001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","28856IN017",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0170001-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","Individual","Yes","35-1545647","28856IN0170002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","28856IN017",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0170002-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0180002","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0180002-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","35-1545647","28856IN0180003","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0180003-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","28856","HIOS","2016-06-25 15:13:19","Individual","Yes","35-1545647","28856IN0230001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","28856IN023",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0230001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_Ped_High_2017","http://www.deltadentalin.com/IN_Ped_High_2017"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010001","CareSource Gold","54192IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010001-00","CareSource Gold","Standard Gold Off Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-gold-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010001","CareSource Gold","54192IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010001-01","CareSource Gold","Standard Gold On Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-gold-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010001","CareSource Gold","54192IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010001-02","CareSource Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-goldzero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010001","CareSource Gold","54192IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010001-03","CareSource Gold Limited","Limited Cost Sharing Plan Variation",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-goldltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010003","CareSource Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010003-00","CareSource Silver","Standard Silver Off Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010003","CareSource Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010003-01","CareSource Silver","Standard Silver On Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010003","CareSource Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010003-02","CareSource Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silverzero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010003","CareSource Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010003-03","CareSource Silver Limited","Limited Cost Sharing Plan Variation",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silverltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010003","CareSource Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010003-04","CareSource Silver 1","73% AV Level Silver Plan",,"0.737353086471558","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver1-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010003","CareSource Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010003-05","CareSource Silver 2","87% AV Level Silver Plan",,"0.874086737632751","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver2-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010003","CareSource Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010003-06","CareSource Silver 3","94% AV Level Silver Plan",,"0.94385153055191","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver3-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010005","CareSource Bronze","54192IN001",,"INN001","INS001","INF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9862",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010005-00","CareSource Bronze","Standard Bronze Off Exchange Plan","60.10%","0.631255805492401","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-in-bronze-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010005","CareSource Bronze","54192IN001",,"INN001","INS001","INF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9862",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010005-01","CareSource Bronze","Standard Bronze On Exchange Plan","60.10%","0.631255805492401","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-in-bronze-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010005","CareSource Bronze","54192IN001",,"INN001","INS001","INF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9862",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010005-02","CareSource Bronze Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/mp2017-in-bronzezero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010005","CareSource Bronze","54192IN001",,"INN001","INS001","INF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9862",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010005-03","CareSource Bronze Limited","Limited Cost Sharing Plan Variation","60.10%","0.631255805492401","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-in-bronzeltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010007","CareSource Hoosier Choice Gold","54192IN001",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010007-00","CareSource Hoosier Choice Gold","Standard Gold Off Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-gold-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010007","CareSource Hoosier Choice Gold","54192IN001",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010007-01","CareSource Hoosier Choice Gold","Standard Gold On Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-gold-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010007","CareSource Hoosier Choice Gold","54192IN001",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010007-02","CareSource Hoosier Choice Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-goldzero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010007","CareSource Hoosier Choice Gold","54192IN001",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010007-03","CareSource Hoosier Choice Gold Limited","Limited Cost Sharing Plan Variation",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-goldltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010008","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010008-00","CareSource Hoosier Choice Silver","Standard Silver Off Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010008","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010008-03","CareSource Hoosier Choice Silver Limited","Limited Cost Sharing Plan Variation",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silverltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010008","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010008-04","CareSource Hoosier Choice Silver 1","73% AV Level Silver Plan",,"0.737353086471558","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver1-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010008","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010008-05","CareSource Hoosier Choice Silver 2","87% AV Level Silver Plan",,"0.874086737632751","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver2-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010008","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010008-06","CareSource Hoosier Choice Silver 3","94% AV Level Silver Plan",,"0.94385153055191","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver3-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010009","CareSource Hoosier Choice Bronze","54192IN001",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9862",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010009-00","CareSource Hoosier Choice Bronze","Standard Bronze Off Exchange Plan","60.10%","0.631255805492401","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-hoosier-in-bronze-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010009","CareSource Hoosier Choice Bronze","54192IN001",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9862",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010009-01","CareSource Hoosier Choice Bronze","Standard Bronze On Exchange Plan","60.10%","0.631255805492401","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-hoosier-in-bronze-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010009","CareSource Hoosier Choice Bronze","54192IN001",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9862",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010009-02","CareSource Hoosier Choice Bronze Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-hoosier-in-bronzezero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0010009","CareSource Hoosier Choice Bronze","54192IN001",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9862",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0010009-03","CareSource Hoosier Choice Bronze Limited","Limited Cost Sharing Plan Variation","60.10%","0.631255805492401","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-hoosier-in-bronzeltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020001","CareSource Gold Dental and Vision","54192IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9276",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020001-00","CareSource Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-gold-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020001","CareSource Gold Dental and Vision","54192IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9276",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020001-01","CareSource Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-gold-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020001","CareSource Gold Dental and Vision","54192IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9276",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020001-02","CareSource Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-goldzero-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020001","CareSource Gold Dental and Vision","54192IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9276",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020001-03","CareSource Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-goldltd-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020003","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020003-00","CareSource Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020003","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020003-01","CareSource Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020003","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020003-02","CareSource Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silverzero-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020003","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020003-03","CareSource Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silverltd-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020003","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020003-04","CareSource Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.737353086471558","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver1-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020003","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020003-05","CareSource Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.874086737632751","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver2-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020003","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020003-06","CareSource Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.94385153055191","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-in-silver3-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020005","CareSource Bronze Dental and Vision","54192IN002",,"INN001","INS001","INF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9029",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020005-00","CareSource Bronze Dental and Vision","Standard Bronze Off Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-in-bronze-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020005","CareSource Bronze Dental and Vision","54192IN002",,"INN001","INS001","INF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9029",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020005-01","CareSource Bronze Dental and Vision","Standard Bronze On Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-in-bronze-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020005","CareSource Bronze Dental and Vision","54192IN002",,"INN001","INS001","INF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9029",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020005-02","CareSource Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/mp2017-in-bronzezero-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020005","CareSource Bronze Dental and Vision","54192IN002",,"INN001","INS001","INF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9029",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020005-03","CareSource Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-in-bronzeltd-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020007","CareSource Hoosier Choice Gold Dental and Vision","54192IN002",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9276",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020007-00","CareSource Hoosier Choice Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-gold-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020007","CareSource Hoosier Choice Gold Dental and Vision","54192IN002",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9276",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020007-01","CareSource Hoosier Choice Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-gold-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020007","CareSource Hoosier Choice Gold Dental and Vision","54192IN002",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9276",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020007-02","CareSource Hoosier Choice Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-goldzero-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020007","CareSource Hoosier Choice Gold Dental and Vision","54192IN002",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9276",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020007-03","CareSource Hoosier Choice Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-goldltd-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020008","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020008-00","CareSource Hoosier Choice Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020008","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020008-01","CareSource Hoosier Choice Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020008","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020008-02","CareSource Hoosier Choice Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silverzero-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020008","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020008-03","CareSource Hoosier Choice Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silverltd-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020008","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020008-04","CareSource Hoosier Choice Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.737353086471558","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver1-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020008","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020008-05","CareSource Hoosier Choice Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.874086737632751","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver2-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020008","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9143",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020008-06","CareSource Hoosier Choice Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.94385153055191","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://caresource.com/documents/mp2017-hoosier-in-silver3-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020009","CareSource Hoosier Choice Bronze Dental and Vision","54192IN002",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9029",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020009-00","CareSource Hoosier Choice Bronze Dental and Vision","Standard Bronze Off Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-hoosier-in-bronze-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020009","CareSource Hoosier Choice Bronze Dental and Vision","54192IN002",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9029",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020009-01","CareSource Hoosier Choice Bronze Dental and Vision","Standard Bronze On Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-hoosier-in-bronze-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020009","CareSource Hoosier Choice Bronze Dental and Vision","54192IN002",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9029",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020009-02","CareSource Hoosier Choice Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-hoosier-in-bronzezero-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0020009","CareSource Hoosier Choice Bronze Dental and Vision","54192IN002",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9029",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0020009-03","CareSource Hoosier Choice Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-hoosier-in-bronzeltd-dv-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030001","CareSource Federal Simple Choice Gold","54192IN003",,"INN001","INS001","INF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030001-00","CareSource Federal Simple Choice Gold","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-gold-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030001","CareSource Federal Simple Choice Gold","54192IN003",,"INN001","INS001","INF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030001-01","CareSource Federal Simple Choice Gold","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-gold-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030001","CareSource Federal Simple Choice Gold","54192IN003",,"INN001","INS001","INF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030001-02","CareSource Federal Simple Choice Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-goldzero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030001","CareSource Federal Simple Choice Gold","54192IN003",,"INN001","INS001","INF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030001-03","CareSource Federal Simple Choice Gold","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-goldltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030002","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030002-00","CareSource Federal Simple Choice Silver","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-silver-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030002","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030002-01","CareSource Federal Simple Choice Silver","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-silver-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030002","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030002-02","CareSource Federal Simple Choice Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-silverzero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030002","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030002-03","CareSource Federal Simple Choice Silver","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-silverltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030002","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030002-04","CareSource Federal Simple Choice Silver","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-silver1-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030002","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030002-05","CareSource Federal Simple Choice Silver","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$40","$1,010","$150","$700","$280","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-silver2-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030002","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030002-06","CareSource Federal Simple Choice Silver","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-silver3-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030003","CareSource Federal Simple Choice Bronze","54192IN003",,"INN001","INS001","INF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030003-00","CareSource Federal Simple Choice Bronze","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-bronze-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030003","CareSource Federal Simple Choice Bronze","54192IN003",,"INN001","INS001","INF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030003-01","CareSource Federal Simple Choice Bronze","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-bronze-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030003","CareSource Federal Simple Choice Bronze","54192IN003",,"INN001","INS001","INF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030003-02","CareSource Federal Simple Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-bronzezero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0030003","CareSource Federal Simple Choice Bronze","54192IN003",,"INN001","INS001","INF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0030003-03","CareSource Federal Simple Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-in-bronzeltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0040001","CareSource Low Premium Silver","54192IN004",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0040001-00","CareSource Low Premium Silver","Standard Silver Off Exchange Plan",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-in-silver-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0040001","CareSource Low Premium Silver","54192IN004",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0040001-01","CareSource Low Premium Silver","Standard Silver On Exchange Plan",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-in-silver-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0040001","CareSource Low Premium Silver","54192IN004",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0040001-02","CareSource Low Premium Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-lp-in-silverzero-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0040001","CareSource Low Premium Silver","54192IN004",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0040001-03","CareSource Low Premium Silver Limited","Limited Cost Sharing Plan Variation",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-in-silverltd-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0040001","CareSource Low Premium Silver","54192IN004",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0040001-04","CareSource Low Premium Silver 1","73% AV Level Silver Plan",,"0.721862494945526","Yes","Yes","No","100%",,"$5,000","$0","$340","$150","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"https://caresource.com/documents/mp2017-lp-in-silver1-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0040001","CareSource Low Premium Silver","54192IN004",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0040001-05","CareSource Low Premium Silver 2","87% AV Level Silver Plan",,"0.868183672428131","Yes","Yes","No","100%",,"$1,100","$30","$510","$150","$1,100","$90","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","No",,,"https://caresource.com/documents/mp2017-lp-in-silver2-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","54192","HIOS","2017-01-21 03:35:28","Individual","No","32-0121856","54192IN0040001","CareSource Low Premium Silver","54192IN004",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","54192IN0040001-06","CareSource Low Premium Silver 3","94% AV Level Silver Plan",,"0.932700634002686","Yes","Yes","No","100%",,"$500","$10","$250","$150","$500","$50","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"https://caresource.com/documents/mp2017-lp-in-silver3-sum","https://www.caresource.com/documents/mp2017-in-broch"
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0040001","Delta Dental Individual PPO, EHB Certified","57874IN004",,"INN002","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0040001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","57874","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","57874IN0060001","Renaissance Group Dental PPO, EHB Certified","57874IN006",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0060001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","57874","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","57874IN0060002","Renaissance Group Dental PPO, EHB Certified","57874IN006",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0060002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0040002","Delta Dental Individual PPO, EHB Certified","57874IN004",,"INN002","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0040002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0050003","Renaissance Individual Dental PPO, EHB Certified","57874IN005",,"INN001","INS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0050003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0050004","Renaissance Individual Dental PPO, EHB Certified","57874IN005",,"INN001","INS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0050004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0070001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","57874IN007",,"INN001","INS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/57874","","57874IN0070001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/IN_EHB_High_2017","http://www.renaissancedental.com/IN_EHB_High_2017"
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0070002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","57874IN007",,"INN001","INS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/57874","","57874IN0070002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/IN_EHB_Low_2017","http://www.renaissancedental.com/IN_EHB_Low_2017"
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0090001","Renaissance Individual Dental Pediatric-Only, EHB Certified","57874IN009",,"INN001","INS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0090001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0090002","Renaissance Individual Dental Pediatric-Only, EHB Certified","57874IN009",,"INN001","INS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0090002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0080001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","57874IN008",,"INN001","INS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/57874","","57874IN0080001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/IN_Ped_High_2017","http://www.renaissancedental.com/IN_Ped_High_2017"
"2017","IN","57874","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","57874IN0080002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","57874IN008",,"INN001","INS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/57874","","57874IN0080002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/IN_Ped_Low_2017","http://www.renaissancedental.com/IN_Ped_Low_2017"
"2017","IN","59560","HIOS","2016-08-05 02:57:02","Individual","Yes","13-5123390","59560IN0070002","Guardian Essentials for Families and Individuals","59560IN007",,"INN002","INS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","59560IN0070002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IN","59560","HIOS","2016-08-05 02:57:02","SHOP (Small Group)","Yes","13-5123390","59560IN0010003","Guardian Pediatric Advantage","59560IN001",,"INN001","INS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","59560IN0010003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IN","59560","HIOS","2016-08-05 02:57:02","SHOP (Small Group)","Yes","13-5123390","59560IN0020003","Guardian Pediatric Essentials","59560IN002",,"INN001","INS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","59560IN0020003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IN","59560","HIOS","2016-08-05 02:57:02","Individual","Yes","13-5123390","59560IN0070002","Guardian Essentials for Families and Individuals","59560IN007",,"INN002","INS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","59560IN0070002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IN","59560","HIOS","2016-08-05 02:57:02","Individual","Yes","13-5123390","59560IN0080001","Guardian Select for Families and Individuals","59560IN008",,"INN002","INS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","59560IN0080001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IN","59560","HIOS","2016-08-05 02:57:02","Individual","Yes","13-5123390","59560IN0080001","Guardian Select for Families and Individuals","59560IN008",,"INN002","INS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","59560IN0080001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IN","59560","HIOS","2016-08-05 02:57:02","Individual","Yes","13-5123390","59560IN0090001","Guardian Basics for Families and Individuals","59560IN009",,"INN002","INS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","59560IN0090001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IN","59560","HIOS","2016-08-05 02:57:02","Individual","Yes","13-5123390","59560IN0090001","Guardian Basics for Families and Individuals","59560IN009",,"INN002","INS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","59560IN0090001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010001","MDwise Marketplace Bronze Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010001-00","MDwise Marketplace Bronze Plus - Off Exchange","Standard Bronze Off Exchange Plan",,"0.619581639766693","Yes","Yes","No","100%",,"$5,400","$20","$760","$150","$5,400","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_off_ex_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010001","MDwise Marketplace Bronze Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010001-01","MDwise Marketplace Bronze Plus - On Exchange","Standard Bronze On Exchange Plan",,"0.619581639766693","Yes","Yes","No","100%",,"$5,400","$20","$760","$150","$5,400","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010001","MDwise Marketplace Bronze Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010001-02","MDwise Marketplace Bronze Plus - Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_zero_cost_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010001","MDwise Marketplace Bronze Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010001-03","MDwise Marketplace Bronze Plus - Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.619581639766693","Yes","Yes","No","100%",,"$5,400","$20","$760","$150","$5,400","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_lcs_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010002-00","MDwise Marketplace Silver Plus - Off Exchange","Standard Silver Off Exchange Plan",,"0.717746436595917","Yes","Yes","No","100%",,"$3,100","$20","$630","$150","$3,100","$580","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_off_ex_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010002-01","MDwise Marketplace Silver Plus - On Exchange","Standard Silver On Exchange Plan",,"0.717746436595917","Yes","Yes","No","100%",,"$3,100","$20","$630","$150","$3,100","$580","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010002-02","MDwise Marketplace Silver Plus - Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_zero_cost_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010002-03","MDwise Marketplace Silver Plus - Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.717746436595917","Yes","Yes","No","100%",,"$3,100","$20","$630","$150","$3,100","$580","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_lcs_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010002-04","MDwise Marketplace Silver Plus - 73% Cost Sharing","73% AV Level Silver Plan",,"0.738309741020203","Yes","Yes","No","100%",,"$2,750","$60","$670","$150","$2,750","$590","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_73_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010002-05","MDwise Marketplace Silver Plus - 87% Cost Sharing","87% AV Level Silver Plan",,"0.87822163105011","Yes","Yes","No","100%",,"$850","$400","$150","$150","$850","$510","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_87_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010002-06","MDwise Marketplace Silver Plus - 94% Cost Sharing","94% AV Level Silver Plan",,"0.949805796146393","Yes","Yes","No","100%",,"$550","$0","$0","$150","$550","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_94_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010004","MDwise Marketplace Bronze Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010004-00","MDwise Marketplace Bronze Basic - Off Exchange","Standard Bronze Off Exchange Plan",,"0.585730671882629","Yes","Yes","No","100%",,"$6,800","$20","$200","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_basic_off_ex_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010004","MDwise Marketplace Bronze Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010004-01","MDwise Marketplace Bronze Basic - On Exchange","Standard Bronze On Exchange Plan",,"0.585730671882629","Yes","Yes","No","100%",,"$6,800","$20","$200","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_basic_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010004","MDwise Marketplace Bronze Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010004-02","MDwise Marketplace Bronze Basic - Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_basic_zero_cost_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010004","MDwise Marketplace Bronze Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010004-03","MDwise Marketplace Bronze Basic - Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.585730671882629","Yes","Yes","No","100%",,"$6,800","$20","$200","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_basic_lcs_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010005-00","MDwise Marketplace Silver Basic - Off Exchange","Standard Silver Off Exchange Plan",,"0.681816220283508","Yes","Yes","No","100%",,"$5,000","$20","$340","$150","$5,000","$80","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_off_ex_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010005-01","MDwise Marketplace Silver Basic - On Exchange","Standard Silver On Exchange Plan",,"0.681816220283508","Yes","Yes","No","100%",,"$5,000","$20","$340","$150","$5,000","$80","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010005-02","MDwise Marketplace Silver Basic - Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_zero_cost_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010005-03","MDwise Marketplace Silver Basic - Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.681816220283508","Yes","Yes","No","100%",,"$5,000","$20","$340","$150","$5,000","$80","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_lcs_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010005-04","MDwise Marketplace Silver Basic - 73% Cost Sharing","73% AV Level Silver Plan",,"0.720171630382538","Yes","Yes","No","100%",,"$4,700","$20","$390","$150","$4,700","$140","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_73_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010005-05","MDwise Marketplace Silver Basic - 87% Cost Sharing","87% AV Level Silver Plan",,"0.861440598964691","Yes","Yes","No","100%",,"$1,200","$370","$330","$150","$1,200","$600","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_87_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010005-06","MDwise Marketplace Silver Basic - 94% Cost Sharing","94% AV Level Silver Plan",,"0.931996166706085","Yes","Yes","No","100%",,"$800","$0","$0","$150","$800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_94_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010031-00","MDwise Marketplace Silver Coinsurance - Off Exchange","Standard Silver Off Exchange Plan",,"0.716537773609161","Yes","Yes","No","100%",,"$3,600","$20","$550","$150","$3,600","$510","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_off_ex_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010031-01","MDwise Marketplace Silver Coinsurance - On Exchange","Standard Silver On Exchange Plan",,"0.716537773609161","Yes","Yes","No","100%",,"$3,600","$20","$550","$150","$3,600","$510","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010031-02","MDwise Marketplace Silver Coinsurance - Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_zero_cost_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010031-03","MDwise Marketplace Silver Coinsurance - Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.716537773609161","Yes","Yes","No","100%",,"$3,600","$20","$550","$150","$3,600","$510","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_lcs_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010031-04","MDwise Marketplace Silver Coinsurance - 73% Cost Sharing","73% AV Level Silver Plan",,"0.737781047821045","Yes","Yes","No","100%",,"$3,500","$20","$570","$150","$3,500","$340","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_73_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010031-05","MDwise Marketplace Silver Coinsurance - 87% Cost Sharing","87% AV Level Silver Plan",,"0.878126442432404","Yes","Yes","No","100%",,"$1,000","$20","$510","$150","$1,000","$360","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_87_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0010031-06","MDwise Marketplace Silver Coinsurance - 94% Cost Sharing","94% AV Level Silver Plan",,"0.947826147079468","Yes","Yes","No","100%",,"$600","$0","$0","$150","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_94_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020001","MDwise Marketplace Bronze Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020001-00","MDwise Marketplace Bronze Plus with Adult Vision - Off Exchange","Standard Bronze Off Exchange Plan",,"0.619581639766693","Yes","Yes","No","100%",,"$5,400","$20","$760","$150","$5,400","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_vision_off_ex_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020001","MDwise Marketplace Bronze Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020001-01","MDwise Marketplace Bronze Plus with Adult Vision - On Exchange","Standard Bronze On Exchange Plan",,"0.619581639766693","Yes","Yes","No","100%",,"$5,400","$20","$760","$150","$5,400","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_vision_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020001","MDwise Marketplace Bronze Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020001-02","MDwise Marketplace Bronze Plus with Adult Vision - Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_vision_zero_cost_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020001","MDwise Marketplace Bronze Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020001-03","MDwise Marketplace Bronze Plus with Adult Vision - Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.619581639766693","Yes","Yes","No","100%",,"$5,400","$20","$760","$150","$5,400","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_vision_lcs_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.981",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020002-00","MDwise Marketplace Silver Plus with Adult Vision - Off Exchange","Standard Silver Off Exchange Plan",,"0.717746436595917","Yes","Yes","No","100%",,"$3,100","$20","$630","$150","$3,100","$580","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_off_ex_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.981",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020002-01","MDwise Marketplace Silver Plus with Adult Vision - On Exchange","Standard Silver On Exchange Plan",,"0.717746436595917","Yes","Yes","No","100%",,"$3,100","$20","$630","$150","$3,100","$580","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.981",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020002-02","MDwise Marketplace Silver Plus with Adult Vision - Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_zero_cost_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.981",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020002-03","MDwise Marketplace Silver Plus with Adult Vision - Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.717746436595917","Yes","Yes","No","100%",,"$3,100","$20","$630","$150","$3,100","$580","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_lcs_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.981",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020002-04","MDwise Marketplace Silver Plus with Adult Vision - 73% Cost Sharing","73% AV Level Silver Plan",,"0.738309741020203","Yes","Yes","No","100%",,"$2,750","$60","$670","$150","$2,750","$590","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_73_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.981",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020002-05","MDwise Marketplace Silver Plus with Adult Vision - 87% Cost Sharing","87% AV Level Silver Plan",,"0.87822163105011","Yes","Yes","No","100%",,"$850","$400","$150","$150","$850","$510","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_87_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.981",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020002-06","MDwise Marketplace Silver Plus with Adult Vision - 94% Cost Sharing","94% AV Level Silver Plan",,"0.949805796146393","Yes","Yes","No","100%",,"$550","$0","$0","$150","$550","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_94_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020003","MDwise Marketplace Gold Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.985",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020003-00","MDwise Marketplace Gold Plus with Adult Vision - Off Exchange","Standard Gold Off Exchange Plan",,"0.801892280578613","Yes","Yes","No","100%",,"$1,500","$440","$450","$150","$1,500","$620","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_vision_off_ex_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020003","MDwise Marketplace Gold Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.985",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020003-01","MDwise Marketplace Gold Plus with Adult Vision - On Exchange","Standard Gold On Exchange Plan",,"0.801892280578613","Yes","Yes","No","100%",,"$1,500","$440","$450","$150","$1,500","$620","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_vision_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020003","MDwise Marketplace Gold Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.985",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020003-02","MDwise Marketplace Gold Plus with Adult Vision - Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_vision_zero_cost_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","62033","HIOS","2016-10-21 02:45:44","Individual","No","46-5270582","62033IN0020003","MDwise Marketplace Gold Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.985",,,"2017-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/","62033IN0020003-03","MDwise Marketplace Gold Plus with Adult Vision - Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.801892280578613","Yes","Yes","No","100%",,"$1,500","$440","$450","$150","$1,500","$620","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_vision_lcs_2017.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110001-03","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/76179IN0110001-03.pdf","https://api.centene.com/Brochures/2017/76179IN0110001-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-00","Ambetter Balanced Care 1 (2017)","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110002-00.pdf","https://api.centene.com/Brochures/2017/76179IN0110002-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-01","Ambetter Balanced Care 1 (2017)","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110002-01.pdf","https://api.centene.com/Brochures/2017/76179IN0110002-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-02","Ambetter Balanced Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110002-02.pdf","https://api.centene.com/Brochures/2017/76179IN0110002-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-03","Ambetter Balanced Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110002-03.pdf","https://api.centene.com/Brochures/2017/76179IN0110002-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-04","Ambetter Balanced Care 1 (2017)","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110002-04.pdf","https://api.centene.com/Brochures/2017/76179IN0110002-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-05","Ambetter Balanced Care 1 (2017)","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110002-05.pdf","https://api.centene.com/Brochures/2017/76179IN0110002-05.pdf"
"2017","IN","69051","HIOS","2016-06-24 02:40:05","SHOP (Small Group)","Yes","13-5581829","69051IN0110001","EHB Basic Dental Plan (Low)","69051IN011",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","69051IN0110001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","69572","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","69572IN0040002","EHB High PPO","69572IN004",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","69572IN0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2017)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110009-03","Ambetter Balanced Care 12 (2017)","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110009-03.pdf","https://api.centene.com/Brochures/2017/76179IN0110009-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2017)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110009-04","Ambetter Balanced Care 12 (2017)","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$400","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110009-04.pdf","https://api.centene.com/Brochures/2017/76179IN0110009-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2017)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110009-05","Ambetter Balanced Care 12 (2017)","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$900","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110009-05.pdf","https://api.centene.com/Brochures/2017/76179IN0110009-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2017)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110009-06","Ambetter Balanced Care 12 (2017)","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$300","$200","$250","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110009-06.pdf","https://api.centene.com/Brochures/2017/76179IN0110009-06.pdf"
"2017","IN","69572","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","69572IN0040001","EHB Low PPO","69572IN004",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","69572IN0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IN","69572","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","69572IN0030002","EHB High Passive","69572IN003",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","69572IN0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IN","69572","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","69572IN0030001","EHB Low Passive","69572IN003",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","69572IN0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IN","72074","HIOS","2016-08-17 03:19:03","SHOP (Small Group)","Yes","57-0523959","72074IN0020001","Group Dental","72074IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","72074IN0020001-00","Group Dental","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110001-00","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/76179IN0110001-00.pdf","https://api.centene.com/Brochures/2017/76179IN0110001-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110001-01","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/76179IN0110001-01.pdf","https://api.centene.com/Brochures/2017/76179IN0110001-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110001-02","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/76179IN0110001-02.pdf","https://api.centene.com/Brochures/2017/76179IN0110001-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-06","Ambetter Balanced Care 1 (2017)","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110002-06.pdf","https://api.centene.com/Brochures/2017/76179IN0110002-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2017)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-00","Ambetter Balanced Care 2 (2017)","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110003-00.pdf","https://api.centene.com/Brochures/2017/76179IN0110003-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2017)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-01","Ambetter Balanced Care 2 (2017)","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110003-01.pdf","https://api.centene.com/Brochures/2017/76179IN0110003-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2017)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-02","Ambetter Balanced Care 2 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110003-02.pdf","https://api.centene.com/Brochures/2017/76179IN0110003-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2017)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-03","Ambetter Balanced Care 2 (2017)","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110003-03.pdf","https://api.centene.com/Brochures/2017/76179IN0110003-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2017)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-04","Ambetter Balanced Care 2 (2017)","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110003-04.pdf","https://api.centene.com/Brochures/2017/76179IN0110003-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2017)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-05","Ambetter Balanced Care 2 (2017)","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110003-05.pdf","https://api.centene.com/Brochures/2017/76179IN0110003-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2017)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-06","Ambetter Balanced Care 2 (2017)","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110003-06.pdf","https://api.centene.com/Brochures/2017/76179IN0110003-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-00","Ambetter Balanced Care 10 (2017)","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110005-00.pdf","https://api.centene.com/Brochures/2017/76179IN0110005-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-01","Ambetter Balanced Care 10 (2017)","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110005-01.pdf","https://api.centene.com/Brochures/2017/76179IN0110005-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-02","Ambetter Balanced Care 10 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110005-02.pdf","https://api.centene.com/Brochures/2017/76179IN0110005-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-03","Ambetter Balanced Care 10 (2017)","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110005-03.pdf","https://api.centene.com/Brochures/2017/76179IN0110005-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-04","Ambetter Balanced Care 10 (2017)","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110005-04.pdf","https://api.centene.com/Brochures/2017/76179IN0110005-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-05","Ambetter Balanced Care 10 (2017)","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110005-05.pdf","https://api.centene.com/Brochures/2017/76179IN0110005-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2017)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-06","Ambetter Balanced Care 10 (2017)","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110005-06.pdf","https://api.centene.com/Brochures/2017/76179IN0110005-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2017)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110008-00","Ambetter Balanced Care 4 (2017)","Standard Silver Off Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110008-00.pdf","https://api.centene.com/Brochures/2017/76179IN0110008-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2017)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110008-01","Ambetter Balanced Care 4 (2017)","Standard Silver On Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110008-01.pdf","https://api.centene.com/Brochures/2017/76179IN0110008-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2017)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110008-02","Ambetter Balanced Care 4 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110008-02.pdf","https://api.centene.com/Brochures/2017/76179IN0110008-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2017)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110008-03","Ambetter Balanced Care 4 (2017)","Limited Cost Sharing Plan Variation",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110008-03.pdf","https://api.centene.com/Brochures/2017/76179IN0110008-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2017)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110008-04","Ambetter Balanced Care 4 (2017)","73% AV Level Silver Plan",,"0.732531428337097","Yes","Yes","No","100%",,"$5,200","$40","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110008-04.pdf","https://api.centene.com/Brochures/2017/76179IN0110008-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2017)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110008-05","Ambetter Balanced Care 4 (2017)","87% AV Level Silver Plan",,"0.865934371948242","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110008-05.pdf","https://api.centene.com/Brochures/2017/76179IN0110008-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2017)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110008-06","Ambetter Balanced Care 4 (2017)","94% AV Level Silver Plan",,"0.947982847690582","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110008-06.pdf","https://api.centene.com/Brochures/2017/76179IN0110008-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2017)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110009-00","Ambetter Balanced Care 12 (2017)","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110009-00.pdf","https://api.centene.com/Brochures/2017/76179IN0110009-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2017)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110009-01","Ambetter Balanced Care 12 (2017)","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110009-01.pdf","https://api.centene.com/Brochures/2017/76179IN0110009-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2017)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110009-02","Ambetter Balanced Care 12 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110009-02.pdf","https://api.centene.com/Brochures/2017/76179IN0110009-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110006","Ambetter Essential Care 1 (2017)","76179IN011",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110006-00","Ambetter Essential Care 1 (2017)","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110006-00.pdf","https://api.centene.com/Brochures/2017/76179IN0110006-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110006","Ambetter Essential Care 1 (2017)","76179IN011",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110006-01","Ambetter Essential Care 1 (2017)","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110006-01.pdf","https://api.centene.com/Brochures/2017/76179IN0110006-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110006","Ambetter Essential Care 1 (2017)","76179IN011",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110006-02","Ambetter Essential Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110006-02.pdf","https://api.centene.com/Brochures/2017/76179IN0110006-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0110006","Ambetter Essential Care 1 (2017)","76179IN011",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110006-03","Ambetter Essential Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0110006-03.pdf","https://api.centene.com/Brochures/2017/76179IN0110006-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9854",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-00","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120001-00.pdf","https://api.centene.com/Brochures/2017/76179IN0120001-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9854",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-01","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120001-01.pdf","https://api.centene.com/Brochures/2017/76179IN0120001-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9854",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-02","Ambetter Balanced Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120001-02.pdf","https://api.centene.com/Brochures/2017/76179IN0120001-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9854",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-03","Ambetter Balanced Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120001-03.pdf","https://api.centene.com/Brochures/2017/76179IN0120001-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9854",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-04","Ambetter Balanced Care 1 (2017) + Vision","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120001-04.pdf","https://api.centene.com/Brochures/2017/76179IN0120001-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9854",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-05","Ambetter Balanced Care 1 (2017) + Vision","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120001-05.pdf","https://api.centene.com/Brochures/2017/76179IN0120001-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9854",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-06","Ambetter Balanced Care 1 (2017) + Vision","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120001-06.pdf","https://api.centene.com/Brochures/2017/76179IN0120001-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2017) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9866",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-00","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120002-00.pdf","https://api.centene.com/Brochures/2017/76179IN0120002-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2017) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9866",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-01","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120002-01.pdf","https://api.centene.com/Brochures/2017/76179IN0120002-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2017) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9866",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-02","Ambetter Balanced Care 2 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120002-02.pdf","https://api.centene.com/Brochures/2017/76179IN0120002-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2017) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9866",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-03","Ambetter Balanced Care 2 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120002-03.pdf","https://api.centene.com/Brochures/2017/76179IN0120002-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2017) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9866",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-04","Ambetter Balanced Care 2 (2017) + Vision","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120002-04.pdf","https://api.centene.com/Brochures/2017/76179IN0120002-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2017) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9866",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-05","Ambetter Balanced Care 2 (2017) + Vision","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120002-05.pdf","https://api.centene.com/Brochures/2017/76179IN0120002-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2017) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9866",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-06","Ambetter Balanced Care 2 (2017) + Vision","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120002-06.pdf","https://api.centene.com/Brochures/2017/76179IN0120002-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-00","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120004-00.pdf","https://api.centene.com/Brochures/2017/76179IN0120004-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-01","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120004-01.pdf","https://api.centene.com/Brochures/2017/76179IN0120004-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-02","Ambetter Balanced Care 10 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120004-02.pdf","https://api.centene.com/Brochures/2017/76179IN0120004-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-03","Ambetter Balanced Care 10 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120004-03.pdf","https://api.centene.com/Brochures/2017/76179IN0120004-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-04","Ambetter Balanced Care 10 (2017) + Vision","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120004-04.pdf","https://api.centene.com/Brochures/2017/76179IN0120004-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-05","Ambetter Balanced Care 10 (2017) + Vision","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120004-05.pdf","https://api.centene.com/Brochures/2017/76179IN0120004-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2017) + Vision","76179IN012",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-06","Ambetter Balanced Care 10 (2017) + Vision","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120004-06.pdf","https://api.centene.com/Brochures/2017/76179IN0120004-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120005","Ambetter Essential Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120005-00","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120005-00.pdf","https://api.centene.com/Brochures/2017/76179IN0120005-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120005","Ambetter Essential Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120005-01","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120005-01.pdf","https://api.centene.com/Brochures/2017/76179IN0120005-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120005","Ambetter Essential Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120005-02","Ambetter Essential Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120005-02.pdf","https://api.centene.com/Brochures/2017/76179IN0120005-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0120005","Ambetter Essential Care 1 (2017) + Vision","76179IN012",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120005-03","Ambetter Essential Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0120005-03.pdf","https://api.centene.com/Brochures/2017/76179IN0120005-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-00","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130001-00.pdf","https://api.centene.com/Brochures/2017/76179IN0130001-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-01","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130001-01.pdf","https://api.centene.com/Brochures/2017/76179IN0130001-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-02","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130001-02.pdf","https://api.centene.com/Brochures/2017/76179IN0130001-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-03","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130001-03.pdf","https://api.centene.com/Brochures/2017/76179IN0130001-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-04","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130001-04.pdf","https://api.centene.com/Brochures/2017/76179IN0130001-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-05","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130001-05.pdf","https://api.centene.com/Brochures/2017/76179IN0130001-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-06","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130001-06.pdf","https://api.centene.com/Brochures/2017/76179IN0130001-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9285",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-00","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130002-00.pdf","https://api.centene.com/Brochures/2017/76179IN0130002-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9285",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-01","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130002-01.pdf","https://api.centene.com/Brochures/2017/76179IN0130002-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9285",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-02","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130002-02.pdf","https://api.centene.com/Brochures/2017/76179IN0130002-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9285",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-03","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130002-03.pdf","https://api.centene.com/Brochures/2017/76179IN0130002-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9285",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-04","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130002-04.pdf","https://api.centene.com/Brochures/2017/76179IN0130002-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9285",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-05","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130002-05.pdf","https://api.centene.com/Brochures/2017/76179IN0130002-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9285",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-06","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130002-06.pdf","https://api.centene.com/Brochures/2017/76179IN0130002-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9244",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-00","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130004-00.pdf","https://api.centene.com/Brochures/2017/76179IN0130004-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9244",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-01","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130004-01.pdf","https://api.centene.com/Brochures/2017/76179IN0130004-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9244",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-02","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130004-02.pdf","https://api.centene.com/Brochures/2017/76179IN0130004-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9244",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-03","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130004-03.pdf","https://api.centene.com/Brochures/2017/76179IN0130004-03.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9244",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-04","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130004-04.pdf","https://api.centene.com/Brochures/2017/76179IN0130004-04.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9244",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-05","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130004-05.pdf","https://api.centene.com/Brochures/2017/76179IN0130004-05.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9244",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-06","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130004-06.pdf","https://api.centene.com/Brochures/2017/76179IN0130004-06.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130005","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9204",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130005-00","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130005-00.pdf","https://api.centene.com/Brochures/2017/76179IN0130005-00.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130005","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9204",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130005-01","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130005-01.pdf","https://api.centene.com/Brochures/2017/76179IN0130005-01.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130005","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9204",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130005-02","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130005-02.pdf","https://api.centene.com/Brochures/2017/76179IN0130005-02.pdf"
"2017","IN","76179","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","76179IN0130005","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9204",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130005-03","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/76179IN0130005-03.pdf","https://api.centene.com/Brochures/2017/76179IN0130005-03.pdf"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","79503IN0010001","DentaTrust - PPO Pediatric High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010001-00","DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIN.dentalcareplus.com","https://hixindsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","79503IN0020003","DentaSpan Family High Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIN.dentalcareplus.com","https://hixsgsbIN.dentalcareplus.com"
"2017","IN","97975","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","97975IN0030002","EHB High Passive","97975IN003",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","97975IN0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IN","97975","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","97975IN0030001","EHB Low Passive","97975IN003",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","97975IN0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","79503IN0020003","DentaSpan Family High Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIN.dentalcareplus.com","https://hixsgsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","79503IN0010001","DentaTrust - PPO Pediatric High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010001-01","DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIN.dentalcareplus.com","https://hixindsbIN.dentalcareplus.com"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010007","BESTDental Premium","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Premium_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83557IN0020003","BESTOne Advantage Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83557IN0020004","BESTOne Plus Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010008","BESTDental Standard - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017IN_BESTDental_Standard-H_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010008","BESTDental Standard - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017IN_BESTDental_Standard-H_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83557IN0020004","BESTOne Plus Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","79503IN0010002","DentaTrust - PPO Pediatric Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010002-00","DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIN.dentalcareplus.com","https://hixindsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","79503IN0020004","DentaSpan Family Low Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIN.dentalcareplus.com","https://hixsgsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","79503IN0020004","DentaSpan Family Low Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIN.dentalcareplus.com","https://hixsgsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","79503IN0010002","DentaTrust - PPO Pediatric Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010002-01","DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIN.dentalcareplus.com","https://hixindsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","79503IN0030003","DentaSpan Family High Option- Off Exchange","79503IN003","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030003-00","DentaSpan Family High Option- Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIN.dentalcareplus.com","https://hixsgsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","79503IN0030004","DentaSpan Family Low Option- Off Exchange","79503IN003","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030004-00","DentaSpan Family Low Option- Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIN.dentalcareplus.com","https://hixsgsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","79503IN0030001","DentaSpan Pediatric High Option- Off Exchange","79503IN003","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIN.dentalcareplus.com","https://hixsgsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","79503IN0010003","DentaTrust - PPO Family High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010003-00","DentaTrust - PPO Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIN.dentalcareplus.com","https://hixindsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","79503IN0010003","DentaTrust - PPO Family High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010003-01","DentaTrust - PPO Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIN.dentalcareplus.com","https://hixindsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","79503IN0030002","DentaSpan Pediatric Low Option- Off Exchange","79503IN003","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIN.dentalcareplus.com","https://hixsgsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","79503IN0010004","DentaTrust - PPO Family Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010004-00","DentaTrust - PPO Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIN.dentalcareplus.com","https://hixindsbIN.dentalcareplus.com"
"2017","IN","79503","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","79503IN0010004","DentaTrust - PPO Family Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010004-01","DentaTrust - PPO Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIN.dentalcareplus.com","https://hixindsbIN.dentalcareplus.com"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83557IN0020003","BESTOne Advantage Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010007","BESTDental Premium","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Premium_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010010","BESTDental Choice - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Choice-H_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010010","BESTDental Choice - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Choice-H_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010009","BESTDental Standard - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Standard-L_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83557IN0020005","BESTOne Plus Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83557IN0020005","BESTOne Plus Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010009","BESTDental Standard - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Standard-L_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010011","BESTDental Choice - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Choice-L_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83557IN0020006","BESTOne Basic Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","83557IN0020006","BESTOne Basic Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010011","BESTDental Choice - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Choice-L_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010012","BESTDental Value","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Value_Plan.pdf"
"2017","IN","83557","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","83557IN0010012","BESTDental Value","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2017/IN_BESTDental_Value_Plan.pdf"
"2017","IN","87417","HIOS","2016-08-15 07:42:31","Individual","Yes","36-3757528","87417IN0010001","TruAssure Basic Adult or Child Dental Plan","87417IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN"
"2017","IN","87417","HIOS","2016-08-15 07:42:31","SHOP (Small Group)","Yes","36-3757528","87417IN0040001","TruAssure Dental Small Group Basic Plan","87417IN004",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","87417IN0040001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","87417","HIOS","2016-08-15 07:42:31","SHOP (Small Group)","Yes","36-3757528","87417IN0030001","TruAssure Dental Small Group Preferred Plan","87417IN003",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","87417IN0030001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IN","87417","HIOS","2016-08-15 07:42:31","Individual","Yes","36-3757528","87417IN0010001","TruAssure Basic Adult or Child Dental Plan","87417IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN"
"2017","IN","87417","HIOS","2016-08-15 07:42:31","Individual","Yes","36-3757528","87417IN0020001","TruAssure Preferred Adult or Child Dental Plan","87417IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN"
"2017","IN","87417","HIOS","2016-08-15 07:42:31","Individual","Yes","36-3757528","87417IN0020001","TruAssure Preferred Adult or Child Dental Plan","87417IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN"
"2017","LA","18802","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","18802LA0010001","Delta Dental PPO Pediatric Basic Plan","18802LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010001-17"
"2017","LA","18802","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","18802LA0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020001-17"
"2017","LA","18802","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","18802LA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020006-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020006-17"
"2017","LA","18802","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","18802LA0010006","Delta Dental PPO Basic Plan for Families","18802LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010006-17"
"2017","IN","90613","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","90613IN0040002","EHB High PPO","90613IN004",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","90613IN0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IN","90613","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","90613IN0040001","EHB Low PPO","90613IN004",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","90613IN0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IN","90613","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","90613IN0030002","EHB High Passive","90613IN003",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","90613IN0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IN","90613","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","90613IN0030001","EHB Low Passive","90613IN003",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","90613IN0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IN","91920","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","91920IN0010001","Dentegra Dental PPO Pediatric Basic Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010001-17"
"2017","IN","91920","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","91920IN0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","91920IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0020001-17"
"2017","IN","91920","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","91920IN0020012","Dentegra Dental PPO for Small Businesses Family Preferred Plan","91920IN002",,"INN001","INS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0020012-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0020012-17"
"2017","IN","91920","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","91920IN0010012","Dentegra Dental PPO Family Preferred Plan","91920IN001",,"INN001","INS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010012-17"
"2017","IN","91920","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","91920IN0010011","Dentegra Dental PPO Family Basic Plan","91920IN001",,"INN001","INS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010011-17"
"2017","IN","91920","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","91920IN0020011","Dentegra Dental PPO for Small Businesses Family Basic Plan","91920IN002",,"INN001","INS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0020011-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0020011-17"
"2017","IN","97975","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","97975IN0040002","EHB High PPO","97975IN004",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","97975IN0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IN","97975","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","97975IN0040001","EHB Low PPO","97975IN004",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","97975IN0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","LA","17940","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","17940LA0030002","EHB High Passive","17940LA003",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","17940LA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","LA","17940","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","17940LA0030001","EHB Low Passive","17940LA003",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","17940LA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","LA","18802","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","18802LA0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020002-17"
"2017","LA","18802","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","18802LA0010002","Delta Dental PPO Pediatric Preferred Plan","18802LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010002-17"
"2017","LA","18802","HIOS","2016-07-01 08:12:23","Individual","Yes","94-2761537","18802LA0010004","Delta Dental PPO Preferred Plan for Families","18802LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010004-17"
"2017","LA","18802","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","94-2761537","18802LA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020004-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020004-17"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3000","19636LA022",,"LAN005","LAS007","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220014-04","Blue POS 80/60 $2000 CSR 0014-04","73% AV Level Silver Plan",,"0.720927536487579","Yes","Yes","No","100%",,"$2,000","$0","$1,056","$150","$2,000","$0","$654","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$10,200","$10200 per person","$20400 per group","$14,900","$14900 per person","$29800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$8,000","$8000 per person","$24000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-04&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3000","19636LA022",,"LAN005","LAS007","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220014-05","Blue POS 90/60 $600 CSR 0014-05","87% AV Level Silver Plan",,"0.863071978092194","Yes","Yes","No","100%",,"$600","$0","$668","$150","$600","$0","$467","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$10,200","$10200 per person","$20400 per group","$12,550","$12550 per person","$25100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","10.00%",,,,,"$6,000","$6000 per person","$18000 per group","$6,600","$6600 per person","$19800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-05&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3000","19636LA022",,"LAN005","LAS007","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220014-06","Blue POS 95/60 $100 CSR 0014-06","94% AV Level Silver Plan",,"0.930999159812927","Yes","Yes","No","100%",,"$100","$0","$359","$150","$100","$0","$259","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$10,200","$10200 per person","$20400 per group","$12,100","$12100 per person","$24200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","5.00%",,,,,"$6,000","$6000 per person","$18000 per group","$6,100","$6100 per person","$18300 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-06&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220005-00","Blue POS copay 80/60 $1000","Standard Gold Off Exchange Plan","78.02%","0.769552767276764","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$9,600","$9600 per person","$19200 per group","$14,400","$14400 per person","$28800 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220005-01","Blue POS copay 80/60 $1000","Standard Gold On Exchange Plan","78.02%","0.769552767276764","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$9,600","$9600 per person","$19200 per group","$14,400","$14400 per person","$28800 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220005-02","Blue POS copay 100/100 $0 CSR 0005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220005-03","Blue POS copay 80/60 $1000 CSR 0005-03","Limited Cost Sharing Plan Variation","78.02%","0.769552767276764","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$9,600","$9600 per person","$19200 per group","$14,400","$14400 per person","$28800 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","72-1071369","19636LA0250003","Blue POS copay 60/40 $3000","19636LA025",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2017","19636LA0250003-00","Blue POS copay 60/40 $3000","Standard Silver Off Exchange Plan",,"0.705886244773865","No","Yes","No","100%",,"$3,000","$75","$589","$150","$1,272","$1,000","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$3,000","$3000 per person","$9000 per group","40.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$0","per person not applicable","per group not applicable","10.00%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=19636LA0250003-00&Year=2017","http://www.bcbsla.com/smallgroup-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220013-00","Blue POS 70/50 $4500","Standard Bronze Off Exchange Plan",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220013-01","Blue POS 70/50 $4500","Standard Bronze On Exchange Plan",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","72-1071369","19636LA0250003","Blue POS copay 60/40 $3000","19636LA025",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2017","19636LA0250003-01","Blue POS copay 60/40 $3000","Standard Silver On Exchange Plan",,"0.705886244773865","No","Yes","No","100%",,"$3,000","$75","$589","$150","$1,272","$1,000","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$3,000","$3000 per person","$9000 per group","40.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$0","per person not applicable","per group not applicable","10.00%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=19636LA0250003-01&Year=2017","http://www.bcbsla.com/smallgroup-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","72-1071369","19636LA0250014","Blue POS copay 80/60 $1000A","19636LA025",,"LAN005","LAS007","LAF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2017","19636LA0250014-00","Blue POS copay 80/60 $1000A","Standard Gold Off Exchange Plan",,"0.790343463420868","No","Yes","No","100%",,"$1,000","$62","$694","$150","$1,000","$630","$54","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","per person not applicable","per group not applicable","10.00%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=19636LA0250014-00&Year=2017","http://www.bcbsla.com/smallgroup-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220013-02","Blue POS 100/100 $0 CSR 0013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220013-03","Blue POS 70/50 $4500 CSR 0013-03","Limited Cost Sharing Plan Variation",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","72-1071369","19636LA0250014","Blue POS copay 80/60 $1000A","19636LA025",,"LAN005","LAS007","LAF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2017","19636LA0250014-01","Blue POS copay 80/60 $1000A","Standard Gold On Exchange Plan",,"0.790343463420868","No","Yes","No","100%",,"$1,000","$62","$694","$150","$1,000","$630","$54","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","per person not applicable","per group not applicable","10.00%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=19636LA0250014-01&Year=2017","http://www.bcbsla.com/smallgroup-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220012-00","Blue POS 60/40 $6500","Standard Bronze Off Exchange Plan",,"0.594321548938751","Yes","Yes","No","100%",,"$6,500","$0","$313","$150","$5,271","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$14300 per group","40.00%",,,,,"$13,000","$13000 per person","$28600 per group","$19,500","$19500 per person","$42900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220012-01","Blue POS 60/40 $6500","Standard Bronze On Exchange Plan",,"0.594321548938751","Yes","Yes","No","100%",,"$6,500","$0","$313","$150","$5,271","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$14300 per group","40.00%",,,,,"$13,000","$13000 per person","$28600 per group","$19,500","$19500 per person","$42900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220012-02","Blue POS 100/100 $0 CSR 0012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220012-03","Blue POS 60/40 $6500 CSR 0012-03","Limited Cost Sharing Plan Variation",,"0.594321548938751","Yes","Yes","No","100%",,"$6,500","$0","$313","$150","$5,271","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$14300 per group","40.00%",,,,,"$13,000","$13000 per person","$28600 per group","$19,500","$19500 per person","$42900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220010-00","Blue POS 100/80 $3500","Standard Silver Off Exchange Plan",,"0.697098612785339","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$109","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220010-01","Blue POS 100/80 $3500","Standard Silver On Exchange Plan",,"0.697098612785339","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$109","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220010-02","Blue POS 100/100 $0 CSR 0010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220010-03","Blue POS 100/80 $3500 CSR 0010-03","Limited Cost Sharing Plan Variation",,"0.697098612785339","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$109","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220010-04","Blue POS 100/80 $2800 CSR 0010-04","73% AV Level Silver Plan",,"0.734449028968811","Yes","Yes","No","100%",,"$2,800","$0","$0","$150","$2,800","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,400","$19400 per person","$38800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$8400 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$9,800","$9800 per person","$29400 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-04&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220010-05","Blue POS 100/80 $950 CSR 0010-05","87% AV Level Silver Plan",,"0.871773540973663","Yes","Yes","No","100%",,"$950","$0","$0","$150","$950","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$13,700","$13700 per person","$27400 per group","$16,050","$16050 per person","$32100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$2850 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,950","$7950 per person","$23850 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-05&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220010-06","Blue POS 100/80 $200 CSR 0010-06","94% AV Level Silver Plan",,"0.945350408554077","Yes","Yes","No","100%",,"$200","$0","$0","$150","$200","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,200","$7200 per person","$21600 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-06&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3000","19636LA022",,"LAN005","LAS007","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220014-00","Blue POS 80/60 $3000","Standard Silver Off Exchange Plan",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3000","19636LA022",,"LAN005","LAS007","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220014-01","Blue POS 80/60 $3000","Standard Silver On Exchange Plan",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3000","19636LA022",,"LAN005","LAS007","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220014-02","Blue POS 100/100 $0 CSR 0014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3000","19636LA022",,"LAN005","LAS007","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0220014-03","Blue POS 80/60 $3000 CSR 0014-03","Limited Cost Sharing Plan Variation",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0230006-00","Community Blue 70/50 $4500","Standard Bronze Off Exchange Plan",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-00&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0230006-01","Community Blue 70/50 $4500","Standard Bronze On Exchange Plan",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-01&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0230006-02","Community Blue 100/100 $0 CSR 0006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-02&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0230006-03","Community Blue 70/50 $4500 CSR 0006-03","Limited Cost Sharing Plan Variation",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-03&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3000","19636LA024",,"LAN006","LAS005","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0240007-00","Blue Connect 80/60 $3000","Standard Silver Off Exchange Plan",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-00&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3000","19636LA024",,"LAN006","LAS005","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0240007-01","Blue Connect 80/60 $3000","Standard Silver On Exchange Plan",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-01&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3000","19636LA024",,"LAN006","LAS005","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0240007-02","Blue Connect 100/100 $0 CSR 0007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-02&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3000","19636LA024",,"LAN006","LAS005","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0240007-03","Blue Connect 80/60 $3000 CSR 0007-03","Limited Cost Sharing Plan Variation",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-03&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3000","19636LA024",,"LAN006","LAS005","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0240007-04","Blue Connect 80/60 $2000 CSR 0007-04","73% AV Level Silver Plan",,"0.720927536487579","Yes","Yes","No","100%",,"$2,000","$0","$1,056","$150","$2,000","$0","$654","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$10,200","$10200 per person","$20400 per group","$14,900","$14900 per person","$29800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$8,000","$8000 per person","$24000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-04&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3000","19636LA024",,"LAN006","LAS005","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0240007-05","Blue Connect 90/60 $600 CSR 0007-05","87% AV Level Silver Plan",,"0.863071978092194","Yes","Yes","No","100%",,"$600","$0","$668","$150","$600","$0","$467","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$10,200","$10200 per person","$20400 per group","$12,550","$12550 per person","$25100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","10.00%",,,,,"$6,000","$6000 per person","$18000 per group","$6,600","$6600 per person","$19800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-05&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3000","19636LA024",,"LAN006","LAS005","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0240007-06","Blue Connect 95/60 $100 CSR 0007-06","94% AV Level Silver Plan",,"0.930999159812927","Yes","Yes","No","100%",,"$100","$0","$359","$150","$100","$0","$259","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$10,200","$10200 per person","$20400 per group","$12,100","$12100 per person","$24200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","5.00%",,,,,"$6,000","$6000 per person","$18000 per group","$6,100","$6100 per person","$18300 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-06&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540002","Blue Connect Acadiana 80/60 $3000","19636LA054",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540002-00","Blue Connect Acadiana 80/60 $3000","Standard Silver Off Exchange Plan",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540002-00&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540002","Blue Connect Acadiana 80/60 $3000","19636LA054",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540002-01","Blue Connect Acadiana 80/60 $3000","Standard Silver On Exchange Plan",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540002-01&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540002","Blue Connect Acadiana 80/60 $3000","19636LA054",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540002-02","Blue Connect Acadiana 100/100 $0 CSR 0002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540002-02&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540002","Blue Connect Acadiana 80/60 $3000","19636LA054",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540002-03","Blue Connect Acadiana 80/60 $3000 CSR 0002-03","Limited Cost Sharing Plan Variation",,"0.680450260639191","Yes","Yes","No","100%",,"$3,000","$0","$856","$150","$3,000","$0","$454","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540002-03&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090001","Vantage Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090001-02","Vantage Individual Platinum","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100002","Vantage Group Gold","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100002-01","Vantage Group Gold","Standard Gold On Exchange Plan","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540002","Blue Connect Acadiana 80/60 $3000","19636LA054",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540002-04","Blue Connect Acadiana 80/60 $2000 CSR 0002-04","73% AV Level Silver Plan",,"0.720927536487579","Yes","Yes","No","100%",,"$2,000","$0","$1,056","$150","$2,000","$0","$654","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$10,200","$10200 per person","$20400 per group","$14,900","$14900 per person","$29800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$18000 per group","$8,000","$8000 per person","$24000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540002-04&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540002","Blue Connect Acadiana 80/60 $3000","19636LA054",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540002-05","Blue Connect Acadiana 90/60 $600 CSR 0002-05","87% AV Level Silver Plan",,"0.863071978092194","Yes","Yes","No","100%",,"$600","$0","$668","$150","$600","$0","$467","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$10,200","$10200 per person","$20400 per group","$12,550","$12550 per person","$25100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","10.00%",,,,,"$6,000","$6000 per person","$18000 per group","$6,600","$6600 per person","$19800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540002-05&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540002","Blue Connect Acadiana 80/60 $3000","19636LA054",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540002-06","Blue Connect Acadiana 95/60 $100 CSR 0002-06","94% AV Level Silver Plan",,"0.930999159812927","Yes","Yes","No","100%",,"$100","$0","$359","$150","$100","$0","$259","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$10,200","$10200 per person","$20400 per group","$12,100","$12100 per person","$24200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","5.00%",,,,,"$6,000","$6000 per person","$18000 per group","$6,100","$6100 per person","$18300 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540002-06&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540003","Blue Connect Acadiana 70/50 $4500","19636LA054",,"LAN006","LAS008","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540003-00","Blue Connect Acadiana 70/50 $4500","Standard Bronze Off Exchange Plan",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540003-00&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540003","Blue Connect Acadiana 70/50 $4500","19636LA054",,"LAN006","LAS008","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540003-01","Blue Connect Acadiana 70/50 $4500","Standard Bronze On Exchange Plan",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540003-01&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540003","Blue Connect Acadiana 70/50 $4500","19636LA054",,"LAN006","LAS008","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540003-02","Blue Connect Acadiana 100/100 $0 CSR 0003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540003-02&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540003","Blue Connect Acadiana 70/50 $4500","19636LA054",,"LAN006","LAS008","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","19636LA0540003-03","Blue Connect Acadiana 70/50 $4500 CSR 0003-03","Limited Cost Sharing Plan Variation",,"0.618226885795593","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540003-03&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3100","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220007-00","Blue POS copay 70/50 $3100","Standard Silver Off Exchange Plan","71.14%","0.702683806419373","No","Yes","No","100%",,"$3,123","$60","$411","$150","$1,772","$924","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$3,100","$3100 per person","$9300 per group","30.00%",,,,,"$6,200","$6200 per person","$18600 per group","$9,300","$9300 per person","$27900 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3100","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220007-01","Blue POS copay 70/50 $3100","Standard Silver On Exchange Plan","71.14%","0.702683806419373","No","Yes","No","100%",,"$3,123","$60","$411","$150","$1,772","$924","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$3,100","$3100 per person","$9300 per group","30.00%",,,,,"$6,200","$6200 per person","$18600 per group","$9,300","$9300 per person","$27900 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3100","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220007-02","Blue POS copay 100/100 $0 CSR 0007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3100","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220007-03","Blue POS copay 70/50 $3100 CSR 0007-03","Limited Cost Sharing Plan Variation","71.14%","0.702683806419373","No","Yes","No","100%",,"$3,123","$60","$411","$150","$1,772","$924","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$3,100","$3100 per person","$9300 per group","30.00%",,,,,"$6,200","$6200 per person","$18600 per group","$9,300","$9300 per person","$27900 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3100","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220007-04","Blue POS copay 80/50 $2800 CSR 0007-04","73% AV Level Silver Plan","73.52%","0.717476427555084","No","Yes","No","100%",,"$2,823","$60","$334","$150","$1,772","$924","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$28600 per group","$20,000","$20000 per person","$40000 per group","$2,800","$2800 per person","$8400 per group","20.00%",,,,,"$6,200","$6200 per person","$18600 per group","$9,000","$9000 per person","$27000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-04&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3100","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220007-05","Blue POS copay 95/50 $500 CSR 0007-05","87% AV Level Silver Plan","86.54%","0.858871757984161","No","Yes","No","100%",,"$523","$35","$199","$150","$750","$423","$39","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$14,300","$14300 per person","$28600 per group","$16,550","$16550 per person","$33100 per group","$500","$500 per person","$1500 per group","5.00%",,,,,"$6,200","$6200 per person","$18600 per group","$6,700","$6700 per person","$20100 per group","$250","$250 per person","per group not applicable","20.00%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-05&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3100","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0220007-06","Blue POS copay 100/50 $25 CSR 0007-06","94% AV Level Silver Plan","93.02%","0.926595330238342","No","Yes","No","100%",,"$48","$25","$0","$150","$125","$330","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$14,300","$14300 per person","$28600 per group","$15,800","$15800 per person","$31600 per group","$25","$25 per person","$75 per group","0.00%",,,,,"$6,200","$6200 per person","$18600 per group","$6,225","$6225 per person","$18675 per group","$100","$100 per person","per group not applicable","20.00%",,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-06&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230002","Community Blue copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230002-00","Community Blue copay 80/60 $1000","Standard Gold Off Exchange Plan","78.46%","0.767937302589417","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230002","Community Blue copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230002-01","Community Blue copay 80/60 $1000","Standard Gold On Exchange Plan","78.46%","0.767937302589417","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-01&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230002","Community Blue copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230002-02","Community Blue copay 100/100 $0 CSR 0002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-02&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230002","Community Blue copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230002-03","Community Blue copay 80/60 $1000 CSR 0002-03","Limited Cost Sharing Plan Variation","78.46%","0.767937302589417","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-03&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230003-00","Community Blue copay 70/50 $3500","Standard Silver Off Exchange Plan","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230003-01","Community Blue copay 70/50 $3500","Standard Silver On Exchange Plan","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-01&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230003-02","Community Blue copay 100/100 $0 CSR 0003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-02&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230003-03","Community Blue copay 70/50 $3500 CSR 0003-03","Limited Cost Sharing Plan Variation","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-03&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230003-04","Community Blue copay 70/50 $2750 CSR 0003-04","73% AV Level Silver Plan","73.44%","0.719966351985931","No","Yes","No","100%",,"$2,773","$60","$516","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,100","$19100 per person","$38200 per group","$2,750","$2750 per person","$8250 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$9,750","$9750 per person","$29250 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-04&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230003-05","Community Blue copay 95/50 $500 CSR 0003-05","87% AV Level Silver Plan","86.65%","0.858871757984161","No","Yes","No","100%",,"$523","$35","$199","$150","$750","$273","$39","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$500","$500 per person","$1500 per group","5.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,500","$7500 per person","$22500 per group","$250","$250 per person","per group not applicable","20.00%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-05&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0230003-06","Community Blue copay 100/50 $25 CSR 0003-06","94% AV Level Silver Plan","93.08%","0.926595330238342","No","Yes","No","100%",,"$48","$25","$0","$150","$125","$280","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,200","$15200 per person","$30400 per group","$25","$25 per person","$75 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,025","$7025 per person","$21075 per group","$100","$100 per person","per group not applicable","20.00%",,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-06&Year=2017","http://www.bcbsla.com/individual-communityblue-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240002","Blue Connect copay 80/60 $1000","19636LA024",,"LAN006","LAS005","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240002-00","Blue Connect copay 80/60 $1000","Standard Gold Off Exchange Plan","78.46%","0.767937302589417","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240003-04","Blue Connect copay 70/50 $2750 CSR 0003-04","73% AV Level Silver Plan","73.44%","0.719966351985931","No","Yes","No","100%",,"$2,773","$60","$516","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,100","$19100 per person","$38200 per group","$2,750","$2750 per person","$8250 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$9,750","$9750 per person","$29250 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-04&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240003-05","Blue Connect copay 95/50 $500 CSR 0003-05","87% AV Level Silver Plan","86.65%","0.858871757984161","No","Yes","No","100%",,"$523","$35","$199","$150","$750","$273","$39","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$500","$500 per person","$1500 per group","5.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,500","$7500 per person","$22500 per group","$250","$250 per person","per group not applicable","20.00%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-05&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240003-06","Blue Connect copay 100/50 $25 CSR 0003-06","94% AV Level Silver Plan","93.08%","0.926595330238342","No","Yes","No","100%",,"$48","$25","$0","$150","$125","$280","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,200","$15200 per person","$30400 per group","$25","$25 per person","$75 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,025","$7025 per person","$21075 per group","$100","$100 per person","per group not applicable","20.00%",,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-06&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540001","Blue Connect Acadiana copay 70/50 $3500","19636LA054",,"LAN006","LAS008","LAF010","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0540001-00","Blue Connect Acadiana copay 70/50 $3500","Standard Silver Off Exchange Plan","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540001-00&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540001","Blue Connect Acadiana copay 70/50 $3500","19636LA054",,"LAN006","LAS008","LAF010","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0540001-01","Blue Connect Acadiana copay 70/50 $3500","Standard Silver On Exchange Plan","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540001-01&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240002","Blue Connect copay 80/60 $1000","19636LA024",,"LAN006","LAS005","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240002-01","Blue Connect copay 80/60 $1000","Standard Gold On Exchange Plan","78.46%","0.767937302589417","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-01&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240002","Blue Connect copay 80/60 $1000","19636LA024",,"LAN006","LAS005","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240002-02","Blue Connect copay 100/100 $0 CSR 0002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-02&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240002","Blue Connect copay 80/60 $1000","19636LA024",,"LAN006","LAS005","LAF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240002-03","Blue Connect copay 80/60 $1000 CSR 0002-03","Limited Cost Sharing Plan Variation","78.46%","0.767937302589417","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-03&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240003-00","Blue Connect copay 70/50 $3500","Standard Silver Off Exchange Plan","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240003-01","Blue Connect copay 70/50 $3500","Standard Silver On Exchange Plan","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-01&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240003-02","Blue Connect copay 100/100 $0 CSR 0003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-02&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF010","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0240003-03","Blue Connect copay 70/50 $3500 0003-03","Limited Cost Sharing Plan Variation","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-03&Year=2017","http://www.bcbsla.com/individual-blueconnect-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540001","Blue Connect Acadiana copay 70/50 $3500","19636LA054",,"LAN006","LAS008","LAF010","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0540001-02","Blue Connect Acadiana copay 100/100$0 CSR 0001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540001-02&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540001","Blue Connect Acadiana copay 70/50 $3500","19636LA054",,"LAN006","LAS008","LAF010","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0540001-03","Blue Connect Acadiana copay 70/50 $3500 CSR 0001-03","Limited Cost Sharing Plan Variation","71.38%","0.699418127536774","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540001-03&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540001","Blue Connect Acadiana copay 70/50 $3500","19636LA054",,"LAN006","LAS008","LAF010","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0540001-04","Blue Connect Acadiana copay 70/50 $2750 CSR 0001-04","73% AV Level Silver Plan","73.44%","0.719966351985931","No","Yes","No","100%",,"$2,773","$60","$516","$150","$1,772","$524","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,100","$19100 per person","$38200 per group","$2,750","$2750 per person","$8250 per group","30.00%",,,,,"$7,000","$7000 per person","$21000 per group","$9,750","$9750 per person","$29250 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540001-04&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540001","Blue Connect Acadiana copay 70/50 $3500","19636LA054",,"LAN006","LAS008","LAF010","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0540001-05","Blue Connect Acadiana copay 95/50 $500 CSR 0001-05","87% AV Level Silver Plan","86.65%","0.858871757984161","No","Yes","No","100%",,"$523","$35","$199","$150","$750","$273","$39","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$500","$500 per person","$1500 per group","5.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,500","$7500 per person","$22500 per group","$250","$250 per person","per group not applicable","20.00%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540001-05&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","19636","HIOS","2016-09-01 07:41:30","Individual","No","72-1071369","19636LA0540001","Blue Connect Acadiana copay 70/50 $3500","19636LA054",,"LAN006","LAS008","LAF010","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","19636LA0540001-06","Blue Connect Acadiana copay 100/50 $25 CSR 0001-06","94% AV Level Silver Plan","93.08%","0.926595330238342","No","Yes","No","100%",,"$48","$25","$0","$150","$125","$280","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,200","$15200 per person","$30400 per group","$25","$25 per person","$75 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,025","$7025 per person","$21075 per group","$100","$100 per person","per group not applicable","20.00%",,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0540001-06&Year=2017","http://www.bcbsla.com/individual-blueconnectacadiana-brochure2017"
"2017","LA","28419","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","28419LA0020003","Renaissance Individual Dental PPO, EHB Certified","28419LA002",,"LAN001","LAS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28419LA0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","LA","28419","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","28419LA0020004","Renaissance Individual Dental PPO, EHB Certified","28419LA002",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28419LA0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","LA","28419","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","28419LA0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","28419LA004",,"LAN001","LAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28419","","28419LA0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/LA_EHB_High_2017","http://www.renaissancedental.com/LA_EHB_High_2017"
"2017","LA","28419","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","28419LA0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","28419LA004",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28419","","28419LA0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/LA_EHB_Low_2017","http://www.renaissancedental.com/LA_EHB_Low_2017"
"2017","LA","28419","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","28419LA0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","28419LA006",,"LAN001","LAS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28419LA0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","LA","28419","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","28419LA0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","28419LA006",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28419LA0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","LA","28419","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","28419LA0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","28419LA005",,"LAN001","LAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28419","","28419LA0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/LA_Ped_High_2017","http://www.renaissancedental.com/LA_Ped_High_2017"
"2017","LA","28419","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","28419LA0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","28419LA005",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28419","","28419LA0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/LA_Ped_Low_2017","http://www.renaissancedental.com/LA_Ped_Low_2017"
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570001","Humana Basic 7150/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570001-00","Humana Basic 7150/Louisiana HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846220",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","Yes","72-1279235","44965LA0590001","Humana Dental Smart Choice","44965LA059",,"LAN003","LAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.984","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44965LA0590001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857062"
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","Yes","72-1279235","44965LA0590001","Humana Dental Smart Choice","44965LA059",,"LAN003","LAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.984","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44965LA0590001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857062"
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570001","Humana Basic 7150/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570001-01","Humana Basic 7150/Louisiana HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846220",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570021","Humana Basic 7150/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570021-00","Humana Basic 7150/Louisiana HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846220",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570021","Humana Basic 7150/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570021-01","Humana Basic 7150/Louisiana HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846220",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570026","Humana Basic 7150/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570026-00","Humana Basic 7150/Louisiana HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846220",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570026","Humana Basic 7150/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570026-01","Humana Basic 7150/Louisiana HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846220",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570002","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570002-00","Humana Bronze 4800/Louisiana HMOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846259",
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100008","Vantage Plus Group Bronze","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100008-00","Vantage Plus Group Bronze","Standard Bronze Off Exchange Plan","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzePlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017Marketplace_PlanFinder_PlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-06","Vantage Individual Silver","94% AV Level Silver Plan","95.00%","0","No","Yes","No","100%",,"$100","$210","$0","$60","$100","$330","$160","$30","$100","$60","$100","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverValueSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlansCSR.pdf"
"2017","LA","87390","HIOS","2016-07-28 02:40:10","Individual","Yes","13-5123390","87390LA0070002","Guardian Essentials for Families and Individuals","87390LA007",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","87390LA0070002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","LA","87390","HIOS","2016-07-28 02:40:10","Individual","Yes","13-5123390","87390LA0070002","Guardian Essentials for Families and Individuals","87390LA007",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","87390LA0070002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","LA","87390","HIOS","2016-07-28 02:40:10","Individual","Yes","13-5123390","87390LA0080001","Guardian Basics for Families and Individuals","87390LA008",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","87390LA0080001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","LA","87390","HIOS","2016-07-28 02:40:10","Individual","Yes","13-5123390","87390LA0080001","Guardian Basics for Families and Individuals","87390LA008",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","87390LA0080001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","Yes","23-7384555","97176LA0390001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390001-00","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","23-7384555","97176LA0360010","Group Care copay 80/60 $1000","97176LA036",,"LAN001","LAS001","LAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2017","97176LA0360010-00","Group Care copay 80/60 $1000","Standard Gold Off Exchange Plan",,"0.790525317192078","No","Yes","No","100%",,"$1,000","$900","$694","$150","$1,000","$1,000","$54","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","$0 per person","per group not applicable","10.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0360010-00&Year=2017","http://www.bcbsla.com/smallgroup-solutions-brochure2017"
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570002","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570002-01","Humana Bronze 4800/Louisiana HMOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846259",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570002","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570002-02","Humana Bronze 4800/Louisiana HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846272",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570002","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570002-03","Humana Bronze 4800/Louisiana HMOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846285",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570022","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570022-00","Humana Bronze 4800/Louisiana HMOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846259",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570022","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570022-01","Humana Bronze 4800/Louisiana HMOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846259",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570022","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570022-02","Humana Bronze 4800/Louisiana HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846272",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570022","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570022-03","Humana Bronze 4800/Louisiana HMOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846285",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570027","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570027-00","Humana Bronze 4800/Louisiana HMOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846259",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570027","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570027-01","Humana Bronze 4800/Louisiana HMOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846259",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570027","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570027-02","Humana Bronze 4800/Louisiana HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846272",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570027","Humana Bronze 4800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","44965LA0570027-03","Humana Bronze 4800/Louisiana HMOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846285",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570003","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570003-00","Humana Silver 3550/Louisiana HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846402",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570003","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570003-01","Humana Silver 3550/Louisiana HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846402",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570003","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570003-02","Humana Silver 3550/Louisiana HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846415",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570003","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570003-03","Humana Silver 3550/Louisiana HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846428",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570003","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570003-04","Humana Silver 3000/Louisiana HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846389",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570003","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570003-05","Humana Silver 900/Louisiana HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846454",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570003","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570003-06","Humana Silver 250/Louisiana HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846376",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570023","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570023-00","Humana Silver 3550/Louisiana HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846402",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570023","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570023-01","Humana Silver 3550/Louisiana HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846402",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570023","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570023-02","Humana Silver 3550/Louisiana HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846415",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570023","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570023-03","Humana Silver 3550/Louisiana HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846428",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570023","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570023-04","Humana Silver 3000/Louisiana HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846389",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570023","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570023-05","Humana Silver 900/Louisiana HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846454",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570023","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570023-06","Humana Silver 250/Louisiana HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846376",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570028","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570028-00","Humana Silver 3550/Louisiana HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846402",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570028","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570028-01","Humana Silver 3550/Louisiana HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846402",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570028","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570028-02","Humana Silver 3550/Louisiana HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846415",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570028","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570028-03","Humana Silver 3550/Louisiana HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846428",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570028","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570028-04","Humana Silver 3000/Louisiana HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846389",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570028","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570028-05","Humana Silver 900/Louisiana HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846454",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570028","Humana Silver 3550/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570028-06","Humana Silver 250/Louisiana HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846376",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570033","Humana Gold 1250/Louisiana HMOx","44965LA057",,"LAN001","LAS006","LAF004","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570033-00","Humana Gold 1250/Louisiana HMOx","Standard Gold Off Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846311",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570033","Humana Gold 1250/Louisiana HMOx","44965LA057",,"LAN001","LAS006","LAF004","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570033-01","Humana Gold 1250/Louisiana HMOx","Standard Gold On Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846311",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570033","Humana Gold 1250/Louisiana HMOx","44965LA057",,"LAN001","LAS006","LAF004","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570033-02","Humana Gold 1250/Louisiana HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846324",
"2017","LA","44965","HIOS","2016-08-20 07:40:33","Individual","No","72-1279235","44965LA0570033","Humana Gold 1250/Louisiana HMOx","44965LA057",,"LAN001","LAS006","LAF004","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","44965LA0570033-03","Humana Gold 1250/Louisiana HMOx","Limited Cost Sharing Plan Variation",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846363",
"2017","LA","58302","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","58302LA0030002","EHB High Passive","58302LA003",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","58302LA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","LA","58302","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","58302LA0030001","EHB Low Passive","58302LA003",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","58302LA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","LA","65168","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","65168LA0030002","EHB High Passive","65168LA003",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","65168LA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","LA","65168","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","65168LA0030001","EHB Low Passive","65168LA003",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","65168LA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100001","Vantage Group Platinum","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100001-00","Vantage Group Platinum","Standard Platinum Off Exchange Plan","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090001","Vantage Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090001-00","Vantage Individual Platinum","Standard Platinum Off Exchange Plan","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090001","Vantage Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090001-01","Vantage Individual Platinum","Standard Platinum On Exchange Plan","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100001","Vantage Group Platinum","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100001-01","Vantage Group Platinum","Standard Platinum On Exchange Plan","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100002","Vantage Group Gold","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100002-00","Vantage Group Gold","Standard Gold Off Exchange Plan","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090001","Vantage Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090001-03","Vantage Individual Platinum","Limited Cost Sharing Plan Variation","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100003","Vantage Group Silver","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100003-00","Vantage Group Silver","Standard Silver Off Exchange Plan","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090002","Vantage Individual Gold","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090002-00","Vantage Individual Gold","Standard Gold Off Exchange Plan","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090002","Vantage Individual Gold","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090002-01","Vantage Individual Gold","Standard Gold On Exchange Plan","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100003","Vantage Group Silver","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100003-01","Vantage Group Silver","Standard Silver On Exchange Plan","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100004","Vantage Group Bronze","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100004-00","Vantage Group Bronze","Standard Bronze Off Exchange Plan","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090002","Vantage Individual Gold","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090002-02","Vantage Individual Gold","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090002","Vantage Individual Gold","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090002-03","Vantage Individual Gold","Limited Cost Sharing Plan Variation","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100004","Vantage Group Bronze","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100004-01","Vantage Group Bronze","Standard Bronze On Exchange Plan","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100005","Vantage Plus Group Platinum","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100005-00","Vantage Plus Group Platinum","Standard Platinum Off Exchange Plan","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017Marketplace_PlanFinder_PlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-00","Vantage Individual Silver","Standard Silver Off Exchange Plan","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-01","Vantage Individual Silver","Standard Silver On Exchange Plan","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100005","Vantage Plus Group Platinum","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100005-01","Vantage Plus Group Platinum","Standard Platinum On Exchange Plan","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017Marketplace_PlanFinder_PlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100006","Vantage Plus Group Gold","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100006-00","Vantage Plus Group Gold","Standard Gold Off Exchange Plan","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017Marketplace_PlanFinder_PlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-02","Vantage Individual Silver","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-03","Vantage Individual Silver","Limited Cost Sharing Plan Variation","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100006","Vantage Plus Group Gold","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100006-01","Vantage Plus Group Gold","Standard Gold On Exchange Plan","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017Marketplace_PlanFinder_PlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100007","Vantage Plus Group Silver","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100007-00","Vantage Plus Group Silver","Standard Silver Off Exchange Plan","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017Marketplace_PlanFinder_PlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-04","Vantage Individual Silver","73% AV Level Silver Plan","73.89%","0","No","Yes","No","100%",,"$2,000","$3,000","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverSelectSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlansCSR.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-05","Vantage Individual Silver","87% AV Level Silver Plan","87.80%","0","No","Yes","No","100%",,"$600","$1,220","$0","$60","$600","$610","$270","$30","$600","$120","$150","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverBasicSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlansCSR.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100007","Vantage Plus Group Silver","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100007-01","Vantage Plus Group Silver","Standard Silver On Exchange Plan","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017Marketplace_PlanFinder_PlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090004","Vantage Individual Bronze","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090004-00","Vantage Individual Bronze","Standard Bronze Off Exchange Plan","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100008","Vantage Plus Group Bronze","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100008-01","Vantage Plus Group Bronze","Standard Bronze On Exchange Plan","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzePlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017Marketplace_PlanFinder_PlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100009","Vantage Group Savings","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100009-00","Vantage Group Savings","Standard Bronze Off Exchange Plan","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSASummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090004","Vantage Individual Bronze","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090004-01","Vantage Individual Bronze","Standard Bronze On Exchange Plan","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090008","Vantage Plus Individual Bronze","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090008-03","Vantage Plus Individual Bronze","Limited Cost Sharing Plan Variation","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzePlusLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","Yes","23-7384555","97176LA0390001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390001-01","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","Yes","23-7384555","97176LA0390002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390002-00","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","23-7384555","97176LA0360013","Group Care copay 70/50 $2800","97176LA036",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2017","97176LA0360013-00","Group Care copay 70/50 $2800","Standard Silver Off Exchange Plan",,"0.707388877868652","No","Yes","No","100%",,"$2,800","$900","$501","$150","$1,272","$1,000","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,800","$2800 per person","$8400 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,400","$8400 per person","$25200 per group","$0","$0 per person","per group not applicable","10.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0360013-00&Year=2017","http://www.bcbsla.com/smallgroup-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","Yes","23-7384555","97176LA0400003","Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","","97176LA0400003-00","Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3100","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350003-02","Blue Saver 100/100 $0 CSR 0003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3100","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350003-03","Blue Saver 100/80 $3100 CSR 0003-03","Limited Cost Sharing Plan Variation",,"0.71738600730896","Yes","Yes","No","100%",,"$3,100","$0","$0","$150","$3,100","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33350 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$6200 per person","$6200 per group","0.00%",,,,,"$6,200","$12400 per person","$12400 per group","$9,300","$18600 per person","$18600 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","Yes","23-7384555","97176LA0400003","Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","","97176LA0400003-01","Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2017"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090004","Vantage Individual Bronze","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090004-02","Vantage Individual Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100009","Vantage Group Savings","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100009-01","Vantage Group Savings","Standard Bronze On Exchange Plan","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSASummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100010","Vantage Group Savings Plus","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100010-00","Vantage Group Savings Plus","Standard Bronze Off Exchange Plan","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSAPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090004","Vantage Individual Bronze","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090004-03","Vantage Individual Bronze","Limited Cost Sharing Plan Variation","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090005","Vantage Plus Individual Platinum","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090005-00","Vantage Plus Individual Platinum","Standard Platinum Off Exchange Plan","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","72-1285173","67243LA0100010","Vantage Group Savings Plus","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9874",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100010-01","Vantage Group Savings Plus","Standard Bronze On Exchange Plan","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSAPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090005","Vantage Plus Individual Platinum","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090005-01","Vantage Plus Individual Platinum","Standard Platinum On Exchange Plan","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090005","Vantage Plus Individual Platinum","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090005-02","Vantage Plus Individual Platinum","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090005","Vantage Plus Individual Platinum","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090005-03","Vantage Plus Individual Platinum","Limited Cost Sharing Plan Variation","90.48%","0","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,060","$520","$30","$0","$210","$330","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017PlatinumPlusLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090006","Vantage Plus Individual Gold","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090006-00","Vantage Plus Individual Gold","Standard Gold Off Exchange Plan","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090006","Vantage Plus Individual Gold","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090006-01","Vantage Plus Individual Gold","Standard Gold On Exchange Plan","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090006","Vantage Plus Individual Gold","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090006-02","Vantage Plus Individual Gold","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090006","Vantage Plus Individual Gold","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090006-03","Vantage Plus Individual Gold","Limited Cost Sharing Plan Variation","81.92%","0","No","Yes","No","100%",,"$750","$2,280","$0","$60","$750","$1,130","$290","$30","$750","$480","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017GoldPlusLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-00","Vantage Plus Individual Silver","Standard Silver Off Exchange Plan","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-01","Vantage Plus Individual Silver","Standard Silver On Exchange Plan","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-02","Vantage Plus Individual Silver","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-03","Vantage Plus Individual Silver","Limited Cost Sharing Plan Variation","71.72%","0","No","Yes","No","100%",,"$2,400","$3,040","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlusLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-04","Vantage Plus Individual Silver","73% AV Level Silver Plan","73.89%","0","No","Yes","No","100%",,"$2,000","$3,000","$0","$60","$1,830","$1,260","$0","$30","$1,630","$70","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverSelectPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlusPlansCSR.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-05","Vantage Plus Individual Silver","87% AV Level Silver Plan","87.80%","0","No","Yes","No","100%",,"$600","$1,220","$0","$60","$600","$610","$270","$30","$600","$120","$150","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverBasicPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlusPlansCSR.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-06","Vantage Plus Individual Silver","94% AV Level Silver Plan","95.00%","0","No","Yes","No","100%",,"$100","$210","$0","$60","$100","$330","$160","$30","$100","$60","$100","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017SilverValuePlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017SilverPlusPlansCSR.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090008","Vantage Plus Individual Bronze","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090008-00","Vantage Plus Individual Bronze","Standard Bronze Off Exchange Plan","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzePlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090008","Vantage Plus Individual Bronze","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090008-01","Vantage Plus Individual Bronze","Standard Bronze On Exchange Plan","61.73%","0.61577433347702","Yes","Yes","No","100%",,"$7,100","$50","$10","$60","$6,000","$520","$0","$30","$1,740","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,100","$7100 per person","$14200 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzePlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090008","Vantage Plus Individual Bronze","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090008-02","Vantage Plus Individual Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017MarketplacePlanFinderPlusPlans.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090009","Vantage Savings","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090009-00","Vantage Savings","Standard Bronze Off Exchange Plan","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSASummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090009","Vantage Savings","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090009-01","Vantage Savings","Standard Bronze On Exchange Plan","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSASummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090009","Vantage Savings","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090009-02","Vantage Savings","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090009","Vantage Savings","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090009-03","Vantage Savings","Limited Cost Sharing Plan Variation","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSALTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090010","Vantage Savings Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090010-00","Vantage Savings Plus","Standard Bronze Off Exchange Plan","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSAPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090010","Vantage Savings Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090010-01","Vantage Savings Plus","Standard Bronze On Exchange Plan","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSAPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090010","Vantage Savings Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090010-02","Vantage Savings Plus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","67243","HIOS","2017-01-25 02:20:17","Individual","No","72-1285173","67243LA0090010","Vantage Savings Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, Weight Loss Programs","0.9879",,,"2017-01-01","2017-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Deductible and Out-of-Network Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2017CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090010-03","Vantage Savings Plus","Limited Cost Sharing Plan Variation","61.38%","0.590055108070374","Yes","Yes","No","100%",,"$6,000","$0","$500","$60","$6,000","$0","$500","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2017BronzeHSAPlusLTDSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2017HSAPlanFinder.pdf"
"2017","LA","74056","HIOS","2016-08-24 02:30:21","Individual","Yes","36-3757528","74056LA0010001","TruAssure Basic Adult or Child Dental Plan","74056LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$95","$95 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA"
"2017","LA","74056","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","36-3757528","74056LA0030001","TruAssure Dental Small Group Basic Plan","74056LA003",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","74056LA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","LA","74056","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","36-3757528","74056LA0040001","TruAssure Dental Small Group Preferred Plan","74056LA004",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","74056LA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","LA","74056","HIOS","2016-08-24 02:30:21","Individual","Yes","36-3757528","74056LA0010001","TruAssure Basic Adult or Child Dental Plan","74056LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$95","$95 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA"
"2017","LA","74056","HIOS","2016-08-24 02:30:21","Individual","Yes","36-3757528","74056LA0020001","TruAssure Preferred Adult or Child Dental Plan","74056LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA"
"2017","LA","74056","HIOS","2016-08-24 02:30:21","Individual","Yes","36-3757528","74056LA0020001","TruAssure Preferred Adult or Child Dental Plan","74056LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA"
"2017","LA","75321","HIOS","2016-08-10 02:51:42","SHOP (Small Group)","Yes","57-0523959","75321LA0020001","Group Dental Policy","75321LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","75321LA0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","LA","75409","HIOS","2016-06-24 02:40:05","SHOP (Small Group)","Yes","13-5581829","75409LA0150001","EHB Basic Dental Plan (Low)","75409LA015",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","75409LA0150001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","LA","78461","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","78461LA0020005","BESTOne Plus Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010007","BESTDental Premium","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Premium_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010007","BESTDental Premium","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Premium_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","78461LA0020005","BESTOne Plus Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","78461LA0020006","BESTOne Basic Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010008","BESTDental Standard - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Standard-H_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010008","BESTDental Standard - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Standard-H_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","78461LA0020006","BESTOne Basic Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010010","BESTDental Choice - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Choice-H_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010010","BESTDental Choice - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Choice-H_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010009","BESTDental Standard - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Standard-L_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","78461LA0020003","BESTOne Dental Advantage - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020003-00","BESTOne Dental Advantage - Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","78461LA0020003","BESTOne Dental Advantage - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020003-01","BESTOne Dental Advantage - Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010009","BESTDental Standard - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Standard-L_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010011","BESTDental Choice - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Choice-L_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","78461LA0020004","BESTOne Dental Plus - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020004-00","BESTOne Dental Plus - Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","78461LA0020004","BESTOne Dental Plus - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020004-01","BESTOne Dental Plus - Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010011","BESTDental Choice - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Choice-L_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010012","BESTDental Value","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Value_Plan.pdf"
"2017","LA","78461","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","78461LA0010012","BESTDental Value","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTDental_Value_Plan.pdf"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","Yes","23-7384555","97176LA0400001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","","97176LA0400001-00","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3100","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350003-00","Blue Saver 100/80 $3100","Standard Silver Off Exchange Plan",,"0.71738600730896","Yes","Yes","No","100%",,"$3,100","$0","$0","$150","$3,100","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33350 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$6200 per person","$6200 per group","0.00%",,,,,"$6,200","$12400 per person","$12400 per group","$9,300","$18600 per person","$18600 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3100","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350003-01","Blue Saver 100/80 $3100","Standard Silver On Exchange Plan",,"0.71738600730896","Yes","Yes","No","100%",,"$3,100","$0","$0","$150","$3,100","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33350 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$6200 per person","$6200 per group","0.00%",,,,,"$6,200","$12400 per person","$12400 per group","$9,300","$18600 per person","$18600 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","Yes","23-7384555","97176LA0400002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","","97176LA0400002-00","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","23-7384555","97176LA0360010","Group Care copay 80/60 $1000","97176LA036",,"LAN001","LAS001","LAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2017","97176LA0360010-01","Group Care copay 80/60 $1000","Standard Gold On Exchange Plan",,"0.790525317192078","No","Yes","No","100%",,"$1,000","$900","$694","$150","$1,000","$1,000","$54","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","$0 per person","per group not applicable","10.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0360010-01&Year=2017","http://www.bcbsla.com/smallgroup-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","23-7384555","97176LA0360013","Group Care copay 70/50 $2800","97176LA036",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2017","97176LA0360013-01","Group Care copay 70/50 $2800","Standard Silver On Exchange Plan",,"0.707388877868652","No","Yes","No","100%",,"$2,800","$900","$501","$150","$1,272","$1,000","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,800","$2800 per person","$8400 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,400","$8400 per person","$25200 per group","$0","$0 per person","per group not applicable","10.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0360013-01&Year=2017","http://www.bcbsla.com/smallgroup-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","Yes","23-7384555","97176LA0390002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390002-01","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3100","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350003-04","Blue Saver 100/80 $2700 CSR 0003-04","73% AV Level Silver Plan",,"0.739873051643372","Yes","Yes","No","100%",,"$2,700","$0","$0","$150","$2,700","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$13,100","$26200 per person","$26200 per group","$18,800","$31900 per person","$37600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$5400 per person","$5400 per group","0.00%",,,,,"$6,200","$12400 per person","$12400 per group","$8,900","$17800 per person","$17800 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-04&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3100","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350003-05","Blue Saver 100/80 $900 CSR 0003-05","87% AV Level Silver Plan",,"0.876443862915039","Yes","Yes","No","100%",,"$900","$0","$0","$150","$900","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2350 per person","$4500 per group",,,,"$13,100","$26200 per person","$26200 per group","$15,350","$28550 per person","$30700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$1800 per person","$1800 per group","0.00%",,,,,"$6,200","$12400 per person","$12400 per group","$7,100","$14200 per person","$14200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-05&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3100","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350003-06","Blue Saver 100/80 $200 CSR 0003-06","94% AV Level Silver Plan",,"0.947025418281555","Yes","Yes","No","100%",,"$200","$0","$0","$150","$200","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$2350 per person","$3400 per group",,,,"$13,100","$26200 per person","$26200 per group","$14,800","$28550 per person","$29600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$400 per person","$400 per group","0.00%",,,,,"$6,200","$12400 per person","$12400 per group","$6,400","$12800 per person","$12800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-06&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $4500","97176LA035",,"LAN001","LAS001","LAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350004-00","Blue Saver 60/40 $4500","Standard Bronze Off Exchange Plan",,"0.619456708431244","Yes","Yes","No","100%",,"$4,500","$0","$1,113","$150","$4,500","$0","$308","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33350 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","40.00%",,,,,"$9,000","$18000 per person","$18000 per group","$13,500","$25150 per person","$27000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $4500","97176LA035",,"LAN001","LAS001","LAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350004-01","Blue Saver 60/40 $4500","Standard Bronze On Exchange Plan",,"0.619456708431244","Yes","Yes","No","100%",,"$4,500","$0","$1,113","$150","$4,500","$0","$308","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33350 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","40.00%",,,,,"$9,000","$18000 per person","$18000 per group","$13,500","$25150 per person","$27000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340015","Blue Max 100/80 $1800","97176LA034",,"LAN001","LAS001","LAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0340015-01","Blue Max 100/80 $1800","Standard Gold On Exchange Plan",,"0.799529910087585","Yes","Yes","No","100%",,"$1,800","$0","$0","$150","$1,800","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$5400 per group","0.00%",,,,,"$3,600","$3600 per person","$10800 per group","$5,400","$5400 per person","$16200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340015","Blue Max 100/80 $1800","97176LA034",,"LAN001","LAS001","LAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0340015-02","Blue Max 100/100 $0 CSR 0015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340015","Blue Max 100/80 $1800","97176LA034",,"LAN001","LAS001","LAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0340015-03","Blue Max 100/80 $1800 CSR 0015-03","Limited Cost Sharing Plan Variation",,"0.799529910087585","Yes","Yes","No","100%",,"$1,800","$0","$0","$150","$1,800","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$5400 per group","0.00%",,,,,"$3,600","$3600 per person","$10800 per group","$5,400","$5400 per person","$16200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","97176LA0340010-00","Blue Max copay 70/50 $2800","Standard Silver Off Exchange Plan","71.31%","0.70478355884552","No","Yes","No","100%",,"$2,823","$880","$501","$150","$1,772","$924","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,800","$2800 per person","$8400 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,400","$8400 per person","$25200 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","Yes","23-7384555","97176LA0390003","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390003-00","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $4500","97176LA035",,"LAN001","LAS001","LAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350004-02","Blue Saver 100/100 $0 CSR 0004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $4500","97176LA035",,"LAN001","LAS001","LAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0350004-03","Blue Saver 60/40 $4500 CSR 0004-03","Limited Cost Sharing Plan Variation",,"0.619456708431244","Yes","Yes","No","100%",,"$4,500","$0","$1,113","$150","$4,500","$0","$308","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33350 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","40.00%",,,,,"$9,000","$18000 per person","$18000 per group","$13,500","$25150 per person","$27000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0340017-00","Blue Max 80/60 $5000","Standard Bronze Off Exchange Plan",,"0.611000955104828","Yes","Yes","No","100%",,"$5,000","$0","$456","$150","$5,000","$0","$54","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$14300 per group","20.00%",,,,,"$10,000","$10000 per person","$28600 per group","$15,000","$15000 per person","$42900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0340017-01","Blue Max 80/60 $5000","Standard Bronze On Exchange Plan",,"0.611000955104828","Yes","Yes","No","100%",,"$5,000","$0","$456","$150","$5,000","$0","$54","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$14300 per group","20.00%",,,,,"$10,000","$10000 per person","$28600 per group","$15,000","$15000 per person","$42900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0340017-02","Blue Max 100/100 $0 CSR 0017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0340017-03","Blue Max 80/60 $5000 CSR 0017-03","Limited Cost Sharing Plan Variation",,"0.611000955104828","Yes","Yes","No","100%",,"$5,000","$0","$456","$150","$5,000","$0","$54","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$14300 per group","20.00%",,,,,"$10,000","$10000 per person","$28600 per group","$15,000","$15000 per person","$42900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340015","Blue Max 100/80 $1800","97176LA034",,"LAN001","LAS001","LAF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2017","97176LA0340015-00","Blue Max 100/80 $1800","Standard Gold Off Exchange Plan",,"0.799529910087585","Yes","Yes","No","100%",,"$1,800","$0","$0","$150","$1,800","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$5400 per group","0.00%",,,,,"$3,600","$3600 per person","$10800 per group","$5,400","$5400 per person","$16200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-00&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","Yes","23-7384555","97176LA0390003","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390003-01","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","97176LA0340010-01","Blue Max copay 70/50 $2800","Standard Silver On Exchange Plan","71.31%","0.70478355884552","No","Yes","No","100%",,"$2,823","$880","$501","$150","$1,772","$924","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,800","$2800 per person","$8400 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,400","$8400 per person","$25200 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-01&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","97176LA0340010-02","Blue Max copay 100/100 $0 CSR 0010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-02&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","97176LA0340010-03","Blue Max copay 70/50 $2800 CSR 0010-03","Limited Cost Sharing Plan Variation","71.31%","0.70478355884552","No","Yes","No","100%",,"$2,823","$880","$501","$150","$1,772","$924","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,800","$2800 per person","$8400 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,400","$8400 per person","$25200 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-03&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","97176LA0340010-04","Blue Max copay 70/50 $2700 CSR 0010-04","73% AV Level Silver Plan","73.60%","0.71401309967041","No","Yes","No","100%",,"$2,723","$880","$531","$150","$1,772","$924","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$28600 per group","$20,000","$20000 per person","$40000 per group","$2,700","$2700 per person","$8100 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,300","$8300 per person","$24900 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-04&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","97176LA0340010-05","Blue Max copay 80/50 $400 CSR 0010-05","87% AV Level Silver Plan","87.00%","0.864899575710297","No","Yes","No","100%",,"$423","$560","$814","$150","$900","$445","$174","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"$14,300","$14300 per person","$28600 per group","$16,450","$16450 per person","$32900 per group","$400","$400 per person","$1200 per group","20.00%",,,,,"$5,600","$5600 per person","$16800 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-05&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770034","Anthem Silver Pathway X 3250","32753MO077",,"MON001","MOS001","MOF015","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770034-04","Anthem Silver Pathway X 3250 S04","73% AV Level Silver Plan","72.88%","0.727209150791168","Yes","Yes","Yes","40%","60%","$3,000","$500","$1,300","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EF7","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770017","Anthem Bronze Pathway X 0 for HSA","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770017-03","Anthem Bronze Pathway X 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","40%","60%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ3","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570002","Humana Bronze 4800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570002-00","Humana Bronze 4800/S.W. Missouri PPOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2847533",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570002","Humana Bronze 4800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570002-01","Humana Bronze 4800/S.W. Missouri PPOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2847533",
"2017","LA","97176","HIOS","2016-09-01 07:41:30","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2017","97176LA0340010-06","Blue Max copay 100/50 $75 CSR 0010-06","94% AV Level Silver Plan","93.02%","0.927155435085297","No","Yes","No","100%",,"$98","$320","$0","$150","$325","$323","$0","$79","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$14,300","$14300 per person","$28600 per group","$15,700","$15700 per person","$31400 per group","$75","$75 per person","$225 per group","0.00%",,,,,"$5,600","$5600 per person","$16800 per group","$5,675","$5675 per person","$17025 per group","$250","$250 per person","per group not applicable","20.00%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-06&Year=2017","http://www.bcbsla.com/individual-solutions-brochure2017"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","29416MO0020003","BESTOne Advantage Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010007","BESTDental Premium","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Premium_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010007","BESTDental Premium","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Premium_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","29416MO0020003","BESTOne Advantage Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","29416MO0020004","BESTOne Plus Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010008","BESTDental Standard - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Standard-H_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010008","BESTDental Standard - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Standard-H_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","29416MO0020004","BESTOne Plus Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010010","BESTDental Choice - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Choice-H_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010010","BESTDental Choice - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Choice-H_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010009","BESTDental Standard - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Standard-L_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","29416MO0020005","BESTOne Plus Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","29416MO0020005","BESTOne Plus Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010009","BESTDental Standard - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Standard-L_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010011","BESTDental Choice - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Choice-L_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","29416MO0020006","BESTOne Basic Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","29416MO0020006","BESTOne Basic Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010011","BESTDental Choice - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Choice-L_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010012","BESTDental Value","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Value_Plan.pdf"
"2017","MO","29416","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","29416MO0010012","BESTDental Value","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/2017/MO_BESTDental_Value_Plan.pdf"
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","Yes","39-1263473","30613MO0560001","Humana Dental Smart Choice","30613MO056",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.99","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","30613MO0560001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857088"
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570011","Humana Basic 7150/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570011-00","Humana Basic 7150/Kansas City PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847052",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570011","Humana Basic 7150/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570011-01","Humana Basic 7150/Kansas City PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847052",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","Yes","39-1263473","30613MO0560001","Humana Dental Smart Choice","30613MO056",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.99","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","30613MO0560001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857088"
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570001","Humana Basic 7150/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570001-00","Humana Basic 7150/S.W. Missouri PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847078",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570001","Humana Basic 7150/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570001-01","Humana Basic 7150/S.W. Missouri PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847078",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570006","Humana Basic 7150/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570006-00","Humana Basic 7150/S.W. Missouri PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847078",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570006","Humana Basic 7150/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570006-01","Humana Basic 7150/S.W. Missouri PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847078",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570012","Humana Bronze 4800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570012-00","Humana Bronze 4800/Kansas City PPOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2847104",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570012","Humana Bronze 4800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570012-01","Humana Bronze 4800/Kansas City PPOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2847104",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570012","Humana Bronze 4800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570012-02","Humana Bronze 4800/Kansas City PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847117",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570012","Humana Bronze 4800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570012-03","Humana Bronze 4800/Kansas City PPOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847130",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570002","Humana Bronze 4800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570002-02","Humana Bronze 4800/S.W. Missouri PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847559",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570002","Humana Bronze 4800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570002-03","Humana Bronze 4800/S.W. Missouri PPOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847572",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780031","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS008","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780031-01","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780004","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS002","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780004-00","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold Off Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","Yes","86-0257201","32753MO0860003","Anthem Dental Family","32753MO086",,"MON003","MOS009",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0860003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215729.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","Yes","86-0257201","32753MO0830004","Anthem Dental Family Enhanced","32753MO083",,"MON003","MOS009",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0830004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215730.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770034","Anthem Silver Pathway X 3250","32753MO077",,"MON001","MOS001","MOF015","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770034-03","Anthem Silver Pathway X 3250","Limited Cost Sharing Plan Variation","68.01%","0.679238259792328","Yes","Yes","Yes","40%","60%","$3,250","$600","$1,700","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50.00%","$3,250","$3250 per person","$6500 per group","50.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EF5","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770034","Anthem Silver Pathway X 3250","32753MO077",,"MON001","MOS001","MOF015","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770034-05","Anthem Silver Pathway X 3250 S05","87% AV Level Silver Plan","87.21%","0.864421844482422","Yes","Yes","Yes","40%","60%","$900","$200","$300","$0","$500","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","50.00%","$900","$900 per person","$1800 per group","50.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EF8","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770034","Anthem Silver Pathway X 3250","32753MO077",,"MON001","MOS001","MOF015","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770034-06","Anthem Silver Pathway X 3250 S06","94% AV Level Silver Plan","93.42%","0.930436670780182","Yes","Yes","Yes","40%","60%","$200","$40","$400","$0","$200","$400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50.00%","$200","$200 per person","$400 per group","50.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EF9","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570007","Humana Bronze 4800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570007-00","Humana Bronze 4800/S.W. Missouri PPOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2847533",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570007","Humana Bronze 4800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570007-01","Humana Bronze 4800/S.W. Missouri PPOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2847533",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570007","Humana Bronze 4800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570007-02","Humana Bronze 4800/S.W. Missouri PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847559",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570007","Humana Bronze 4800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-MO","30613MO0570007-03","Humana Bronze 4800/S.W. Missouri PPOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2847572",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570013","Humana Silver 3550/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570013-00","Humana Silver 3550/Kansas City PPOx","Standard Silver Off Exchange Plan",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848001",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570013","Humana Silver 3550/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570013-01","Humana Silver 3550/Kansas City PPOx","Standard Silver On Exchange Plan",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848001",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570013","Humana Silver 3550/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570013-02","Humana Silver 3550/Kansas City PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848027",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570013","Humana Silver 3550/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570013-03","Humana Silver 3550/Kansas City PPOx","Limited Cost Sharing Plan Variation",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848118",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570013","Humana Silver 3550/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570013-04","Humana Silver 3550/Kansas City PPOx","73% AV Level Silver Plan",,"0.724220395088196","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847702",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570013","Humana Silver 3550/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570013-05","Humana Silver 3550/Kansas City PPOx","87% AV Level Silver Plan",,"0.866297364234924","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848209",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570013","Humana Silver 3550/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570013-06","Humana Silver 3550/Kansas City PPOx","94% AV Level Silver Plan",,"0.932235598564148","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847676",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570003","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570003-00","Humana Silver 3550/S.W. Missouri PPOx","Standard Silver Off Exchange Plan",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848157",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570003","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570003-01","Humana Silver 3550/S.W. Missouri PPOx","Standard Silver On Exchange Plan",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848157",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570003","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570003-02","Humana Silver 3550/S.W. Missouri PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848170",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570003","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570003-03","Humana Silver 3550/S.W. Missouri PPOx","Limited Cost Sharing Plan Variation",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848183",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570003","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570003-04","Humana Silver 3550/S.W. Missouri PPOx","73% AV Level Silver Plan",,"0.724220395088196","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847715",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570003","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570003-05","Humana Silver 3550/S.W. Missouri PPOx","87% AV Level Silver Plan",,"0.866297364234924","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848222",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570003","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570003-06","Humana Silver 3550/S.W. Missouri PPOx","94% AV Level Silver Plan",,"0.932235598564148","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847689",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570008","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570008-00","Humana Silver 3550/S.W. Missouri PPOx","Standard Silver Off Exchange Plan",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848157",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570008","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570008-01","Humana Silver 3550/S.W. Missouri PPOx","Standard Silver On Exchange Plan",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848157",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570008","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570008-02","Humana Silver 3550/S.W. Missouri PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848170",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570008","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570008-03","Humana Silver 3550/S.W. Missouri PPOx","Limited Cost Sharing Plan Variation",,"0.681958138942719","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848183",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570008","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570008-04","Humana Silver 3550/S.W. Missouri PPOx","73% AV Level Silver Plan",,"0.724220395088196","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847715",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570008","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570008-05","Humana Silver 3550/S.W. Missouri PPOx","87% AV Level Silver Plan",,"0.866297364234924","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848222",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570008","Humana Silver 3550/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570008-06","Humana Silver 3550/S.W. Missouri PPOx","94% AV Level Silver Plan",,"0.932235598564148","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847689",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570031","Humana Gold 1250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS004","MOF004","New","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570031-00","Humana Gold 1250/S.W. Missouri PPOx","Standard Gold Off Exchange Plan",,"0.781902492046356","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847637",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570031","Humana Gold 1250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS004","MOF004","New","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570031-01","Humana Gold 1250/S.W. Missouri PPOx","Standard Gold On Exchange Plan",,"0.781902492046356","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847637",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570031","Humana Gold 1250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS004","MOF004","New","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570031-02","Humana Gold 1250/S.W. Missouri PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847650",
"2017","MO","30613","HIOS","2016-10-18 03:04:46","Individual","No","39-1263473","30613MO0570031","Humana Gold 1250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS004","MOF004","New","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-MO","30613MO0570031-03","Humana Gold 1250/S.W. Missouri PPOx","Limited Cost Sharing Plan Variation",,"0.781902492046356","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847663",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770015","Anthem Bronze Pathway X 6350","32753MO077",,"MON001","MOS001","MOF016","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770015-00","Anthem Bronze Pathway 6350","Standard Bronze Off Exchange Plan","61.93%","0.639862179756165","Yes","Yes","Yes","40%","60%","$6,350","$100","$200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%","$6,350","$6350 per person","$12700 per group","20.00%","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHZ","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","Yes","86-0257201","32753MO0860005","Anthem Dental Family Value","32753MO086",,"MON003","MOS009",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0860005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215731.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","Yes","86-0257201","32753MO0830003","Anthem Dental Family","32753MO083",,"MON003","MOS009",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0830003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215729.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780025","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS002","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780025-00","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780025","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS002","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780025-01","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","Yes","86-0257201","32753MO0890003","Anthem Dental Family","32753MO089",,"MON003","MOS009",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0890003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215729.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","Yes","86-0257201","32753MO0920005","Anthem Dental Family Value","32753MO092",,"MON003","MOS009",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0920005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215731.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770015","Anthem Bronze Pathway X 6350","32753MO077",,"MON001","MOS001","MOF016","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770015-01","Anthem Bronze Pathway X 6350","Standard Bronze On Exchange Plan","61.93%","0.639862179756165","Yes","Yes","Yes","40%","60%","$6,350","$100","$200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%","$6,350","$6350 per person","$12700 per group","20.00%","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHX","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770015","Anthem Bronze Pathway X 6350","32753MO077",,"MON001","MOS001","MOF016","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770015-02","Anthem Bronze Pathway X 6350 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GHY","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780026","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS003","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780026-00","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780026","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS003","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780026-01","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770015","Anthem Bronze Pathway X 6350","32753MO077",,"MON001","MOS001","MOF016","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770015-03","Anthem Bronze Pathway X 6350","Limited Cost Sharing Plan Variation","61.93%","0.639862179756165","Yes","Yes","Yes","40%","60%","$6,350","$100","$200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%","$6,350","$6350 per person","$12700 per group","20.00%","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHX","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780027","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS004","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780027-00","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780027","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS004","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780027-01","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780028","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS005","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780028-00","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780028","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS005","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780028-01","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780029","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS006","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780029-00","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780029","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS006","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780029-01","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780030","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS007","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780030-00","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780030","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS007","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780030-01","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780031","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","32753MO078",,"MON002","MOS008","MOF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780031-00","Anthem Bronze Blue Preferred X 6350EC 40 6550 w HSA SelRx","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2004",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770017","Anthem Bronze Pathway X 0 for HSA","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770017-00","Anthem Bronze Pathway 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","40%","60%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ5","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770017","Anthem Bronze Pathway X 0 for HSA","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770017-01","Anthem Bronze Pathway X 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","40%","60%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ3","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","Yes","86-0257201","32753MO0890004","Anthem Dental Family Enhanced","32753MO089",,"MON003","MOS009",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0890004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215730.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","Yes","86-0257201","32753MO0920003","Anthem Dental Family","32753MO092",,"MON003","MOS009",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0920003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215729.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780004","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS002","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780004-01","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold On Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780005","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS003","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780005-00","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold Off Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770017","Anthem Bronze Pathway X 0 for HSA","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770017-02","Anthem Bronze Pathway X 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ4","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780005","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS003","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780005-01","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold On Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780006","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS004","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780006-00","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold Off Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770018","Anthem Bronze Pathway X 20 for HSA","32753MO077",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770018-00","Anthem Bronze Pathway 20 for HSA","Standard Bronze Off Exchange Plan","61.84%","0.619547247886658","Yes","Yes","Yes","40%","60%","$5,250","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20.00%","$5,250","$5250 per person","$10500 per group","20.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ8","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770018","Anthem Bronze Pathway X 20 for HSA","32753MO077",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770018-01","Anthem Bronze Pathway X 20 for HSA","Standard Bronze On Exchange Plan","61.84%","0.619547247886658","Yes","Yes","Yes","40%","60%","$5,250","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20.00%","$5,250","$5250 per person","$10500 per group","20.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ6","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780006","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS004","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780006-01","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold On Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780007","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS005","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780007-00","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold Off Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770018","Anthem Bronze Pathway X 20 for HSA","32753MO077",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770018-02","Anthem Bronze Pathway X 20 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ7","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770018","Anthem Bronze Pathway X 20 for HSA","32753MO077",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770018-03","Anthem Bronze Pathway X 20 for HSA","Limited Cost Sharing Plan Variation","61.84%","0.619547247886658","Yes","Yes","Yes","40%","60%","$5,250","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20.00%","$5,250","$5250 per person","$10500 per group","20.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ6","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780007","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS005","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780007-01","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold On Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780008","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS006","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780008-00","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold Off Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3850","32753MO077",,"MON001","MOS001","MOF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-00","Anthem Silver Pathway 3850","Standard Silver Off Exchange Plan","71.95%","0.722452044487","Yes","Yes","Yes","40%","60%","$3,850","$600","$300","$0","$500","$1,800","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","0.00%","$3,850","$3850 per person","$7700 per group","0.00%","$7,700","$7700 per person","$15400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJE","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3850","32753MO077",,"MON001","MOS001","MOF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-01","Anthem Silver Pathway X 3850","Standard Silver On Exchange Plan","71.95%","0.722452044487","Yes","Yes","Yes","40%","60%","$3,850","$600","$300","$0","$500","$1,800","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","0.00%","$3,850","$3850 per person","$7700 per group","0.00%","$7,700","$7700 per person","$15400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJC","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780008","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS006","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780008-01","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold On Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780009","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS007","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780009-00","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold Off Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3850","32753MO077",,"MON001","MOS001","MOF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-02","Anthem Silver Pathway X 3850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJD","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3850","32753MO077",,"MON001","MOS001","MOF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-03","Anthem Silver Pathway X 3850","Limited Cost Sharing Plan Variation","71.95%","0.722452044487","Yes","Yes","Yes","40%","60%","$3,850","$600","$300","$0","$500","$1,800","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","0.00%","$3,850","$3850 per person","$7700 per group","0.00%","$7,700","$7700 per person","$15400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJC","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780009","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS007","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780009-01","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold On Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780010","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS008","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780010-00","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold Off Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3850","32753MO077",,"MON001","MOS001","MOF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-04","Anthem Silver Pathway X 3850 S04","73% AV Level Silver Plan","73.95%","0.742939412593842","Yes","Yes","Yes","40%","60%","$3,450","$600","$500","$0","$500","$1,400","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group","0.00%","$3,450","$3450 per person","$6900 per group","0.00%","$7,700","$7700 per person","$15400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJF","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3850","32753MO077",,"MON001","MOS001","MOF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-05","Anthem Silver Pathway X 3850 S05","87% AV Level Silver Plan","87.87%","0.88060587644577","Yes","Yes","Yes","40%","60%","$1,000","$500","$500","$0","$500","$1,300","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%","$1,000","$1000 per person","$2000 per group","0.00%","$7,700","$7700 per person","$15400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJG","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780010","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","32753MO078",,"MON002","MOS008","MOF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780010-01","Anthem Gold Blue Preferred X 1000 20 5500 SelRx","Standard Gold On Exchange Plan","79.50%","0.804328680038452","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2000",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3850","32753MO077",,"MON001","MOS001","MOF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-06","Anthem Silver Pathway X 3850 S06","94% AV Level Silver Plan","94.94%","0.950404465198517","Yes","Yes","Yes","40%","60%","$250","$200","$400","$0","$250","$600","$10","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%","$250","$250 per person","$500 per group","0.00%","$7,700","$7700 per person","$15400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJH","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-00","Anthem Silver Pathway for HSA","Standard Silver Off Exchange Plan","68.21%","0.68887847661972","Yes","Yes","Yes","40%","60%","$3,000","$500","$900","$0","$3,000","$0","$200","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJS","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-01","Anthem Silver Pathway X for HSA","Standard Silver On Exchange Plan","68.21%","0.68887847661972","Yes","Yes","Yes","40%","60%","$3,000","$500","$900","$0","$3,000","$0","$200","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJQ","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-02","Anthem Silver Pathway X AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJR","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770032","Anthem Silver Pathway X 4700","32753MO077",,"MON001","MOS001","MOF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770032-01","Anthem Silver Pathway X 4700","Standard Silver On Exchange Plan","68.07%","0.661316871643066","Yes","Yes","Yes","40%","60%","$4,700","$400","$400","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","20.00%","$4,700","$4700 per person","$9400 per group","20.00%","$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFB","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770032","Anthem Silver Pathway X 4700","32753MO077",,"MON001","MOS001","MOF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770032-02","Anthem Silver Pathway X 4700 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EFC","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770032","Anthem Silver Pathway X 4700","32753MO077",,"MON001","MOS001","MOF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770032-03","Anthem Silver Pathway X 4700","Limited Cost Sharing Plan Variation","68.07%","0.661316871643066","Yes","Yes","Yes","40%","60%","$4,700","$400","$400","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","20.00%","$4,700","$4700 per person","$9400 per group","20.00%","$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFB","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770032","Anthem Silver Pathway X 4700","32753MO077",,"MON001","MOS001","MOF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770032-04","Anthem Silver Pathway X 4700 S04","73% AV Level Silver Plan","72.27%","0.704918265342712","Yes","Yes","Yes","40%","60%","$3,500","$600","$900","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%","$3,500","$3500 per person","$7000 per group","20.00%","$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFD","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770032","Anthem Silver Pathway X 4700","32753MO077",,"MON001","MOS001","MOF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770032-05","Anthem Silver Pathway X 4700 S05","87% AV Level Silver Plan","86.04%","0.848748385906219","Yes","Yes","Yes","40%","60%","$1,000","$500","$400","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%","$1,000","$1000 per person","$2000 per group","20.00%","$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFE","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780024","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS008","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780024-00","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver Off Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780024","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS008","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780024-01","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver On Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-03","Anthem Silver Pathway X for HSA","Limited Cost Sharing Plan Variation","68.21%","0.68887847661972","Yes","Yes","Yes","40%","60%","$3,000","$500","$900","$0","$3,000","$0","$200","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJQ","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-04","Anthem Silver Pathway X for HSA S04","73% AV Level Silver Plan","72.12%","0.724972903728485","Yes","Yes","Yes","40%","60%","$2,700","$500","$1,000","$0","$2,700","$0","$300","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","$4,300","$4300 per person","$8600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJT","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-05","Anthem Silver Pathway X S05","87% AV Level Silver Plan","87.64%","0.876363337039948","Yes","Yes","Yes","40%","60%","$1,200","$0","$0","$0","$1,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%","$1,200","$1200 per person","$2400 per group","0.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJU","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-06","Anthem Silver Pathway X S06","94% AV Level Silver Plan","94.28%","0.942757964134216","Yes","Yes","Yes","40%","60%","$500","$0","$0","$0","$500","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJV","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770028","Anthem Bronze Pathway X 5450","32753MO077",,"MON001","MOS001","MOF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770028-00","Anthem Bronze Pathway 5450","Standard Bronze Off Exchange Plan","59.32%","0.595403671264648","Yes","Yes","Yes","40%","60%","$5,450","$0","$600","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAT","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770028","Anthem Bronze Pathway X 5450","32753MO077",,"MON001","MOS001","MOF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770028-01","Anthem Bronze Pathway X 5450","Standard Bronze On Exchange Plan","59.32%","0.595403671264648","Yes","Yes","Yes","40%","60%","$5,450","$0","$600","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAU","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770028","Anthem Bronze Pathway X 5450","32753MO077",,"MON001","MOS001","MOF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770028-02","Anthem Bronze Pathway X 5450 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XAV","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770028","Anthem Bronze Pathway X 5450","32753MO077",,"MON001","MOS001","MOF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770028-03","Anthem Bronze Pathway X 5450","Limited Cost Sharing Plan Variation","59.32%","0.595403671264648","Yes","Yes","Yes","40%","60%","$5,450","$0","$600","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAU","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770030","Anthem Bronze Pathway X 4950","32753MO077",,"MON001","MOS001","MOF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770030-00","Anthem Bronze Pathway 4950","Standard Bronze Off Exchange Plan","58.86%","0.589503049850464","Yes","Yes","Yes","40%","60%","$4,950","$200","$1,100","$0","$4,950","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB2","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770030","Anthem Bronze Pathway X 4950","32753MO077",,"MON001","MOS001","MOF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770030-01","Anthem Bronze Pathway X 4950","Standard Bronze On Exchange Plan","58.86%","0.589503049850464","Yes","Yes","Yes","40%","60%","$4,950","$200","$1,100","$0","$4,950","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB3","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770030","Anthem Bronze Pathway X 4950","32753MO077",,"MON001","MOS001","MOF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770030-02","Anthem Bronze Pathway X 4950 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XB4","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770030","Anthem Bronze Pathway X 4950","32753MO077",,"MON001","MOS001","MOF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770030-03","Anthem Bronze Pathway X 4950","Limited Cost Sharing Plan Variation","58.86%","0.589503049850464","Yes","Yes","Yes","40%","60%","$4,950","$200","$1,100","$0","$4,950","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB3","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250","32753MO077",,"MON001","MOS001","MOF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-00","Anthem Silver Pathway 2250","Standard Silver Off Exchange Plan","68.12%","0.681578397750854","Yes","Yes","Yes","40%","60%","$2,250","$600","$2,200","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50.00%","$2,250","$2250 per person","$4500 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB5","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250","32753MO077",,"MON001","MOS001","MOF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-01","Anthem Silver Pathway X 2250","Standard Silver On Exchange Plan","68.12%","0.681578397750854","Yes","Yes","Yes","40%","60%","$2,250","$600","$2,200","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50.00%","$2,250","$2250 per person","$4500 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB6","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250","32753MO077",,"MON001","MOS001","MOF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-02","Anthem Silver Pathway X 2250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XB7","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250","32753MO077",,"MON001","MOS001","MOF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-03","Anthem Silver Pathway X 2250","Limited Cost Sharing Plan Variation","68.12%","0.681578397750854","Yes","Yes","Yes","40%","60%","$2,250","$600","$2,200","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50.00%","$2,250","$2250 per person","$4500 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB6","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250","32753MO077",,"MON001","MOS001","MOF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-04","Anthem Silver Pathway X 2250 S04","73% AV Level Silver Plan","73.23%","0.73091858625412","Yes","Yes","Yes","40%","60%","$2,200","$700","$1,900","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","50.00%","$2,200","$2200 per person","$4400 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB8","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250","32753MO077",,"MON001","MOS001","MOF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-05","Anthem Silver Pathway X 2250 S05","87% AV Level Silver Plan","87.37%","0.866139650344849","Yes","Yes","Yes","40%","60%","$850","$200","$300","$0","$500","$900","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","50.00%","$850","$850 per person","$1700 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB9","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250","32753MO077",,"MON001","MOS001","MOF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-06","Anthem Silver Pathway X 2250 S06","94% AV Level Silver Plan","93.66%","0.932875692844391","Yes","Yes","Yes","40%","60%","$150","$40","$400","$0","$150","$400","$60","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50.00%","$150","$150 per person","$300 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XBA","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770033","Anthem Silver Pathway X 5300","32753MO077",,"MON001","MOS001","MOF010","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770033-00","Anthem Silver Pathway 5300","Standard Silver Off Exchange Plan","68.15%","0.681887686252594","Yes","Yes","Yes","40%","60%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFG","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770033","Anthem Silver Pathway X 5300","32753MO077",,"MON001","MOS001","MOF010","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770033-01","Anthem Silver Pathway X 5300","Standard Silver On Exchange Plan","68.15%","0.681887686252594","Yes","Yes","Yes","40%","60%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFH","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770033","Anthem Silver Pathway X 5300","32753MO077",,"MON001","MOS001","MOF010","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770033-02","Anthem Silver Pathway X 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EFJ","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770033","Anthem Silver Pathway X 5300","32753MO077",,"MON001","MOS001","MOF010","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770033-03","Anthem Silver Pathway X 5300","Limited Cost Sharing Plan Variation","68.15%","0.681887686252594","Yes","Yes","Yes","40%","60%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFH","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770033","Anthem Silver Pathway X 5300","32753MO077",,"MON001","MOS001","MOF010","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770033-04","Anthem Silver Pathway X 5300 S04","73% AV Level Silver Plan","72.06%","0.723617970943451","Yes","Yes","Yes","40%","60%","$3,000","$600","$1,200","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%","$3,000","$3000 per person","$6000 per group","25.00%","$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFK","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770033","Anthem Silver Pathway X 5300","32753MO077",,"MON001","MOS001","MOF010","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770033-05","Anthem Silver Pathway X 5300 S05","87% AV Level Silver Plan","86.08%","0.859486281871796","Yes","Yes","Yes","40%","60%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFL","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770033","Anthem Silver Pathway X 5300","32753MO077",,"MON001","MOS001","MOF010","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770033-06","Anthem Silver Pathway X 5300 S06","94% AV Level Silver Plan","93.13%","0.929591596126556","Yes","Yes","Yes","40%","60%","$200","$100","$500","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFM","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770034","Anthem Silver Pathway X 3250","32753MO077",,"MON001","MOS001","MOF015","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770034-00","Anthem Silver Pathway 3250","Standard Silver Off Exchange Plan","68.01%","0.679238259792328","Yes","Yes","Yes","40%","60%","$3,250","$600","$1,700","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50.00%","$3,250","$3250 per person","$6500 per group","50.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EF4","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770034","Anthem Silver Pathway X 3250","32753MO077",,"MON001","MOS001","MOF015","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770034-01","Anthem Silver Pathway X 3250","Standard Silver On Exchange Plan","68.01%","0.679238259792328","Yes","Yes","Yes","40%","60%","$3,250","$600","$1,700","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50.00%","$3,250","$3250 per person","$6500 per group","50.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EF5","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770034","Anthem Silver Pathway X 3250","32753MO077",,"MON001","MOS001","MOF015","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770034-02","Anthem Silver Pathway X 3250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EF6","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770032","Anthem Silver Pathway X 4700","32753MO077",,"MON001","MOS001","MOF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770032-00","Anthem Silver Pathway 4700","Standard Silver Off Exchange Plan","68.07%","0.661316871643066","Yes","Yes","Yes","40%","60%","$4,700","$400","$400","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","20.00%","$4,700","$4700 per person","$9400 per group","20.00%","$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFA","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770032","Anthem Silver Pathway X 4700","32753MO077",,"MON001","MOS001","MOF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770032-06","Anthem Silver Pathway X 4700 S06","94% AV Level Silver Plan","93.08%","0.925898730754852","Yes","Yes","Yes","40%","60%","$250","$200","$400","$0","$250","$600","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EFF","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500","32753MO077",,"MON001","MOS001","MOF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-00","Anthem Silver Pathway 2500","Standard Silver Off Exchange Plan","71.30%","0.722271859645844","Yes","Yes","Yes","40%","60%","$2,500","$600","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJL","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780018","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780018-00","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver Off Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","Yes","86-0257201","32753MO0860004","Anthem Dental Family Enhanced","32753MO086",,"MON003","MOS009",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0860004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215730.pdf",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","Yes","86-0257201","32753MO0920004","Anthem Dental Family Enhanced","32753MO092",,"MON003","MOS009",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0920004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215730.pdf",
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140012","Saver PCB Gold","34762MO014","7023011258","MON001","MOS004","MOF002","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140012-01","Saver PCB Gold","Standard Gold On Exchange Plan",,"0.794238448143005","Yes","Yes","No","100%",,"$1,500","$20","$580","$150","$1,500","$330","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"$6,000","$12000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbgold2.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","58883MO0010001","DentaQuest PPO  Pediatric High","58883MO001",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","59-0397210","58883MO0020003","DentaQuest PPO Family High","58883MO002",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0020003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","59-0397210","58883MO0020003","DentaQuest PPO Family High","58883MO002",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0020003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","58883MO0010001","DentaQuest PPO  Pediatric High","58883MO001",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","59-0397210","58883MO0020004","DentaQuest PPO Family Low","58883MO002",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0020004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","59-0397210","58883MO0020004","DentaQuest PPO Family Low","58883MO002",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0020004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780018","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9998",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780018-01","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver On Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500","32753MO077",,"MON001","MOS001","MOF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-01","Anthem Silver Pathway X 2500","Standard Silver On Exchange Plan","71.30%","0.722271859645844","Yes","Yes","Yes","40%","60%","$2,500","$600","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJJ","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500","32753MO077",,"MON001","MOS001","MOF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-02","Anthem Silver Pathway X 2500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJK","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780019","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS003","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780019-00","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver Off Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780019","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS003","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780019-01","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver On Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500","32753MO077",,"MON001","MOS001","MOF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-03","Anthem Silver Pathway X 2500","Limited Cost Sharing Plan Variation","71.30%","0.722271859645844","Yes","Yes","Yes","40%","60%","$2,500","$600","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJJ","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500","32753MO077",,"MON001","MOS001","MOF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-04","Anthem Silver Pathway X 2500 S04","73% AV Level Silver Plan","74.00%","0.747189581394196","Yes","Yes","Yes","40%","60%","$2,450","$600","$1,100","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10.00%","$2,450","$2450 per person","$4900 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJM","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780020","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS004","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780020-00","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver Off Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780020","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS004","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780020-01","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver On Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500","32753MO077",,"MON001","MOS001","MOF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-05","Anthem Silver Pathway X 2500 S05","87% AV Level Silver Plan","87.90%","0.879717469215393","Yes","Yes","Yes","40%","60%","$750","$500","$600","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%","$750","$750 per person","$1500 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJN","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500","32753MO077",,"MON001","MOS001","MOF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-06","Anthem Silver Pathway X 2500 S06","94% AV Level Silver Plan","94.88%","0.947639465332031","Yes","Yes","Yes","40%","60%","$200","$200","$300","$0","$200","$500","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJP","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780021","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS005","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780021-00","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver Off Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780021","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS005","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780021-01","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver On Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770025","Anthem Catastrophic Pathway X 7150","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770025-00","Anthem Catastrophic Pathway 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHW","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770025","Anthem Catastrophic Pathway X 7150","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770025-01","Anthem Catastrophic Pathway X 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHV","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780022","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS006","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780022-00","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver Off Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780022","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS006","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780022-01","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver On Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780023","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS007","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780023-00","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver Off Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","SHOP (Small Group)","No","86-0257201","32753MO0780023","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","32753MO078",,"MON002","MOS007","MOF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Limited Blue Card","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780023-01","Anthem Silver Blue Preferred X 2400 30 6850 SelRx","Standard Silver On Exchange Plan","69.46%","0.713717103004456","No","Yes","No","100%",,"$2,400","$100","$1,400","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$500","0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd1ZZY",
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900","32753MO077",,"MON001","MOS001","MOF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-00","Anthem Silver Pathway 2900","Standard Silver Off Exchange Plan","69.38%","0.700241804122925","No","Yes","Yes","40%","60%","$2,900","$600","$1,200","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAW","http://editiondigital.net/view/IU65/2017/OFF_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900","32753MO077",,"MON001","MOS001","MOF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-01","Anthem Silver Pathway X 2900","Standard Silver On Exchange Plan","69.38%","0.700241804122925","No","Yes","Yes","40%","60%","$2,900","$600","$1,200","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAX","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900","32753MO077",,"MON001","MOS001","MOF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-02","Anthem Silver Pathway X 2900 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAY","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900","32753MO077",,"MON001","MOS001","MOF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-03","Anthem Silver Pathway X 2900","Limited Cost Sharing Plan Variation","69.38%","0.700241804122925","No","Yes","Yes","40%","60%","$2,900","$600","$1,200","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAX","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900","32753MO077",,"MON001","MOS001","MOF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-04","Anthem Silver Pathway X 2900 S04","73% AV Level Silver Plan","73.41%","0.734112858772278","No","Yes","Yes","40%","60%","$2,100","$800","$1,400","$0","$1,300","$1,200","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$4,600","$4600 per person","$9200 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","25.00%","$2,100","$2100 per person","$4200 per group","25.00%","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","40.00%","$850","$850 per person","$1700 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAZ","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900","32753MO077",,"MON001","MOS001","MOF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-05","Anthem Silver Pathway X 2900 S05","87% AV Level Silver Plan","87.88%","0.848487913608551","No","Yes","Yes","40%","60%","$750","$300","$400","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XB0","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","HIOS","2017-01-19 02:20:17","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900","32753MO077",,"MON001","MOS001","MOF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-06","Anthem Silver Pathway X 2900 S06","94% AV Level Silver Plan","94.45%","0.924979388713837","No","Yes","Yes","40%","60%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XB1","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140014-04","Saver PCB Silver","73% AV Level Silver Plan",,"0.734719634056091","Yes","Yes","No","100%",,"$2,500","$10","$480","$150","$2,500","$120","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbsilver5.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","43-1257251","34762MO0220001","First 1000 PCB Gold","34762MO022","7023011258","MON001","MOS001","MOF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0220001-00","First 1000 PCB Gold","Standard Gold Off Exchange Plan",,"0.817878067493439","Yes","Yes","No","100%",,"$1,000","$20","$940","$150","$1,000","$400","$160","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2017/sg/mo/firstpcbgold1000.html","http://www.bluekc.com/qhp/2017/sgbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","43-1257251","34762MO0220001","First 1000 PCB Gold","34762MO022","7023011258","MON001","MOS001","MOF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0220001-01","First 1000 PCB Gold","Standard Gold On Exchange Plan",,"0.817878067493439","Yes","Yes","No","100%",,"$1,000","$20","$940","$150","$1,000","$400","$160","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2017/sg/mo/firstpcbgold21000.html","http://www.bluekc.com/qhp/2017/sgbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140012","Saver PCB Gold","34762MO014","7023011258","MON001","MOS004","MOF002","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140012-02","Saver PCB Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbgold3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140012","Saver PCB Gold","34762MO014","7023011258","MON001","MOS004","MOF002","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140012-03","Saver PCB Gold","Limited Cost Sharing Plan Variation",,"0.794238448143005","Yes","Yes","No","100%",,"$1,500","$20","$580","$150","$1,500","$330","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"$6,000","$12000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbgold4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","43-1257251","34762MO0220002","First 2500 PCB Silver","34762MO022","7023011258","MON001","MOS001","MOF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0220002-00","First 2500 PCB Silver","Standard Silver Off Exchange Plan",,"0.716523170471191","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$280","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2017/sg/mo/firstpcbsilver2500.html","http://www.bluekc.com/qhp/2017/sgbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","SHOP (Small Group)","No","43-1257251","34762MO0220002","First 2500 PCB Silver","34762MO022","7023011258","MON001","MOS001","MOF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0220002-01","First 2500 PCB Silver","Standard Silver On Exchange Plan",,"0.716523170471191","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$280","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2017/sg/mo/firstpcbsilver22500.html","http://www.bluekc.com/qhp/2017/sgbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140014-01","Saver PCB Silver","Standard Silver On Exchange Plan",,"0.696337044239044","Yes","Yes","No","100%",,"$3,000","$20","$430","$150","$3,000","$200","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbsilver2.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140014-02","Saver PCB Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbsilver3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140014-03","Saver PCB Silver","Limited Cost Sharing Plan Variation",,"0.696337044239044","Yes","Yes","No","100%",,"$3,000","$20","$430","$150","$3,000","$200","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbsilver4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140014-05","Saver PCB Silver","87% AV Level Silver Plan",,"0.869894027709961","Yes","Yes","No","100%",,"$950","$0","$500","$150","$950","$180","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbsilver6.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140014-06","Saver PCB Silver","94% AV Level Silver Plan",,"0.931298017501831","Yes","Yes","No","100%",,"$350","$0","$370","$150","$350","$170","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbsilver7.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140016","Saver PCB Bronze","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140016-01","Saver PCB Bronze","Standard Bronze On Exchange Plan",,"0.619797587394714","Yes","Yes","No","100%",,"$5,500","$0","$250","$150","$5,130","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbbronze2.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140016","Saver PCB Bronze","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140016-02","Saver PCB Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbbronze3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0140016","Saver PCB Bronze","34762MO014","7023011258","MON001","MOS003","MOF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided, for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0140016-03","Saver PCB Bronze","Limited Cost Sharing Plan Variation",,"0.619797587394714","Yes","Yes","No","100%",,"$5,500","$0","$250","$150","$5,130","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/mo/saverpcbbronze4.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON003","MOS002","MOF005","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440001-01","Basic Select Silver","Standard Silver On Exchange Plan",,"0.692016899585724","No","Yes","No","100%",,"$3,500","$0","$1,500","$150","$3,420","$270","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectsilver.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON003","MOS002","MOF005","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440001-02","Basic Select Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectsilver3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON003","MOS002","MOF005","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440001-03","Basic Select Silver","Limited Cost Sharing Plan Variation",,"0.692016899585724","No","Yes","No","100%",,"$3,500","$0","$1,500","$150","$3,420","$270","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectsilver4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON003","MOS002","MOF005","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440001-04","Basic Select Silver","73% AV Level Silver Plan",,"0.728238701820374","No","Yes","No","100%",,"$2,750","$0","$0","$150","$2,560","$190","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectsilver5.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON003","MOS002","MOF005","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440001-05","Basic Select Silver","87% AV Level Silver Plan",,"0.874364137649536","No","Yes","No","100%",,"$600","$0","$850","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectsilver6.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON003","MOS002","MOF005","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440001-06","Basic Select Silver","94% AV Level Silver Plan",,"0.93395060300827","No","Yes","No","100%",,"$300","$0","$250","$150","$400","$90","$60","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectsilver7.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440002","Basic Select Bronze","34762MO044","7023011258","MON003","MOS002","MOF006","Existing","EPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440002-01","Basic Select Bronze","Standard Bronze On Exchange Plan",,"0.61550384759903","No","Yes","No","100%",,"$6,350","$0","$0","$150","$3,220","$600","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectbronze.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440002","Basic Select Bronze","34762MO044","7023011258","MON003","MOS002","MOF006","Existing","EPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440002-02","Basic Select Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectbronze3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","34762","HIOS","2016-09-28 03:28:44","Individual","No","43-1257251","34762MO0440002","Basic Select Bronze","34762MO044","7023011258","MON003","MOS002","MOF006","Existing","EPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing, except as provided. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/modruglist.html","34762MO0440002-03","Basic Select Bronze","Limited Cost Sharing Plan Variation",,"0.61550384759903","No","Yes","No","100%",,"$6,350","$0","$0","$150","$3,220","$600","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/mo/basicselectbronze4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","MO","35853","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","35853MO0020003","Renaissance Individual Dental PPO, EHB Certified","35853MO002",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","35853MO0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MO","35853","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","35853MO0020004","Renaissance Individual Dental PPO, EHB Certified","35853MO002",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","35853MO0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MO","35853","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","35853MO0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","35853MO004",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/35853","","35853MO0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MO_EHB_High_2017","http://www.renaissancedental.com/MO_EHB_High_2017"
"2017","MO","35853","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","35853MO0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","35853MO004",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/35853","","35853MO0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MO_EHB_Low_2017","http://www.renaissancedental.com/MO_EHB_Low_2017"
"2017","MO","35853","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","35853MO0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","35853MO006",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","35853MO0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MO","35853","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","35853MO0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","35853MO006",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","35853MO0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MO","35853","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","35853MO0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","35853MO005",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/35853","","35853MO0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MO_Ped_High_2017","http://www.renaissancedental.com/MO_Ped_High_2017"
"2017","MO","35853","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","35853MO0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","35853MO005",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/35853","","35853MO0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MO_Ped_Low_2017","http://www.renaissancedental.com/MO_Ped_Low_2017"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040001","Cigna Connect HSA 5500","74483MO004","7730182962","MON001","MOS001","MOF001","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040001-02","Cigna Connect HSA-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040001","Cigna Connect HSA 5500","74483MO004","7730182962","MON001","MOS001","MOF001","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040001-03","Cigna Connect HSA 5500 -1","Limited Cost Sharing Plan Variation","61.35%","0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$760","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5500-1-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-hsa-5500-1-st-louis-mo"
"2017","MO","48616","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","48616MO0030002","EHB High Passive","48616MO003",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","48616MO0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","MO","48616","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","48616MO0030001","EHB Low Passive","48616MO003",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","48616MO0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","MO","48786","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","48786MO0090004","Guardian Pediatric Advantage","48786MO009",,"MON001","MOS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","48786MO0090004-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MO","48786","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","48786MO0160001","Guardian Essentials for Families and Individuals","48786MO016",,"MON002","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","48786MO0160001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","MO","48786","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","48786MO0160001","Guardian Essentials for Families and Individuals","48786MO016",,"MON002","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","48786MO0160001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","MO","48786","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","48786MO0100004","Guardian Pediatric Essentials","48786MO010",,"MON001","MOS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","48786MO0100004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MO","48786","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","48786MO0150001","Guardian Basics for Families and Individuals","48786MO015",,"MON002","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","48786MO0150001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","MO","48786","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","48786MO0150001","Guardian Basics for Families and Individuals","48786MO015",,"MON002","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","48786MO0150001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","MO","58284","HIOS","2016-06-28 02:39:00","Individual","Yes","27-3347197","58284MO0010001","LIBERTY MO Family Value Dental Plan","58284MO001",,"MON001","MOS001",,"New","HMO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.libertydentalplan.com/ExchangePayment","","58284MO0010001-00","LIBERTY MO Family Value Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2017-LDP-MO-IND-Exchange.pdf","https://www.libertydentalplan.com/Resources/Documents/2017-LDP-MO-IND-Exchange.pdf"
"2017","MO","58284","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","27-3347197","58284MO0020001","LIBERTY MO Pediatric High with Adult Option","58284MO002",,"MON001","MOS001",,"New","HMO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","58284MO0020001-00","LIBERTY MO Pediatric High with Adult Option","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2017-LDP-MO-SHOP-Exchange.pdf","https://www.libertydentalplan.com/Resources/Documents/2017-LDP-MO-SHOP-Exchange.pdf"
"2017","MO","58284","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","27-3347197","58284MO0020001","LIBERTY MO Pediatric High with Adult Option","58284MO002",,"MON001","MOS001",,"New","HMO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","58284MO0020001-01","LIBERTY MO Pediatric High with Adult Option","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2017-LDP-MO-SHOP-Exchange.pdf","https://www.libertydentalplan.com/Resources/Documents/2017-LDP-MO-SHOP-Exchange.pdf"
"2017","MO","58284","HIOS","2016-06-28 02:39:00","Individual","Yes","27-3347197","58284MO0010001","LIBERTY MO Family Value Dental Plan","58284MO001",,"MON001","MOS001",,"New","HMO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.libertydentalplan.com/ExchangePayment","","58284MO0010001-01","LIBERTY MO Family Value Dental Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2017-LDP-MO-IND-Exchange.pdf","https://www.libertydentalplan.com/Resources/Documents/2017-LDP-MO-IND-Exchange.pdf"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","58883MO0010003","DentaQuest PPO Family High","58883MO001",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","58883MO0010003","DentaQuest PPO Family High","58883MO001",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","58883MO0010004","DentaQuest PPO Family Low","58883MO001",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","58883","HIOS","2016-06-29 04:36:58","Individual","Yes","59-0397210","58883MO0010004","DentaQuest PPO Family Low","58883MO001",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2017","MO","68265","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","68265MO0010007","Dentegra Dental PPO Pediatric Basic Plan","68265MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010007-17"
"2017","MO","68265","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","68265MO0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","68265MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0020007-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0020007-17"
"2017","MO","68265","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","68265MO0020012","Dentegra Dental PPO for Small Businesses Family Preferred Plan","68265MO002",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0020012-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0020012-17"
"2017","MO","68265","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","68265MO0010012","Dentegra Dental PPO Family Preferred Plan","68265MO001",,"MON001","MOS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010012-17"
"2017","MO","68265","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","68265MO0010011","Dentegra Dental PPO Family Basic Plan","68265MO001",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010011-17"
"2017","MO","68265","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","68265MO0020011","Dentegra Dental PPO for Small Businesses Family Basic Plan","68265MO002",,"MON001","MOS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0020011-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0020011-17"
"2017","MO","68396","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","68396MO0190001","Family Basic Dental Plan (Low)","68396MO019",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0190001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48044"
"2017","MO","68396","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","68396MO0190001","Family Basic Dental Plan (Low)","68396MO019",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0190001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48044"
"2017","MO","68396","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","68396MO0200001","Family Enhanced Dental Plan (High)","68396MO020",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.86","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0200001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49093"
"2017","MO","68396","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","68396MO0200001","Family Enhanced Dental Plan (High)","68396MO020",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.86","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0200001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49093"
"2017","MO","71691","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","57-0523959","71691MO0030001","Group Dental Policy","71691MO003",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","71691MO0030001-00","Group Dental Policy","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","Yes","59-1031071","74483MO0030001","Cigna Dental Pediatric","74483MO003","7730182962","MON002","MOS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","74483MO0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040001","Cigna Connect HSA 5500","74483MO004","7730182962","MON001","MOS001","MOF001","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040001-00","Cigna Connect HSA 5500","Standard Bronze Off Exchange Plan","61.35%","0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$760","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5500-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-hsa-5500-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040001","Cigna Connect HSA 5500","74483MO004","7730182962","MON001","MOS001","MOF001","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040001-01","Cigna Connect HSA 5500","Standard Bronze On Exchange Plan","61.35%","0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$760","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5500-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-hsa-5500-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040011","Cigna Connect HSA 5500","74483MO004","7730182962","MON003","MOS003","MOF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040011-00","Cigna Connect HSA 5500","Standard Bronze Off Exchange Plan","61.35%","0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$760","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5500-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-hsa-5500-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040011","Cigna Connect HSA 5500","74483MO004","7730182962","MON003","MOS003","MOF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040011-01","Cigna Connect HSA 5500","Standard Bronze On Exchange Plan","61.35%","0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$760","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5500-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-hsa-5500-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040011","Cigna Connect HSA 5500","74483MO004","7730182962","MON003","MOS003","MOF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040011-02","Cigna Connect HSA-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040011","Cigna Connect HSA 5500","74483MO004","7730182962","MON003","MOS003","MOF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040011-03","Cigna Connect HSA 5500 -1","Limited Cost Sharing Plan Variation","61.35%","0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$760","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5500-1-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-hsa-5500-1-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040003","Cigna Connect 2700","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-00","Cigna Connect 2700","Standard Silver Off Exchange Plan","68.68%","0.686801016330719","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$330","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2700-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-2700-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040003","Cigna Connect 2700","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-01","Cigna Connect 2700","Standard Silver On Exchange Plan","68.68%","0.686801016330719","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$330","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2700-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-2700-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040003","Cigna Connect 2700","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040003","Cigna Connect 2700","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-03","Cigna Connect 2700-1","Limited Cost Sharing Plan Variation","68.68%","0.686801016330719","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$330","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2700-1-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-2700-1-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040003","Cigna Connect 2700","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-04","Cigna Connect 2000-2","73% AV Level Silver Plan","73.03%","0.730376005172729","Yes","Yes","No","100%",,"$2,000","$0","$810","$30","$2,000","$0","$440","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-2-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-2000-2-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040003","Cigna Connect 2700","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-05","Cigna Connect 350-3","87% AV Level Silver Plan","87.63%","0.876459777355194","Yes","Yes","No","100%",,"$350","$0","$1,060","$30","$350","$0","$690","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-350-3-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-350-3-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040003","Cigna Connect 2700","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-06","Cigna Connect 50-4","94% AV Level Silver Plan","93.97%","0.939688324928284","Yes","Yes","No","100%",,"$50","$0","$740","$30","$50","$0","$490","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-50-4-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-50-4-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040014","Cigna Connect 2700","74483MO004","7730182962","MON003","MOS003","MOF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040014-00","Cigna Connect 2700","Standard Silver Off Exchange Plan","68.68%","0.686801016330719","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$330","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2700-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-2700-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040014","Cigna Connect 2700","74483MO004","7730182962","MON003","MOS003","MOF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040014-01","Cigna Connect 2700","Standard Silver On Exchange Plan","68.68%","0.686801016330719","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$330","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2700-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-2700-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040014","Cigna Connect 2700","74483MO004","7730182962","MON003","MOS003","MOF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040014-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040014","Cigna Connect 2700","74483MO004","7730182962","MON003","MOS003","MOF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040014-03","Cigna Connect 2700-1","Limited Cost Sharing Plan Variation","68.68%","0.686801016330719","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$330","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2700-1-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-2700-1-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040014","Cigna Connect 2700","74483MO004","7730182962","MON003","MOS003","MOF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040014-04","Cigna Connect 2000-2","73% AV Level Silver Plan","73.03%","0.730376005172729","Yes","Yes","No","100%",,"$2,000","$0","$810","$30","$2,000","$0","$440","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-2-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-2000-2-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040014","Cigna Connect 2700","74483MO004","7730182962","MON003","MOS003","MOF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040014-05","Cigna Connect 350-3","87% AV Level Silver Plan","87.63%","0.876459777355194","Yes","Yes","No","100%",,"$350","$0","$1,060","$30","$350","$0","$690","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-350-3-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-350-3-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040014","Cigna Connect 2700","74483MO004","7730182962","MON003","MOS003","MOF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040014-06","Cigna Connect 50-4","94% AV Level Silver Plan","93.97%","0.939688324928284","Yes","Yes","No","100%",,"$50","$0","$740","$30","$50","$0","$490","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-50-4-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-50-4-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040002","Cigna Connect 6400","74483MO004","7730182962","MON001","MOS001","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","60.08%","0.618337571620941","Yes","Yes","No","100%",,"$5,460","$1,700","$0","$30","$140","$750","$770","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-6400-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040002","Cigna Connect 6400","74483MO004","7730182962","MON001","MOS001","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","60.08%","0.618337571620941","Yes","Yes","No","100%",,"$5,460","$1,700","$0","$30","$140","$750","$770","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-6400-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040002","Cigna Connect 6400","74483MO004","7730182962","MON001","MOS001","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040002","Cigna Connect 6400","74483MO004","7730182962","MON001","MOS001","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","60.08%","0.618337571620941","Yes","Yes","No","100%",,"$5,460","$1,700","$0","$30","$140","$750","$770","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-1-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-6400-1-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040012","Cigna Connect 6400","74483MO004","7730182962","MON003","MOS003","MOF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040012-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","60.08%","0.618337571620941","Yes","Yes","No","100%",,"$5,460","$1,700","$0","$30","$140","$750","$770","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-6400-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040012","Cigna Connect 6400","74483MO004","7730182962","MON003","MOS003","MOF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040012-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","60.08%","0.618337571620941","Yes","Yes","No","100%",,"$5,460","$1,700","$0","$30","$140","$750","$770","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-6400-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040012","Cigna Connect 6400","74483MO004","7730182962","MON003","MOS003","MOF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040012-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040012","Cigna Connect 6400","74483MO004","7730182962","MON003","MOS003","MOF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040012-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","60.08%","0.618337571620941","Yes","Yes","No","100%",,"$5,460","$1,700","$0","$30","$140","$750","$770","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-1-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-6400-1-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4000","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-00","Cigna Connect 4000","Standard Silver Off Exchange Plan","68.25%","0.6851447224617","Yes","Yes","No","100%",,"$4,000","$80","$970","$30","$140","$870","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-4000-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4000","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-01","Cigna Connect 4000","Standard Silver On Exchange Plan","68.25%","0.6851447224617","Yes","Yes","No","100%",,"$4,000","$80","$970","$30","$140","$870","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-4000-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4000","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-02","Cigna Connect -0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4000","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-03","Cigna Connect 4000-1","Limited Cost Sharing Plan Variation","68.25%","0.6851447224617","Yes","Yes","No","100%",,"$4,000","$80","$970","$30","$140","$870","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-1-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-4000-1-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4000","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-04","Cigna Connect 2700-2","73% AV Level Silver Plan","72.38%","0.727300226688385","Yes","Yes","No","100%",,"$2,700","$80","$1,360","$30","$140","$870","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2700-2-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-2700-2-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4000","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-05","Cigna Connect 700-3","87% AV Level Silver Plan","86.83%","0.871465086936951","Yes","Yes","No","100%",,"$700","$40","$650","$30","$140","$430","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-700-3-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-700-3-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4000","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.43%","0.936063230037689","Yes","Yes","No","100%",,"$100","$40","$710","$30","$100","$430","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-100-4-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4000","74483MO004","7730182962","MON003","MOS003","MOF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-00","Cigna Connect 4000","Standard Silver Off Exchange Plan","68.25%","0.6851447224617","Yes","Yes","No","100%",,"$4,000","$80","$970","$30","$140","$870","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-4000-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4000","74483MO004","7730182962","MON003","MOS003","MOF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-01","Cigna Connect 4000","Standard Silver On Exchange Plan","68.25%","0.6851447224617","Yes","Yes","No","100%",,"$4,000","$80","$970","$30","$140","$870","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-4000-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4000","74483MO004","7730182962","MON003","MOS003","MOF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-02","Cigna Connect -0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4000","74483MO004","7730182962","MON003","MOS003","MOF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-03","Cigna Connect 4000-1","Limited Cost Sharing Plan Variation","68.25%","0.6851447224617","Yes","Yes","No","100%",,"$4,000","$80","$970","$30","$140","$870","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-1-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-4000-1-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4000","74483MO004","7730182962","MON003","MOS003","MOF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-04","Cigna Connect 2700-2","73% AV Level Silver Plan","72.38%","0.727300226688385","Yes","Yes","No","100%",,"$2,700","$80","$1,360","$30","$140","$870","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2700-2-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-2700-2-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4000","74483MO004","7730182962","MON003","MOS003","MOF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-05","Cigna Connect 700-3","87% AV Level Silver Plan","86.83%","0.871465086936951","Yes","Yes","No","100%",,"$700","$40","$650","$30","$140","$430","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-700-3-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-700-3-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4000","74483MO004","7730182962","MON003","MOS003","MOF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.43%","0.936063230037689","Yes","Yes","No","100%",,"$100","$40","$710","$30","$100","$430","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-100-4-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-00","Cigna Connect 3000","Standard Silver Off Exchange Plan","69.41%","0.696566939353943","Yes","Yes","No","100%",,"$3,000","$70","$1,270","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-3000-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-01","Cigna Connect 3000","Standard Silver On Exchange Plan","69.41%","0.696566939353943","Yes","Yes","No","100%",,"$3,000","$70","$1,270","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-3000-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-02","Cigna Connect -0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-03","Cigna Connect 3000-1","Limited Cost Sharing Plan Variation","69.41%","0.696566939353943","Yes","Yes","No","100%",,"$3,000","$70","$1,270","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-1-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-3000-1-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-04","Cigna Connect 1900-2","73% AV Level Silver Plan","73.90%","0.741654694080353","Yes","Yes","No","100%",,"$1,900","$70","$1,600","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1900-2-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-1900-2-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-05","Cigna Connect 200-3","87% AV Level Silver Plan","87.63%","0.880002796649933","Yes","Yes","No","100%",,"$200","$60","$1,060","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-200-3-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-200-3-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-06","Cigna Connect 0-4","94% AV Level Silver Plan","93.30%","0.937583088874817","Yes","Yes","No","100%",,"$0","$40","$360","$30","$0","$400","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-4-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-4-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3000","74483MO004","7730182962","MON003","MOS003","MOF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-00","Cigna Connect 3000","Standard Silver Off Exchange Plan","69.41%","0.696566939353943","Yes","Yes","No","100%",,"$3,000","$70","$1,270","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-3000-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3000","74483MO004","7730182962","MON003","MOS003","MOF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-01","Cigna Connect 3000","Standard Silver On Exchange Plan","69.41%","0.696566939353943","Yes","Yes","No","100%",,"$3,000","$70","$1,270","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-3000-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3000","74483MO004","7730182962","MON003","MOS003","MOF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-02","Cigna Connect -0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3000","74483MO004","7730182962","MON003","MOS003","MOF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-03","Cigna Connect 3000-1","Limited Cost Sharing Plan Variation","69.41%","0.696566939353943","Yes","Yes","No","100%",,"$3,000","$70","$1,270","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-1-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-3000-1-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3000","74483MO004","7730182962","MON003","MOS003","MOF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-04","Cigna Connect 1900-2","73% AV Level Silver Plan","73.90%","0.741654694080353","Yes","Yes","No","100%",,"$1,900","$70","$1,600","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1900-2-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-1900-2-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3000","74483MO004","7730182962","MON003","MOS003","MOF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-05","Cigna Connect 200-3","87% AV Level Silver Plan","87.63%","0.880002796649933","Yes","Yes","No","100%",,"$200","$60","$1,060","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-200-3-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-200-3-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3000","74483MO004","7730182962","MON003","MOS003","MOF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-06","Cigna Connect 0-4","94% AV Level Silver Plan","93.30%","0.937583088874817","Yes","Yes","No","100%",,"$0","$40","$360","$30","$0","$400","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-4-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-4-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040008","Cigna Connect 1200","74483MO004","7730182962","MON001","MOS001","MOF006","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.14%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-1200-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040008","Cigna Connect 1200","74483MO004","7730182962","MON001","MOS001","MOF006","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.14%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-1200-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040008","Cigna Connect 1200","74483MO004","7730182962","MON001","MOS001","MOF006","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-02","Cigna Connect -0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040008","Cigna Connect 1200","74483MO004","7730182962","MON001","MOS001","MOF006","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.14%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-1-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-1200-1-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040018","Cigna Connect 1200","74483MO004","7730182962","MON003","MOS003","MOF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040018-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.14%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-1200-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040018","Cigna Connect 1200","74483MO004","7730182962","MON003","MOS003","MOF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040018-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.14%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-1200-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040018","Cigna Connect 1200","74483MO004","7730182962","MON003","MOS003","MOF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040018-02","Cigna Connect -0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040018","Cigna Connect 1200","74483MO004","7730182962","MON003","MOS003","MOF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040018-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.14%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-1-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-1200-1-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040009","Cigna US-MO Connect 6650","74483MO004","7730182962","MON001","MOS001","MOF007","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040009-00","Cigna US-MO Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-6650-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-6650-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040009","Cigna US-MO Connect 6650","74483MO004","7730182962","MON001","MOS001","MOF007","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040009-01","Cigna US-MO Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-6650-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-6650-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040009","Cigna US-MO Connect 6650","74483MO004","7730182962","MON001","MOS001","MOF007","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040009-02","Cigna Connect 0-4","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040009","Cigna US-MO Connect 6650","74483MO004","7730182962","MON001","MOS001","MOF007","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040009-03","Cigna US-MO Connect 6650 -1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-6650-1-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-6650-1-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040013","Cigna US-MO Connect 6650","74483MO004","7730182962","MON003","MOS003","MOF007","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040013-00","Cigna US-MO Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-6650-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-6650-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040013","Cigna US-MO Connect 6650","74483MO004","7730182962","MON003","MOS003","MOF007","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040013-01","Cigna US-MO Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-6650-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-6650-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040013","Cigna US-MO Connect 6650","74483MO004","7730182962","MON003","MOS003","MOF007","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040013-02","Cigna Connect 0-4","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040013","Cigna US-MO Connect 6650","74483MO004","7730182962","MON003","MOS003","MOF007","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040013-03","Cigna US-MO Connect 6650 -1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-6650-1-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-6650-1-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040010","Cigna US-MO Connect 3500","74483MO004","7730182962","MON001","MOS001","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040010-00","Cigna US-MO Connect 3500","Standard Silver Off Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-3500-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-3500-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040010","Cigna US-MO Connect 3500","74483MO004","7730182962","MON001","MOS001","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040010-01","Cigna US-MO Connect 3500","Standard Silver On Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-3500-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-3500-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040010","Cigna US-MO Connect 3500","74483MO004","7730182962","MON001","MOS001","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040010-02","Cigna Connect 0-4","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-st-louis-mo","http://www.cigna.com/2017/sob/cigna-connect-0-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040010","Cigna US-MO Connect 3500","74483MO004","7730182962","MON001","MOS001","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040010-03","Cigna US-MO Connect 3500 -1","Limited Cost Sharing Plan Variation","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-3500-1-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-3500-1st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040010","Cigna US-MO Connect 3500","74483MO004","7730182962","MON001","MOS001","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040010-04","Cigna US-MO Connect 3000-2","73% AV Level Silver Plan","73.61%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-3000-2-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-3000-2-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040010","Cigna US-MO Connect 3500","74483MO004","7730182962","MON001","MOS001","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040010-05","Cigna US-MO Connect 700-3","87% AV Level Silver Plan","87.50%","0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-700-3-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-700-3-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040010","Cigna US-MO Connect 3500","74483MO004","7730182962","MON001","MOS001","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040010-06","Cigna US-MO Connect 250-4","94% AV Level Silver Plan","94.31%","0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$990","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-250-4-st-louis-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-250-4-st-louis-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040017","Cigna US-MO Connect 3500","74483MO004","7730182962","MON003","MOS003","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040017-00","Cigna US-MO Connect 3500","Standard Silver Off Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-3500-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-3500-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040017","Cigna US-MO Connect 3500","74483MO004","7730182962","MON003","MOS003","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040017-01","Cigna US-MO Connect 3500","Standard Silver On Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-3500-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-3500-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040017","Cigna US-MO Connect 3500","74483MO004","7730182962","MON003","MOS003","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040017-02","Cigna Connect 0-4","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2017/sob/cigna-connect-0-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040017","Cigna US-MO Connect 3500","74483MO004","7730182962","MON003","MOS003","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040017-03","Cigna US-MO Connect 3500 -1","Limited Cost Sharing Plan Variation","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-3500-1-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-3500-1-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040017","Cigna US-MO Connect 3500","74483MO004","7730182962","MON003","MOS003","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040017-04","Cigna US-MO Connect 3000-2","73% AV Level Silver Plan","73.61%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-3000-2-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-3000-2-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040017","Cigna US-MO Connect 3500","74483MO004","7730182962","MON003","MOS003","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040017-05","Cigna US-MO Connect 700-3","87% AV Level Silver Plan","87.50%","0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-700-3-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-700-3-kc-mo"
"2017","MO","74483","HIOS","2017-01-20 09:19:19","Individual","No","59-1031071","74483MO0040017","Cigna US-MO Connect 3500","74483MO004","7730182962","MON003","MOS003","MOF008","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040017-06","Cigna US-MO Connect 250-4","94% AV Level Silver Plan","94.31%","0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$990","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-mo-connect-250-4-kc-mo","http://www.cigna.com/2017/sob/cigna-us-mo-connect-250-4-kc-mo"
"2017","MO","82905","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","82905MO0010001","TruAssure Basic Adult or Child Dental Plan","82905MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO"
"2017","MO","82905","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","82905MO0030001","TruAssure Dental Small Group Basic Plan","82905MO003",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82905MO0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MO","82905","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","82905MO0040001","TruAssure Dental Small Group Preferred Plan","82905MO004",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82905MO0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MO","82905","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","82905MO0010001","TruAssure Basic Adult or Child Dental Plan","82905MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO"
"2017","MO","82905","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","82905MO0020001","TruAssure Preferred Adult or Child Dental Plan","82905MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO"
"2017","MO","82905","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","82905MO0020001","TruAssure Preferred Adult or Child Dental Plan","82905MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO"
"2017","MS","11324","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","11324MS0020005","BESTOne Plus Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/MS/2017/MS_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","MO","86182","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","86182MO0030002","EHB High Passive","86182MO003",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86182MO0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","MO","86182","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","86182MO0030001","EHB Low Passive","86182MO003",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86182MO0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","MO","94322","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","94322MO0030002","EHB High Passive","94322MO003",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","94322MO0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520015","Humana Bronze 6550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520015-00","Humana Bronze 6550/Mississippi PPOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2849106",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520015","Humana Bronze 6550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520015-01","Humana Bronze 6550/Mississippi PPOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2849106",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520010","Humana Bronze 6550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520010-01","Humana Bronze 6550/Mississippi PPOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2849106",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520010","Humana Bronze 6550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520010-02","Humana Bronze 6550/Mississippi PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849119",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520010","Humana Bronze 6550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520010-03","Humana Bronze 6550/Mississippi PPOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849132",
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-01","Ambetter Balanced Care 1 (2017)","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010002-01.pdf","https://api.centene.com/Brochures/2017/90714MS0010002-01.pdf"
"2017","MO","94322","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","94322MO0030001","EHB Low Passive","94322MO003",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","94322MO0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","MS","11324","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","11324MS0020003","BESTOne Advantage Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MS/2017/MS_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","MS","11324","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","11324MS0020003","BESTOne Advantage Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MS/2017/MS_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","MS","11324","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","11324MS0020004","BESTOne Plus Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MS/2017/MS_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","MS","11324","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","11324MS0020004","BESTOne Plus Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MS/2017/MS_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","MS","11324","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","11324MS0020005","BESTOne Plus Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/MS/2017/MS_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","MS","11324","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","11324MS0020006","BESTOne Basic Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/MS/2017/MS_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","MS","11324","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","11324MS0020006","BESTOne Basic Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/MS/2017/MS_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490011","Humana Basic 7150/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490011-00","Humana Basic 7150/Jackson PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848690",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","Yes","39-1263473","48963MS0510001","Humana Dental Smart Choice","48963MS051",,"MSN003","MSS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9712","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","48963MS0510001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857101"
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","Yes","39-1263473","48963MS0510001","Humana Dental Smart Choice","48963MS051",,"MSN003","MSS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9712","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","48963MS0510001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857101"
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520015","Humana Bronze 6550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520015-02","Humana Bronze 6550/Mississippi PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849119",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520015","Humana Bronze 6550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520015-03","Humana Bronze 6550/Mississippi PPOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849132",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520010","Humana Bronze 6550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520010-00","Humana Bronze 6550/Mississippi PPOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2849106",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490011","Humana Basic 7150/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490011-01","Humana Basic 7150/Jackson PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848690",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490001","Humana Basic 7150/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490001-00","Humana Basic 7150/Memphis PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848729",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490001","Humana Basic 7150/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490001-01","Humana Basic 7150/Memphis PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848729",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520005","Humana Basic 7150/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF001","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520005-00","Humana Basic 7150/ChoiceCare PPO","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848664",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520005","Humana Basic 7150/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF001","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520005-01","Humana Basic 7150/ChoiceCare PPO","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848664",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520014","Humana Basic 7150/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF001","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520014-00","Humana Basic 7150/Mississippi PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848755",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520014","Humana Basic 7150/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF001","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520014-01","Humana Basic 7150/Mississippi PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848755",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520009","Humana Basic 7150/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF001","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520009-00","Humana Basic 7150/Mississippi PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848755",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520009","Humana Basic 7150/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF001","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520009-01","Humana Basic 7150/Mississippi PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848755",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490012","Humana Bronze 6550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490012-00","Humana Bronze 6550/Jackson PPOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2848937",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490012","Humana Bronze 6550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490012-01","Humana Bronze 6550/Jackson PPOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2848937",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490012","Humana Bronze 6550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490012-02","Humana Bronze 6550/Jackson PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849015",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490012","Humana Bronze 6550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490012-03","Humana Bronze 6550/Jackson PPOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849028",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490002","Humana Bronze 6550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490002-00","Humana Bronze 6550/Memphis PPOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2849054",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490002","Humana Bronze 6550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490002-01","Humana Bronze 6550/Memphis PPOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2849054",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490002","Humana Bronze 6550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490002-02","Humana Bronze 6550/Memphis PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849067",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490002","Humana Bronze 6550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0490002-03","Humana Bronze 6550/Memphis PPOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849080",
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-02","Ambetter Balanced Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010002-02.pdf","https://api.centene.com/Brochures/2017/90714MS0010002-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-03","Ambetter Balanced Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010002-03.pdf","https://api.centene.com/Brochures/2017/90714MS0010002-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-04","Ambetter Balanced Care 1 (2017)","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010002-04.pdf","https://api.centene.com/Brochures/2017/90714MS0010002-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-05","Ambetter Balanced Care 1 (2017)","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010002-05.pdf","https://api.centene.com/Brochures/2017/90714MS0010002-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-06","Ambetter Balanced Care 1 (2017)","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010002-06.pdf","https://api.centene.com/Brochures/2017/90714MS0010002-06.pdf"
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490003","Humana Silver 3550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490003-02","Humana Silver 3550/Memphis PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849522",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490003","Humana Silver 3550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490003-03","Humana Silver 3550/Memphis PPOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849535",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490003","Humana Silver 3550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490003-04","Humana Silver 3000/Memphis PPOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849301",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520007","Humana Bronze 4800/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520007-00","Humana Bronze 4800/ChoiceCare PPO","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2848768",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520007","Humana Bronze 4800/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520007-01","Humana Bronze 4800/ChoiceCare PPO","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2848768",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520007","Humana Bronze 4800/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520007-02","Humana Bronze 4800/ChoiceCare PPO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848781",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520007","Humana Bronze 4800/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","48963MS0520007-03","Humana Bronze 4800/ChoiceCare PPO","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2848794",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520016","Humana Bronze 6150/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520016-00","Humana Bronze 6150/Mississippi PPOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848898",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520016","Humana Bronze 6150/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520016-01","Humana Bronze 6150/Mississippi PPOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848898",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520016","Humana Bronze 6150/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520016-02","Humana Bronze 6150/Mississippi PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848911",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520016","Humana Bronze 6150/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520016-03","Humana Bronze 6150/Mississippi PPOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848924",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520011","Humana Bronze 6150/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520011-00","Humana Bronze 6150/Mississippi PPOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848898",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520011","Humana Bronze 6150/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520011-01","Humana Bronze 6150/Mississippi PPOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848898",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520011","Humana Bronze 6150/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520011-02","Humana Bronze 6150/Mississippi PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848911",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520011","Humana Bronze 6150/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520011-03","Humana Bronze 6150/Mississippi PPOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848924",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520006","Humana Bronze 6150/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520006-00","Humana Bronze 6150/ChoiceCare PPO","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848820",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520006","Humana Bronze 6150/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520006-01","Humana Bronze 6150/ChoiceCare PPO","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848820",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520006","Humana Bronze 6150/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520006-02","Humana Bronze 6150/ChoiceCare PPO","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848833",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520006","Humana Bronze 6150/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520006-03","Humana Bronze 6150/ChoiceCare PPO","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2848846",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490013","Humana Silver 3550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490013-00","Humana Silver 3550/Jackson PPOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849379",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490013","Humana Silver 3550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490013-01","Humana Silver 3550/Jackson PPOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849379",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490013","Humana Silver 3550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490013-02","Humana Silver 3550/Jackson PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849444",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490013","Humana Silver 3550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490013-03","Humana Silver 3550/Jackson PPOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849457",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490013","Humana Silver 3550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490013-04","Humana Silver 3000/Jackson PPOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849288",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490013","Humana Silver 3550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490013-05","Humana Silver 900/Jackson PPOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849613",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490013","Humana Silver 3550/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490013-06","Humana Silver 250/Jackson PPOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849236",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490003","Humana Silver 3550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490003-00","Humana Silver 3550/Memphis PPOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849496",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490003","Humana Silver 3550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490003-01","Humana Silver 3550/Memphis PPOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849496",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490003","Humana Silver 3550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490003-05","Humana Silver 900/Memphis PPOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849626",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0490003","Humana Silver 3550/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0490003-06","Humana Silver 250/Memphis PPOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849249",
"2017","MS","49374","HIOS","2016-08-15 07:42:31","Individual","Yes","94-2761537","49374MS0010002","Delta Dental PPO Pediatric Preferred Plan","49374MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010002-17"
"2017","MS","49374","HIOS","2016-08-15 07:42:31","Individual","Yes","94-2761537","49374MS0010001","Delta Dental PPO Pediatric Basic Plan","49374MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010001-17"
"2017","MS","49374","HIOS","2016-08-15 07:42:31","Individual","Yes","94-2761537","49374MS0010006","Delta Dental PPO Basic Plan for Families","49374MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010006-17"
"2017","MS","49374","HIOS","2016-08-15 07:42:31","Individual","Yes","94-2761537","49374MS0010004","Delta Dental PPO Preferred Plan for Families","49374MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010004-17"
"2017","MS","74718","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","74718MS0010001","TruAssure Basic Adult or Child Dental Plan","74718MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS"
"2017","MS","74718","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","74718MS0010001","TruAssure Basic Adult or Child Dental Plan","74718MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS"
"2017","MS","74718","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","74718MS0020001","TruAssure Preferred Adult or Child Dental Plan","74718MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS"
"2017","MS","74718","HIOS","2016-08-18 02:41:03","Individual","Yes","36-3757528","74718MS0020001","TruAssure Preferred Adult or Child Dental Plan","74718MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS"
"2017","MS","84254","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","84254MS0020003","Renaissance Individual Dental PPO, EHB Certified","84254MS002",,"MSN001","MSS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","84254MS0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MS","84254","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","84254MS0020004","Renaissance Individual Dental PPO, EHB Certified","84254MS002",,"MSN001","MSS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","84254MS0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MS","84254","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","84254MS0050001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","84254MS005",,"MSN001","MSS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/84254","","84254MS0050001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MS_EHB_High_2017","http://www.renaissancedental.com/MS_EHB_High_2017"
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520017","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520017-00","Humana Silver 3550/Mississippi PPOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849561",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520017","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520017-01","Humana Silver 3550/Mississippi PPOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849561",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520017","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520017-02","Humana Silver 3550/Mississippi PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849574",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520017","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520017-03","Humana Silver 3550/Mississippi PPOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849587",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520017","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520017-04","Humana Silver 3000/Mississippi PPOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849314",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520017","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520017-05","Humana Silver 900/Mississippi PPOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849639",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520017","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS007","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520017-06","Humana Silver 250/Mississippi PPOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849262",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520012","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520012-00","Humana Silver 3550/Mississippi PPOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849561",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520012","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520012-01","Humana Silver 3550/Mississippi PPOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849561",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520012","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520012-02","Humana Silver 3550/Mississippi PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849574",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520012","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520012-03","Humana Silver 3550/Mississippi PPOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849587",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520012","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520012-04","Humana Silver 3000/Mississippi PPOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849314",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520012","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520012-05","Humana Silver 900/Mississippi PPOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849639",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520012","Humana Silver 3550/Mississippi PPOx","48963MS052",,"MSN005","MSS005","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520012-06","Humana Silver 250/Mississippi PPOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849262",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520008","Humana Silver 3550/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520008-00","Humana Silver 3550/ChoiceCare PPO","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849327",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520008","Humana Silver 3550/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520008-01","Humana Silver 3550/ChoiceCare PPO","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849327",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520008","Humana Silver 3550/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520008-02","Humana Silver 3550/ChoiceCare PPO","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849340",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520008","Humana Silver 3550/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520008-03","Humana Silver 3550/ChoiceCare PPO","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849353",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520008","Humana Silver 3550/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520008-04","Humana Silver 3000/ChoiceCare PPO","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849275",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520008","Humana Silver 3550/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520008-05","Humana Silver 900/ChoiceCare PPO","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849600",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520008","Humana Silver 3550/ChoiceCare PPO","48963MS052",,"MSN004","MSS004","MSF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520008-06","Humana Silver 250/ChoiceCare PPO","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849223",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520013","Humana Gold 1250/Mississippi PPOx","48963MS052",,"MSN005","MSS006","MSF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520013-00","Humana Gold 1250/Mississippi PPOx","Standard Gold Off Exchange Plan",,"0.784688711166382","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849184",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520013","Humana Gold 1250/Mississippi PPOx","48963MS052",,"MSN005","MSS006","MSF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520013-01","Humana Gold 1250/Mississippi PPOx","Standard Gold On Exchange Plan",,"0.784688711166382","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849184",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520013","Humana Gold 1250/Mississippi PPOx","48963MS052",,"MSN005","MSS006","MSF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520013-02","Humana Gold 1250/Mississippi PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849197",
"2017","MS","48963","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","48963MS0520013","Humana Gold 1250/Mississippi PPOx","48963MS052",,"MSN005","MSS006","MSF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","48963MS0520013-03","Humana Gold 1250/Mississippi PPOx","Limited Cost Sharing Plan Variation",,"0.784688711166382","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2849210",
"2017","MS","84254","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","84254MS0050002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","84254MS005",,"MSN001","MSS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/84254","","84254MS0050002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MS_EHB_Low_2017","http://www.renaissancedental.com/MS_EHB_Low_2017"
"2017","MS","84254","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","84254MS0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified","84254MS007",,"MSN001","MSS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","84254MS0070001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MS","84254","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","84254MS0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified","84254MS007",,"MSN001","MSS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","84254MS0070002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2017)","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010008-06","Ambetter Balanced Care 3 (2017)","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010008-06.pdf","https://api.centene.com/Brochures/2017/90714MS0010008-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010009","Ambetter Balanced Care 12 (2017)","90714MS001",,"MSN001","MSS001","MSF007","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010009-00","Ambetter Balanced Care 12 (2017)","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010009-00.pdf","https://api.centene.com/Brochures/2017/90714MS0010009-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010009","Ambetter Balanced Care 12 (2017)","90714MS001",,"MSN001","MSS001","MSF007","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010009-01","Ambetter Balanced Care 12 (2017)","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010009-01.pdf","https://api.centene.com/Brochures/2017/90714MS0010009-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010009","Ambetter Balanced Care 12 (2017)","90714MS001",,"MSN001","MSS001","MSF007","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010009-02","Ambetter Balanced Care 12 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010009-02.pdf","https://api.centene.com/Brochures/2017/90714MS0010009-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010009","Ambetter Balanced Care 12 (2017)","90714MS001",,"MSN001","MSS001","MSF007","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010009-03","Ambetter Balanced Care 12 (2017)","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010009-03.pdf","https://api.centene.com/Brochures/2017/90714MS0010009-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010009","Ambetter Balanced Care 12 (2017)","90714MS001",,"MSN001","MSS001","MSF007","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010009-04","Ambetter Balanced Care 12 (2017)","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$400","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010009-04.pdf","https://api.centene.com/Brochures/2017/90714MS0010009-04.pdf"
"2017","MS","84254","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","84254MS0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","84254MS006",,"MSN001","MSS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/84254","","84254MS0060001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MS_Ped_High_2017","http://www.renaissancedental.com/MS_Ped_High_2017"
"2017","MS","84254","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","84254MS0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","84254MS006",,"MSN001","MSS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/84254","","84254MS0060002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MS_Ped_Low_2017","http://www.renaissancedental.com/MS_Ped_Low_2017"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010001-00","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/90714MS0010001-00.pdf","https://api.centene.com/Brochures/2017/90714MS0010001-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010001-01","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/90714MS0010001-01.pdf","https://api.centene.com/Brochures/2017/90714MS0010001-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010001-02","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/90714MS0010001-02.pdf","https://api.centene.com/Brochures/2017/90714MS0010001-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010001-03","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/90714MS0010001-03.pdf","https://api.centene.com/Brochures/2017/90714MS0010001-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-00","Ambetter Balanced Care 1 (2017)","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010002-00.pdf","https://api.centene.com/Brochures/2017/90714MS0010002-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2017)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-00","Ambetter Balanced Care 2 (2017)","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010003-00.pdf","https://api.centene.com/Brochures/2017/90714MS0010003-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2017)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-01","Ambetter Balanced Care 2 (2017)","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010003-01.pdf","https://api.centene.com/Brochures/2017/90714MS0010003-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2017)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-02","Ambetter Balanced Care 2 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010003-02.pdf","https://api.centene.com/Brochures/2017/90714MS0010003-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2017)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-03","Ambetter Balanced Care 2 (2017)","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010003-03.pdf","https://api.centene.com/Brochures/2017/90714MS0010003-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2017)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-04","Ambetter Balanced Care 2 (2017)","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010003-04.pdf","https://api.centene.com/Brochures/2017/90714MS0010003-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2017)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-05","Ambetter Balanced Care 2 (2017)","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010003-05.pdf","https://api.centene.com/Brochures/2017/90714MS0010003-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2017)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-06","Ambetter Balanced Care 2 (2017)","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010003-06.pdf","https://api.centene.com/Brochures/2017/90714MS0010003-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2017)","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-00","Ambetter Balanced Care 10 (2017)","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010005-00.pdf","https://api.centene.com/Brochures/2017/90714MS0010005-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2017)","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-01","Ambetter Balanced Care 10 (2017)","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010005-01.pdf","https://api.centene.com/Brochures/2017/90714MS0010005-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2017)","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-02","Ambetter Balanced Care 10 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010005-02.pdf","https://api.centene.com/Brochures/2017/90714MS0010005-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2017)","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-03","Ambetter Balanced Care 10 (2017)","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010005-03.pdf","https://api.centene.com/Brochures/2017/90714MS0010005-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2017)","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-04","Ambetter Balanced Care 10 (2017)","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010005-04.pdf","https://api.centene.com/Brochures/2017/90714MS0010005-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2017)","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-05","Ambetter Balanced Care 10 (2017)","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010005-05.pdf","https://api.centene.com/Brochures/2017/90714MS0010005-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2017)","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-06","Ambetter Balanced Care 10 (2017)","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010005-06.pdf","https://api.centene.com/Brochures/2017/90714MS0010005-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010006","Ambetter Essential Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010006-00","Ambetter Essential Care 1 (2017)","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010006-00.pdf","https://api.centene.com/Brochures/2017/90714MS0010006-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010006","Ambetter Essential Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010006-01","Ambetter Essential Care 1 (2017)","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010006-01.pdf","https://api.centene.com/Brochures/2017/90714MS0010006-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010006","Ambetter Essential Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010006-02","Ambetter Essential Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010006-02.pdf","https://api.centene.com/Brochures/2017/90714MS0010006-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010006","Ambetter Essential Care 1 (2017)","90714MS001",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010006-03","Ambetter Essential Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010006-03.pdf","https://api.centene.com/Brochures/2017/90714MS0010006-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2017)","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010008-00","Ambetter Balanced Care 3 (2017)","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010008-00.pdf","https://api.centene.com/Brochures/2017/90714MS0010008-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2017)","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010008-01","Ambetter Balanced Care 3 (2017)","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010008-01.pdf","https://api.centene.com/Brochures/2017/90714MS0010008-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2017)","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010008-02","Ambetter Balanced Care 3 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010008-02.pdf","https://api.centene.com/Brochures/2017/90714MS0010008-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2017)","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010008-03","Ambetter Balanced Care 3 (2017)","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010008-03.pdf","https://api.centene.com/Brochures/2017/90714MS0010008-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2017)","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010008-04","Ambetter Balanced Care 3 (2017)","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010008-04.pdf","https://api.centene.com/Brochures/2017/90714MS0010008-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2017)","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010008-05","Ambetter Balanced Care 3 (2017)","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010008-05.pdf","https://api.centene.com/Brochures/2017/90714MS0010008-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010009","Ambetter Balanced Care 12 (2017)","90714MS001",,"MSN001","MSS001","MSF007","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010009-05","Ambetter Balanced Care 12 (2017)","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$900","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010009-05.pdf","https://api.centene.com/Brochures/2017/90714MS0010009-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0010009","Ambetter Balanced Care 12 (2017)","90714MS001",,"MSN001","MSS001","MSF007","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010009-06","Ambetter Balanced Care 12 (2017)","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$300","$200","$250","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0010009-06.pdf","https://api.centene.com/Brochures/2017/90714MS0010009-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-00","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020001-00.pdf","https://api.centene.com/Brochures/2017/90714MS0020001-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-01","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020001-01.pdf","https://api.centene.com/Brochures/2017/90714MS0020001-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-02","Ambetter Balanced Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020001-02.pdf","https://api.centene.com/Brochures/2017/90714MS0020001-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-03","Ambetter Balanced Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020001-03.pdf","https://api.centene.com/Brochures/2017/90714MS0020001-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-04","Ambetter Balanced Care 1 (2017) + Vision","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020001-04.pdf","https://api.centene.com/Brochures/2017/90714MS0020001-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-05","Ambetter Balanced Care 1 (2017) + Vision","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020001-05.pdf","https://api.centene.com/Brochures/2017/90714MS0020001-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-06","Ambetter Balanced Care 1 (2017) + Vision","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020001-06.pdf","https://api.centene.com/Brochures/2017/90714MS0020001-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9899",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-00","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020002-00.pdf","https://api.centene.com/Brochures/2017/90714MS0020002-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9899",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-01","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020002-01.pdf","https://api.centene.com/Brochures/2017/90714MS0020002-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9899",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-02","Ambetter Balanced Care 2 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020002-02.pdf","https://api.centene.com/Brochures/2017/90714MS0020002-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9899",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-03","Ambetter Balanced Care 2 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020002-03.pdf","https://api.centene.com/Brochures/2017/90714MS0020002-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9899",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-04","Ambetter Balanced Care 2 (2017) + Vision","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020002-04.pdf","https://api.centene.com/Brochures/2017/90714MS0020002-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9899",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-05","Ambetter Balanced Care 2 (2017) + Vision","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020002-05.pdf","https://api.centene.com/Brochures/2017/90714MS0020002-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9899",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-06","Ambetter Balanced Care 2 (2017) + Vision","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020002-06.pdf","https://api.centene.com/Brochures/2017/90714MS0020002-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9897",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-00","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020003-00.pdf","https://api.centene.com/Brochures/2017/90714MS0020003-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9897",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-01","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020003-01.pdf","https://api.centene.com/Brochures/2017/90714MS0020003-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9897",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-02","Ambetter Balanced Care 10 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020003-02.pdf","https://api.centene.com/Brochures/2017/90714MS0020003-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9897",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-03","Ambetter Balanced Care 10 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020003-03.pdf","https://api.centene.com/Brochures/2017/90714MS0020003-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9897",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-04","Ambetter Balanced Care 10 (2017) + Vision","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020003-04.pdf","https://api.centene.com/Brochures/2017/90714MS0020003-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9897",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-05","Ambetter Balanced Care 10 (2017) + Vision","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020003-05.pdf","https://api.centene.com/Brochures/2017/90714MS0020003-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9897",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-06","Ambetter Balanced Care 10 (2017) + Vision","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020003-06.pdf","https://api.centene.com/Brochures/2017/90714MS0020003-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020006","Ambetter Balanced Care 3 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9896",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020006-00","Ambetter Balanced Care 3 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020006-00.pdf","https://api.centene.com/Brochures/2017/90714MS0020006-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020006","Ambetter Balanced Care 3 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9896",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020006-01","Ambetter Balanced Care 3 (2017) + Vision","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020006-01.pdf","https://api.centene.com/Brochures/2017/90714MS0020006-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020006","Ambetter Balanced Care 3 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9896",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020006-02","Ambetter Balanced Care 3 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020006-02.pdf","https://api.centene.com/Brochures/2017/90714MS0020006-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020006","Ambetter Balanced Care 3 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9896",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020006-03","Ambetter Balanced Care 3 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020006-03.pdf","https://api.centene.com/Brochures/2017/90714MS0020006-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020006","Ambetter Balanced Care 3 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9896",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020006-04","Ambetter Balanced Care 3 (2017) + Vision","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020006-04.pdf","https://api.centene.com/Brochures/2017/90714MS0020006-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020006","Ambetter Balanced Care 3 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9896",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020006-05","Ambetter Balanced Care 3 (2017) + Vision","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020006-05.pdf","https://api.centene.com/Brochures/2017/90714MS0020006-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020006","Ambetter Balanced Care 3 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9896",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020006-06","Ambetter Balanced Care 3 (2017) + Vision","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020006-06.pdf","https://api.centene.com/Brochures/2017/90714MS0020006-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020004","Ambetter Essential Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020004-00","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020004-00.pdf","https://api.centene.com/Brochures/2017/90714MS0020004-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020004","Ambetter Essential Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020004-01","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020004-01.pdf","https://api.centene.com/Brochures/2017/90714MS0020004-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020004","Ambetter Essential Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020004-02","Ambetter Essential Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020004-02.pdf","https://api.centene.com/Brochures/2017/90714MS0020004-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0020004","Ambetter Essential Care 1 (2017) + Vision","90714MS002",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020004-03","Ambetter Essential Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0020004-03.pdf","https://api.centene.com/Brochures/2017/90714MS0020004-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9542",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-00","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030001-00.pdf","https://api.centene.com/Brochures/2017/90714MS0030001-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9542",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-01","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030001-01.pdf","https://api.centene.com/Brochures/2017/90714MS0030001-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9542",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-02","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030001-02.pdf","https://api.centene.com/Brochures/2017/90714MS0030001-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9542",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-03","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030001-03.pdf","https://api.centene.com/Brochures/2017/90714MS0030001-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9542",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-04","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030001-04.pdf","https://api.centene.com/Brochures/2017/90714MS0030001-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9542",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-05","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030001-05.pdf","https://api.centene.com/Brochures/2017/90714MS0030001-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9542",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-06","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030001-06.pdf","https://api.centene.com/Brochures/2017/90714MS0030001-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9577",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-00","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030002-00.pdf","https://api.centene.com/Brochures/2017/90714MS0030002-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9577",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-01","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030002-01.pdf","https://api.centene.com/Brochures/2017/90714MS0030002-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9577",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-02","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030002-02.pdf","https://api.centene.com/Brochures/2017/90714MS0030002-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9577",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-03","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030002-03.pdf","https://api.centene.com/Brochures/2017/90714MS0030002-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9577",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-04","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030002-04.pdf","https://api.centene.com/Brochures/2017/90714MS0030002-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9577",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-05","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030002-05.pdf","https://api.centene.com/Brochures/2017/90714MS0030002-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9577",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-06","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030002-06.pdf","https://api.centene.com/Brochures/2017/90714MS0030002-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9568",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-00","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030003-00.pdf","https://api.centene.com/Brochures/2017/90714MS0030003-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9568",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-01","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030003-01.pdf","https://api.centene.com/Brochures/2017/90714MS0030003-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9568",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-02","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030003-02.pdf","https://api.centene.com/Brochures/2017/90714MS0030003-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9568",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-03","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030003-03.pdf","https://api.centene.com/Brochures/2017/90714MS0030003-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9568",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-04","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030003-04.pdf","https://api.centene.com/Brochures/2017/90714MS0030003-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9568",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-05","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030003-05.pdf","https://api.centene.com/Brochures/2017/90714MS0030003-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9568",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-06","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030003-06.pdf","https://api.centene.com/Brochures/2017/90714MS0030003-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030006-00","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030006-00.pdf","https://api.centene.com/Brochures/2017/90714MS0030006-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030006-01","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030006-01.pdf","https://api.centene.com/Brochures/2017/90714MS0030006-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030006-02","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030006-02.pdf","https://api.centene.com/Brochures/2017/90714MS0030006-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030006-03","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030006-03.pdf","https://api.centene.com/Brochures/2017/90714MS0030006-03.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030006-04","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030006-04.pdf","https://api.centene.com/Brochures/2017/90714MS0030006-04.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030006-05","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030006-05.pdf","https://api.centene.com/Brochures/2017/90714MS0030006-05.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9565",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030006-06","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030006-06.pdf","https://api.centene.com/Brochures/2017/90714MS0030006-06.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9503",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030004-00","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030004-00.pdf","https://api.centene.com/Brochures/2017/90714MS0030004-00.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9503",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030004-01","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030004-01.pdf","https://api.centene.com/Brochures/2017/90714MS0030004-01.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9503",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030004-02","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030004-02.pdf","https://api.centene.com/Brochures/2017/90714MS0030004-02.pdf"
"2017","MS","90714","HIOS","2016-10-19 02:44:25","Individual","No","35-2525384","90714MS0030004","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9503",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030004-03","Ambetter Essential Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/90714MS0030004-03.pdf","https://api.centene.com/Brochures/2017/90714MS0030004-03.pdf"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0020069","Blue Options Platinum 500 CX","11512NC002",,"NCN001","NCS010","NCF010","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0020069-00","Blue Options Platinum 500 CX","Standard Platinum Off Exchange Plan",,"0.895291030406952","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060018","Blue Advantage 1500 (broad network)","11512NC006",,"NCN001","NCS017","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060018-00","Blue Advantage 1500 (broad network)","Standard Gold Off Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060018","Blue Advantage 1500 (broad network)","11512NC006",,"NCN001","NCS017","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060018-01","Blue Advantage 1500 (broad network)","Standard Gold On Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0020069","Blue Options Platinum 500 CX","11512NC002",,"NCN001","NCS010","NCF010","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0020069-01","Blue Options Platinum 500 CX","Standard Platinum On Exchange Plan",,"0.895291030406952","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0020078","Blue Options Silver 2000 CX","11512NC002",,"NCN001","NCS010","NCF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0020078-00","Blue Options Silver 2000 CX","Standard Silver Off Exchange Plan",,"0.702568113803864","No","Yes","No","100%",,"$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060018","Blue Advantage 1500 (broad network)","11512NC006",,"NCN001","NCS017","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060018-02","Blue Advantage 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060018","Blue Advantage 1500 (broad network)","11512NC006",,"NCN001","NCS017","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060018-03","Blue Advantage 1500 (broad network)","Limited Cost Sharing Plan Variation",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0020078","Blue Options Silver 2000 CX","11512NC002",,"NCN001","NCS010","NCF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0020078-01","Blue Options Silver 2000 CX","Standard Silver On Exchange Plan",,"0.702568113803864","No","Yes","No","100%",,"$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0020105","Blue Options Gold 1500 CX","11512NC002",,"NCN001","NCS010","NCF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0020105-00","Blue Options Gold 1500 CX","Standard Gold Off Exchange Plan",,"0.789732992649078","No","Yes","No","100%",,"$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-00","Blue Advantage 3500 (broad network)","Standard Silver Off Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-01","Blue Advantage 3500 (broad network)","Standard Silver On Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0020105","Blue Options Gold 1500 CX","11512NC002",,"NCN001","NCS010","NCF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0020105-01","Blue Options Gold 1500 CX","Standard Gold On Exchange Plan",,"0.789732992649078","No","Yes","No","100%",,"$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130055","Blue Value Silver 2000 CX","11512NC013",,"NCN002","NCS011","NCF009","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130055-00","Blue Value Silver 2000 CX","Standard Silver Off Exchange Plan",,"0.702568113803864","No","Yes","No","100%",,"$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-02","Blue Advantage 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-03","Blue Advantage 3500 (broad network)","Limited Cost Sharing Plan Variation",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130055","Blue Value Silver 2000 CX","11512NC013",,"NCN002","NCS011","NCF009","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130055-01","Blue Value Silver 2000 CX","Standard Silver On Exchange Plan",,"0.702568113803864","No","Yes","No","100%",,"$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130056","Blue Value Silver 2000 CX","11512NC013",,"NCN002","NCS012","NCF009","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130056-00","Blue Value Silver 2000 CX","Standard Silver Off Exchange Plan",,"0.702568113803864","No","Yes","No","100%",,"$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-04","Blue Advantage Silver Enhanced 2800 (broad network)","73% AV Level Silver Plan",,"0.738000571727753","No","Yes","No","100%",,"$2,800","$30","$1,200","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$11400 per person","$22800 per group","$17,100","$17100 per person","$34200 per group","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_2800_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-05","Blue Advantage Silver Enhanced 800 (broad network)","87% AV Level Silver Plan",,"0.865577518939972","No","Yes","No","100%",,"$800","$10","$1,500","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$4,700","$4700 per person","$9400 per group","$7,050","$7050 per person","$14100 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_800_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130056","Blue Value Silver 2000 CX","11512NC013",,"NCN002","NCS012","NCF009","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130056-01","Blue Value Silver 2000 CX","Standard Silver On Exchange Plan",,"0.702568113803864","No","Yes","No","100%",,"$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130057","Blue Value Gold 1500 CX","11512NC013",,"NCN002","NCS011","NCF010","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130057-00","Blue Value Gold 1500 CX","Standard Gold Off Exchange Plan",,"0.789732992649078","No","Yes","No","100%",,"$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-06","Blue Advantage Silver Enhanced 450 (broad network)","94% AV Level Silver Plan",,"0.932928800582886","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$450","$450 per person","$900 per group","30.00%",,,,,"$900","$900 per person","$1800 per group","$1,350","$1350 per person","$2700 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_450_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-00","Blue Advantage 5000 (broad network)","Standard Silver Off Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130057","Blue Value Gold 1500 CX","11512NC013",,"NCN002","NCS011","NCF010","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130057-01","Blue Value Gold 1500 CX","Standard Gold On Exchange Plan",,"0.789732992649078","No","Yes","No","100%",,"$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130058","Blue Value Gold 1500 CX","11512NC013",,"NCN002","NCS012","NCF010","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130058-00","Blue Value Gold 1500 CX","Standard Gold Off Exchange Plan",,"0.789732992649078","No","Yes","No","100%",,"$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-01","Blue Advantage 5000 (broad network)","Standard Silver On Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-02","Blue Advantage 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130058","Blue Value Gold 1500 CX","11512NC013",,"NCN002","NCS012","NCF010","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130058-01","Blue Value Gold 1500 CX","Standard Gold On Exchange Plan",,"0.789732992649078","No","Yes","No","100%",,"$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130059","Blue Value Platinum 500 CX","11512NC013",,"NCN002","NCS011","NCF010","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130059-00","Blue Value Platinum 500 CX","Standard Platinum Off Exchange Plan",,"0.895291030406952","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-03","Blue Advantage 5000 (broad network)","Limited Cost Sharing Plan Variation",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-04","Blue Advantage Silver Enhanced 3000 (broad network)","73% AV Level Silver Plan",,"0.734630703926086","No","Yes","No","100%",,"$3,000","$30","$1,100","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$11400 per person","$22800 per group","$17,100","$17100 per person","$34200 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_3000_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130059","Blue Value Platinum 500 CX","11512NC013",,"NCN002","NCS011","NCF010","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130059-01","Blue Value Platinum 500 CX","Standard Platinum On Exchange Plan",,"0.895291030406952","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130060","Blue Value Platinum 500 CX","11512NC013",,"NCN002","NCS012","NCF010","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130060-00","Blue Value Platinum 500 CX","Standard Platinum Off Exchange Plan",,"0.895291030406952","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-05","Blue Advantage Silver Enhanced 1000 (broad network)","87% AV Level Silver Plan",,"0.860919177532196","No","Yes","No","100%",,"$1,000","$10","$1,300","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$4,700","$4700 per person","$9400 per group","$7,050","$7050 per person","$14100 per group","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_1000_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-06","Blue Advantage Silver Enhanced 500 (broad network)","94% AV Level Silver Plan",,"0.932854652404785","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0130060","Blue Value Platinum 500 CX","11512NC013",,"NCN002","NCS012","NCF010","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0130060-01","Blue Value Platinum 500 CX","Standard Platinum On Exchange Plan",,"0.895291030406952","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100022","Blue Value 1500 (limited network)","11512NC010",,"NCN002","NCS018","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100022-00","Blue Value 1500 (limited network)","Standard Gold Off Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100022","Blue Value 1500 (limited network)","11512NC010",,"NCN002","NCS018","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100022-01","Blue Value 1500 (limited network)","Standard Gold On Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100022","Blue Value 1500 (limited network)","11512NC010",,"NCN002","NCS018","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100022-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100022","Blue Value 1500 (limited network)","11512NC010",,"NCN002","NCS018","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100022-03","Blue Value 1500 (limited network)","Limited Cost Sharing Plan Variation",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-00","Blue Value 3500 (limited network)","Standard Silver Off Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-01","Blue Value 3500 (limited network)","Standard Silver On Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-03","Blue Value 3500 (limited network)","Limited Cost Sharing Plan Variation",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-04","Blue Value Silver Enhanced 2800 (limited network)","73% AV Level Silver Plan",,"0.738000571727753","No","Yes","No","100%",,"$2,800","$30","$1,200","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,800","$22800 per person","$45600 per group","$28,500","$28500 per person","$57000 per group","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"$11,200","$11200 per person","$22400 per group","$14,000","$14000 per person","$28000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_2800_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-05","Blue Value Silver Enhanced 800 (limited network)","87% AV Level Silver Plan",,"0.865577518939972","No","Yes","No","100%",,"$800","$10","$1,500","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","$11,750","$11750 per person","$23500 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_800_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-06","Blue Value Silver Enhanced 450 (limited network)","94% AV Level Silver Plan",,"0.932928800582886","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$450","$450 per person","$900 per group","30.00%",,,,,"$1,800","$1800 per person","$3600 per group","$2,250","$2250 per person","$4500 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_450_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-00","Blue Value 5000 (limited network)","Standard Silver Off Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-01","Blue Value 5000 (limited network)","Standard Silver On Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-03","Blue Value 5000 (limited network)","Limited Cost Sharing Plan Variation",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-04","Blue Value Silver Enhanced 3000 (limited network)","73% AV Level Silver Plan",,"0.734630703926086","No","Yes","No","100%",,"$3,000","$30","$1,100","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,800","$22800 per person","$45600 per group","$28,500","$28500 per person","$57000 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_3000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-05","Blue Value Silver Enhanced 1000 (limited network)","87% AV Level Silver Plan",,"0.860919177532196","No","Yes","No","100%",,"$1,000","$10","$1,300","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","$11,750","$11750 per person","$23500 per group","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_1000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS018","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-06","Blue Value Silver Enhanced 500 (limited network)","94% AV Level Silver Plan",,"0.932854652404785","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100034","Blue Value 1500 (limited network)","11512NC010",,"NCN002","NCS019","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100034-00","Blue Value 1500 (limited network)","Standard Gold Off Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100034","Blue Value 1500 (limited network)","11512NC010",,"NCN002","NCS019","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100034-01","Blue Value 1500 (limited network)","Standard Gold On Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100034","Blue Value 1500 (limited network)","11512NC010",,"NCN002","NCS019","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100034-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100034","Blue Value 1500 (limited network)","11512NC010",,"NCN002","NCS019","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100034-03","Blue Value 1500 (limited network)","Limited Cost Sharing Plan Variation",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-00","Blue Value 3500 (limited network)","Standard Silver Off Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-01","Blue Value 3500 (limited network)","Standard Silver On Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-03","Blue Value 3500 (limited network)","Limited Cost Sharing Plan Variation",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-04","Blue Value Silver Enhanced 2800 (limited network)","73% AV Level Silver Plan",,"0.738000571727753","No","Yes","No","100%",,"$2,800","$30","$1,200","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,800","$22800 per person","$45600 per group","$28,500","$28500 per person","$57000 per group","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"$11,200","$11200 per person","$22400 per group","$14,000","$14000 per person","$28000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_2800_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-05","Blue Value Silver Enhanced 800 (limited network)","87% AV Level Silver Plan",,"0.865577518939972","No","Yes","No","100%",,"$800","$10","$1,500","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","$11,750","$11750 per person","$23500 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_800_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-06","Blue Value Silver Enhanced 450 (limited network)","94% AV Level Silver Plan",,"0.932928800582886","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$450","$450 per person","$900 per group","30.00%",,,,,"$1,800","$1800 per person","$3600 per group","$2,250","$2250 per person","$4500 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_450_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-00","Blue Value 5000 (limited network)","Standard Silver Off Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-01","Blue Value 5000 (limited network)","Standard Silver On Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-03","Blue Value 5000 (limited network)","Limited Cost Sharing Plan Variation",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-04","Blue Value Silver Enhanced 3000 (limited network)","73% AV Level Silver Plan",,"0.734630703926086","No","Yes","No","100%",,"$3,000","$30","$1,100","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,800","$22800 per person","$45600 per group","$28,500","$28500 per person","$57000 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_3000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-05","Blue Value Silver Enhanced 1000 (limited network)","87% AV Level Silver Plan",,"0.860919177532196","No","Yes","No","100%",,"$1,000","$10","$1,300","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","$11,750","$11750 per person","$23500 per group","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_1000_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-06","Blue Value Silver Enhanced 500 (limited network)","94% AV Level Silver Plan",,"0.932854652404785","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140002","Blue Local 1500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140002-00","Blue Local 1500 (local network with Carolinas HealthCare System)","Standard Gold Off Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140002","Blue Local 1500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140002-01","Blue Local 1500 (local network with Carolinas HealthCare System)","Standard Gold On Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140002","Blue Local 1500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140002-02","Blue Local with Carolinas HealthCare System 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140002","Blue Local 1500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140002-03","Blue Local 1500 (local network with Carolinas HealthCare System)","Limited Cost Sharing Plan Variation",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-00","Blue Local 3500 (local network with Carolinas HealthCare System)","Standard Silver Off Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-01","Blue Local 3500 (local network with Carolinas HealthCare System)","Standard Silver On Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-02","Blue Local with Carolinas HealthCare System 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-03","Blue Local 3500 (local network with Carolinas HealthCare System)","Limited Cost Sharing Plan Variation",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-04","Blue Local Silver Enhanced 2800 (local network with Carolinas HealthCare System)","73% AV Level Silver Plan",,"0.738000571727753","No","Yes","No","100%",,"$2,800","$30","$1,200","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,800","$22800 per person","$45600 per group","$28,500","$28500 per person","$57000 per group","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"$11,200","$11200 per person","$22400 per group","$14,000","$14000 per person","$28000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_2800_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-05","Blue Local Silver Enhanced 800 (local network with Carolinas HealthCare System)","87% AV Level Silver Plan",,"0.865577518939972","No","Yes","No","100%",,"$800","$10","$1,500","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","$11,750","$11750 per person","$23500 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_800_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-06","Blue Local Silver Enhanced 450 (local network with Carolinas HealthCare System)","94% AV Level Silver Plan",,"0.932928800582886","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$450","$450 per person","$900 per group","30.00%",,,,,"$1,800","$1800 per person","$3600 per group","$2,250","$2250 per person","$4500 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_450_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-00","Blue Local 5000 (local network with Carolinas HealthCare System)","Standard Silver Off Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_5000_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-01","Blue Local 5000 (local network with Carolinas HealthCare System)","Standard Silver On Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_5000_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-02","Blue Local with Carolinas HealthCare System 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-03","Blue Local 5000 (local network with Carolinas HealthCare System)","Limited Cost Sharing Plan Variation",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_5000_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-04","Blue Local Silver Enhanced 3000 (local network with Carolinas HealthCare System)","73% AV Level Silver Plan",,"0.734630703926086","No","Yes","No","100%",,"$3,000","$30","$1,100","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,800","$22800 per person","$45600 per group","$28,500","$28500 per person","$57000 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_3000_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-05","Blue Local Silver Enhanced 1000 (local network with Carolinas HealthCare System)","87% AV Level Silver Plan",,"0.860919177532196","No","Yes","No","100%",,"$1,000","$10","$1,300","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","$11,750","$11750 per person","$23500 per group","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_1000_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-06","Blue Local Silver Enhanced 500 (local network with Carolinas HealthCare System)","94% AV Level Silver Plan",,"0.932854652404785","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170002","Blue Local 1500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170002-00","Blue Local 1500 (local network with Duke Medicine and WakeMed)","Standard Gold Off Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170002","Blue Local 1500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170002-01","Blue Local 1500 (local network with Duke Medicine and WakeMed)","Standard Gold On Exchange Plan",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170002","Blue Local 1500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170002-02","Blue Local with Duke Medicine and WakeMed 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Medicine_and_WakeMed_100_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170002","Blue Local 1500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170002-03","Blue Local 1500 (local network with Duke Medicine and WakeMed)","Limited Cost Sharing Plan Variation",,"0.784846365451813","No","Yes","No","100%",,"$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_1500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-00","Blue Local 3500 (local network with Duke Medicine and WakeMed)","Standard Silver Off Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-01","Blue Local 3500 (local network with Duke Medicine and WakeMed)","Standard Silver On Exchange Plan",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-02","Blue Local with Duke Medicine and WakeMed 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Medicine_and_WakeMed_100_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-03","Blue Local 3500 (local network with Duke Medicine and WakeMed)","Limited Cost Sharing Plan Variation",,"0.703833341598511","No","Yes","No","100%",,"$3,500","$30","$1,000","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$17,500","$17500 per person","$35000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_3500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-04","Blue Local Silver Enhanced 2800 (local network with Duke Medicine and WakeMed)","73% AV Level Silver Plan",,"0.738000571727753","No","Yes","No","100%",,"$2,800","$30","$1,200","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,800","$22800 per person","$45600 per group","$28,500","$28500 per person","$57000 per group","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"$11,200","$11200 per person","$22400 per group","$14,000","$14000 per person","$28000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_2800_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-05","Blue Local Silver Enhanced 800 (local network with Duke Medicine and WakeMed)","87% AV Level Silver Plan",,"0.865577518939972","No","Yes","No","100%",,"$800","$10","$1,500","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","$11,750","$11750 per person","$23500 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_800_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-06","Blue Local Silver Enhanced 450 (local network with Duke Medicine and WakeMed)","94% AV Level Silver Plan",,"0.932928800582886","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$450","$450 per person","$900 per group","30.00%",,,,,"$1,800","$1800 per person","$3600 per group","$2,250","$2250 per person","$4500 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_450_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-00","Blue Local 5000 (local network with Duke Medicine and WakeMed)","Standard Silver Off Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_5000_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-01","Blue Local 5000 (local network with Duke Medicine and WakeMed)","Standard Silver On Exchange Plan",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_5000_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-02","Blue Local with Duke Medicine and WakeMed 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Medicine_and_WakeMed_100_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-03","Blue Local 5000 (local network with Duke Medicine and WakeMed)","Limited Cost Sharing Plan Variation",,"0.6834836602211","No","Yes","No","100%",,"$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_5000_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-04","Blue Local Silver Enhanced 3000 (local network with Duke Medicine and WakeMed)","73% AV Level Silver Plan",,"0.734630703926086","No","Yes","No","100%",,"$3,000","$30","$1,100","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,800","$22800 per person","$45600 per group","$28,500","$28500 per person","$57000 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_3000_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-05","Blue Local Silver Enhanced 1000 (local network with Duke Medicine and WakeMed)","87% AV Level Silver Plan",,"0.860919177532196","No","Yes","No","100%",,"$1,000","$10","$1,300","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","$11,750","$11750 per person","$23500 per group","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_1000_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-06","Blue Local Silver Enhanced 500 (local network with Duke Medicine and WakeMed)","94% AV Level Silver Plan",,"0.932854652404785","No","Yes","No","100%",,"$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060026","Blue Advantage 7150 (broad network)","11512NC006",,"NCN001","NCS017","NCF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060026-00","Blue Advantage 7150 (broad network)","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,550","$15550 per person","$29850 per group","$22,700","$22700 per person","$44150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_7150_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110013","Blue Select Gold 1500 CX","11512NC011",,"NCN005","NCS015","NCF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110013-00","Blue Select Gold 1500 CX","Standard Gold Off Exchange Plan",,"0.788697421550751","No","Yes","Yes","85%","15%","$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%","$1,500","$1500 per person","$3000 per group","40.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110013","Blue Select Gold 1500 CX","11512NC011",,"NCN005","NCS015","NCF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110013-01","Blue Select Gold 1500 CX","Standard Gold On Exchange Plan",,"0.788697421550751","No","Yes","Yes","85%","15%","$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%","$1,500","$1500 per person","$3000 per group","40.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060026","Blue Advantage 7150 (broad network)","11512NC006",,"NCN001","NCS017","NCF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060026-01","Blue Advantage 7150 (broad network)","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,550","$15550 per person","$29850 per group","$22,700","$22700 per person","$44150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_7150_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060026","Blue Advantage 7150 (broad network)","11512NC006",,"NCN001","NCS017","NCF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060026-02","Blue Advantage 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110014","Blue Select Gold 1500 CX","11512NC011",,"NCN005","NCS016","NCF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110014-00","Blue Select Gold 1500 CX","Standard Gold Off Exchange Plan",,"0.788697421550751","No","Yes","Yes","85%","15%","$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%","$1,500","$1500 per person","$3000 per group","40.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110014","Blue Select Gold 1500 CX","11512NC011",,"NCN005","NCS016","NCF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110014-01","Blue Select Gold 1500 CX","Standard Gold On Exchange Plan",,"0.788697421550751","No","Yes","Yes","85%","15%","$1,500","$30","$1,000","$200","$600","$400","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20.00%","$1,500","$1500 per person","$3000 per group","40.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060026","Blue Advantage 7150 (broad network)","11512NC006",,"NCN001","NCS017","NCF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060026-03","Blue Advantage 7150 (broad network)","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,550","$15550 per person","$29850 per group","$22,700","$22700 per person","$44150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_7150_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100030","Blue Value 7150 (limited network)","11512NC010",,"NCN002","NCS018","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100030-00","Blue Value 7150 (limited network)","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_7150_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110019","Blue Select Silver 2000 CX","11512NC011",,"NCN005","NCS015","NCF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110019-00","Blue Select Silver 2000 CX","Standard Silver Off Exchange Plan",,"0.700427830219269","No","Yes","Yes","85%","15%","$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%","$2,000","$2000 per person","$4000 per group","50.00%","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110019","Blue Select Silver 2000 CX","11512NC011",,"NCN005","NCS015","NCF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110019-01","Blue Select Silver 2000 CX","Standard Silver On Exchange Plan",,"0.700427830219269","No","Yes","Yes","85%","15%","$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%","$2,000","$2000 per person","$4000 per group","50.00%","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100030","Blue Value 7150 (limited network)","11512NC010",,"NCN002","NCS018","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100030-01","Blue Value 7150 (limited network)","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_7150_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100030","Blue Value 7150 (limited network)","11512NC010",,"NCN002","NCS018","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100030-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110020","Blue Select Silver 2000 CX","11512NC011",,"NCN005","NCS016","NCF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110020-00","Blue Select Silver 2000 CX","Standard Silver Off Exchange Plan",,"0.700427830219269","No","Yes","Yes","85%","15%","$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%","$2,000","$2000 per person","$4000 per group","50.00%","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110020","Blue Select Silver 2000 CX","11512NC011",,"NCN005","NCS016","NCF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110020-01","Blue Select Silver 2000 CX","Standard Silver On Exchange Plan",,"0.700427830219269","No","Yes","Yes","85%","15%","$2,000","$70","$1,400","$200","$600","$1,200","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$2,000","$2000 per person","$4000 per group","30.00%","$2,000","$2000 per person","$4000 per group","50.00%","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_2000_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100030","Blue Value 7150 (limited network)","11512NC010",,"NCN002","NCS018","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100030-03","Blue Value 7150 (limited network)","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_7150_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100042","Blue Value 7150 (limited network)","11512NC010",,"NCN002","NCS019","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100042-00","Blue Value 7150 (limited network)","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_7150_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110023","Blue Select Platinum 500 CX","11512NC011",,"NCN005","NCS015","NCF010","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110023-00","Blue Select Platinum 500 CX","Standard Platinum Off Exchange Plan",,"0.89516419172287","No","Yes","Yes","85%","15%","$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110023","Blue Select Platinum 500 CX","11512NC011",,"NCN005","NCS015","NCF010","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110023-01","Blue Select Platinum 500 CX","Standard Platinum On Exchange Plan",,"0.89516419172287","No","Yes","Yes","85%","15%","$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100042","Blue Value 7150 (limited network)","11512NC010",,"NCN002","NCS019","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100042-01","Blue Value 7150 (limited network)","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_7150_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100042","Blue Value 7150 (limited network)","11512NC010",,"NCN002","NCS019","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100042-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110024","Blue Select Platinum 500 CX","11512NC011",,"NCN005","NCS016","NCF010","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110024-00","Blue Select Platinum 500 CX","Standard Platinum Off Exchange Plan",,"0.89516419172287","No","Yes","Yes","85%","15%","$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0110024","Blue Select Platinum 500 CX","11512NC011",,"NCN005","NCS016","NCF010","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0110024-01","Blue Select Platinum 500 CX","Standard Platinum On Exchange Plan",,"0.89516419172287","No","Yes","Yes","85%","15%","$500","$10","$1,000","$200","$500","$200","$200","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Platinum_500_CX_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100042","Blue Value 7150 (limited network)","11512NC010",,"NCN002","NCS019","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100042-03","Blue Value 7150 (limited network)","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_7150_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140006","Blue Local 7150 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140006-00","Blue Local 7150 (local network with Carolinas HealthCare System)","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_7150_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140006","Blue Local 7150 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140006-01","Blue Local 7150 (local network with Carolinas HealthCare System)","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_7150_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140006","Blue Local 7150 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140006-02","Blue Local with Carolinas HealthCare System 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140006","Blue Local 7150 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140006-03","Blue Local 7150 (local network with Carolinas HealthCare System)","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_7150_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170005","Blue Local 7150 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170005-00","Blue Local 7150 (local network with Duke Medicine and WakeMed)","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_7150_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170005","Blue Local 7150 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170005-01","Blue Local 7150 (local network with Duke Medicine and WakeMed)","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_7150_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170005","Blue Local 7150 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170005-02","Blue Local with Duke Medicine and WakeMed 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Medicine_and_WakeMed_100_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170005","Blue Local 7150 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS021","NCF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170005-03","Blue Local 7150 (local network with Duke Medicine and WakeMed)","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$29,850","$29850 per person","$58450 per group","$37,000","$37000 per person","$72750 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_7150_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120001","Blue Select 1500 (tiered network)","11512NC012",,"NCN005","NCS022","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120001-00","Blue Select 1500 (tiered network)","Standard Gold Off Exchange Plan",,"0.783379018306732","No","Yes","Yes","85%","15%","$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,500","$1500 per person","$3000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0040032","Blue Options HSA Bronze 5500 X","11512NC004",,"NCN001","NCS010","NCF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0040032-00","Blue Options HSA Bronze 5500 X","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$11,000","$13100 per person","$22000 per group","$16,500","$19650 per person","$33000 per group","Yes","Yes","$0.00","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Bronze_5500_X_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0040032","Blue Options HSA Bronze 5500 X","11512NC004",,"NCN001","NCS010","NCF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0040032-01","Blue Options HSA Bronze 5500 X","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$11,000","$13100 per person","$22000 per group","$16,500","$19650 per person","$33000 per group","Yes","Yes","$0.00","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Bronze_5500_X_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120001","Blue Select 1500 (tiered network)","11512NC012",,"NCN005","NCS022","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120001-01","Blue Select 1500 (tiered network)","Standard Gold On Exchange Plan",,"0.783379018306732","No","Yes","Yes","85%","15%","$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,500","$1500 per person","$3000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120001","Blue Select 1500 (tiered network)","11512NC012",,"NCN005","NCS022","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120001-02","Blue Select 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0040021","Blue Options HSA Silver 2000 X","11512NC004",,"NCN001","NCS010","NCF008","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0040021-00","Blue Options HSA Silver 2000 X","Standard Silver Off Exchange Plan",,"0.712150514125824","Yes","Yes","No","100%",,"$2,000","$0","$1,000","$200","$2,000","$0","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20.00%",,,,,"$4,000","$8000 per person","$8000 per group","$6,000","$12000 per person","$12000 per group","Yes","Yes","$0.00","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Silver_2000_X_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","SHOP (Small Group)","No","56-0894904","11512NC0040021","Blue Options HSA Silver 2000 X","11512NC004",,"NCN001","NCS010","NCF008","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0040021-01","Blue Options HSA Silver 2000 X","Standard Silver On Exchange Plan",,"0.712150514125824","Yes","Yes","No","100%",,"$2,000","$0","$1,000","$200","$2,000","$0","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20.00%",,,,,"$4,000","$8000 per person","$8000 per group","$6,000","$12000 per person","$12000 per group","Yes","Yes","$0.00","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Silver_2000_X_2017.pdf",
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120001","Blue Select 1500 (tiered network)","11512NC012",,"NCN005","NCS022","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120001-03","Blue Select 1500 (tiered network)","Limited Cost Sharing Plan Variation",,"0.783379018306732","No","Yes","Yes","85%","15%","$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,500","$1500 per person","$3000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-00","Blue Select 5000 (tiered network)","Standard Silver Off Exchange Plan",,"0.681284189224243","No","Yes","Yes","85%","15%","$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","50.00%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-01","Blue Select 5000 (tiered network)","Standard Silver On Exchange Plan",,"0.681284189224243","No","Yes","Yes","85%","15%","$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","50.00%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-02","Blue Select 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-03","Blue Select 5000 (tiered network)","Limited Cost Sharing Plan Variation",,"0.681284189224243","No","Yes","Yes","85%","15%","$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","50.00%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-04","Blue Select Silver Enhanced 3000 (tiered network)","73% AV Level Silver Plan",,"0.734160482883453","No","Yes","Yes","85%","15%","$3,000","$30","$1,100","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$11,400","$11400 per person","$22800 per group","$17,100","$17100 per person","$34200 per group","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","50.00%","$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_3000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-05","Blue Select Silver Enhanced 1000 (tiered network)","87% AV Level Silver Plan",,"0.863085925579071","No","Yes","Yes","85%","15%","$1,000","$10","$1,300","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","$4,700","$4700 per person","$9400 per group","$7,050","$7050 per person","$14100 per group","$1,000","$1000 per person","$2000 per group","30.00%","$1,000","$1000 per person","$2000 per group","50.00%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_1000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-06","Blue Select Silver Enhanced 500 (tiered network)","94% AV Level Silver Plan",,"0.932922422885895","No","Yes","Yes","85%","15%","$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","50.00%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_500_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120003","Blue Select 1500 (tiered network)","11512NC012",,"NCN005","NCS023","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120003-00","Blue Select 1500 (tiered network)","Standard Gold Off Exchange Plan",,"0.783379018306732","No","Yes","Yes","85%","15%","$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,500","$1500 per person","$3000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120003","Blue Select 1500 (tiered network)","11512NC012",,"NCN005","NCS023","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120003-01","Blue Select 1500 (tiered network)","Standard Gold On Exchange Plan",,"0.783379018306732","No","Yes","Yes","85%","15%","$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,500","$1500 per person","$3000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120003","Blue Select 1500 (tiered network)","11512NC012",,"NCN005","NCS023","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120003-02","Blue Select 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120003","Blue Select 1500 (tiered network)","11512NC012",,"NCN005","NCS023","NCF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120003-03","Blue Select 1500 (tiered network)","Limited Cost Sharing Plan Variation",,"0.783379018306732","No","Yes","Yes","85%","15%","$1,500","$10","$500","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,500","$1500 per person","$3000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-00","Blue Select 5000 (tiered network)","Standard Silver Off Exchange Plan",,"0.681284189224243","No","Yes","Yes","85%","15%","$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","50.00%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-01","Blue Select 5000 (tiered network)","Standard Silver On Exchange Plan",,"0.681284189224243","No","Yes","Yes","85%","15%","$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","50.00%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-02","Blue Select 100","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-03","Blue Select 5000 (tiered network)","Limited Cost Sharing Plan Variation",,"0.681284189224243","No","Yes","Yes","85%","15%","$5,000","$30","$500","$200","$800","$400","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","50.00%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-04","Blue Select Silver Enhanced 3000 (tiered network)","73% AV Level Silver Plan",,"0.734160482883453","No","Yes","Yes","85%","15%","$3,000","$30","$1,100","$200","$600","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$11,400","$11400 per person","$22800 per group","$17,100","$17100 per person","$34200 per group","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","50.00%","$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_3000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-05","Blue Select Silver Enhanced 1000 (tiered network)","87% AV Level Silver Plan",,"0.863085925579071","No","Yes","Yes","85%","15%","$1,000","$10","$1,300","$200","$600","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","$4,700","$4700 per person","$9400 per group","$7,050","$7050 per person","$14100 per group","$1,000","$1000 per person","$2000 per group","30.00%","$1,000","$1000 per person","$2000 per group","50.00%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_1000_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-06","Blue Select Silver Enhanced 500 (tiered network)","94% AV Level Silver Plan",,"0.932922422885895","No","Yes","Yes","85%","15%","$500","$10","$300","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","50.00%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_500_2017.pdf","http://www.bcbsnc.com/bsplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060024","Blue Advantage 5500 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060024-00","Blue Advantage 5500 (broad network, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$11,000","$13100 per person","$22000 per group","$16,500","$19650 per person","$33000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060024","Blue Advantage 5500 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060024-01","Blue Advantage 5500 (broad network, HSA eligible)","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$11,000","$13100 per person","$22000 per group","$16,500","$19650 per person","$33000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060024","Blue Advantage 5500 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060024-02","Blue Advantage 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060024","Blue Advantage 5500 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060024-03","Blue Advantage 5500 (broad network, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$11,000","$13100 per person","$22000 per group","$16,500","$19650 per person","$33000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100028","Blue Value 5500 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS018","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100028-00","Blue Value 5500 (limited network, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100028","Blue Value 5500 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS018","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100028-01","Blue Value 5500 (limited network, HSA eligible)","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100028","Blue Value 5500 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS018","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100028-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100028","Blue Value 5500 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS018","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100028-03","Blue Value 5500 (limited network, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100040","Blue Value 5500 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100040-00","Blue Value 5500 (limited network, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100040","Blue Value 5500 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100040-01","Blue Value 5500 (limited network, HSA eligible)","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100040","Blue Value 5500 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100040-02","Blue Value 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100040","Blue Value 5500 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100040-03","Blue Value 5500 (limited network, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140005","Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS020","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140005-00","Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140005","Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS020","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140005-01","Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140005","Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS020","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140005-02","Blue Local with Carolinas HealthCare System 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0140005","Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS020","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140005-03","Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_with_Carolinas_HealthCare_System_2017.pdf","http://www.bcbsnc.com/blplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170006","Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS021","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170006-00","Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170006","Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS021","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170006-01","Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible)","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170006","Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS021","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170006-02","Blue Local with Duke Medicine and WakeMed 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Medicine_and_WakeMed_100_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0170006","Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS021","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170006-03","Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$300","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","$32,750","$32750 per person","$65500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$6550 per person","$11000 per group","20.00%",,,,,"$22,000","$26200 per person","$44000 per group","$27,500","$32750 per person","$55000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_5500_with_Duke_Medicine_and_WakeMed_2017.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060027","Blue Advantage Catastrophic (broad network)","11512NC006",,"NCN001","NCS017","NCF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs",,,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060027-00","Blue Advantage Catastrophic (broad network)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$3,800","$100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0060027","Blue Advantage Catastrophic (broad network)","11512NC006",,"NCN001","NCS017","NCF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs",,,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060027-01","Blue Advantage Catastrophic (broad network)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$3,800","$100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic_2017.pdf","http://www.bcbsnc.com/baplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100031","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS018","NCF002","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs",,,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100031-00","Blue Value Catastrophic (limited network)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$3,800","$100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100031","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS018","NCF002","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs",,,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100031-01","Blue Value Catastrophic (limited network)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$3,800","$100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100043","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS019","NCF002","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs",,,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100043-00","Blue Value Catastrophic (limited network)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$3,800","$100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","11512","HIOS","2016-09-01 07:41:30","Individual","No","56-0894904","11512NC0100043","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS019","NCF002","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs",,,,"2017-01-01","2017-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100043-01","Blue Value Catastrophic (limited network)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$3,800","$100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","$35,750","$35750 per person","$71500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2017.pdf","http://www.bcbsnc.com/bvplanbrochure_2017"
"2017","NC","56964","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","56964NC0040001","EHB Low PPO","56964NC004",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","56964NC0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NC","56964","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","56964NC0030002","EHB High Passive","56964NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","56964NC0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070008","Cigna Connect 1200","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070008-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.27%","0.785574197769165","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-nc","http://www.cigna.com/2017/sob/cigna-connect-1200-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070008","Cigna Connect 1200","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070008-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.27%","0.785574197769165","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-nc","http://www.cigna.com/2017/sob/cigna-connect-1200-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070008","Cigna Connect 1200","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070008-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nc","http://www.cigna.com/2017/sob/cigna-connect-0-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070008","Cigna Connect 1200","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070008-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.27%","0.785574197769165","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-1-nc","http://www.cigna.com/2017/sob/cigna-connect-1200-1-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-00","Cigna Connect 4000","Standard Silver Off Exchange Plan","68.21%","0.68929523229599","Yes","Yes","No","100%",,"$4,000","$80","$490","$30","$660","$730","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-nc","http://www.cigna.com/2017/sob/cigna-connect-4000-nc"
"2017","NC","24112","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","24112NC0040002","EHB High PPO","24112NC004",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","24112NC0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NC","24112","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","24112NC0040001","EHB Low PPO","24112NC004",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","24112NC0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NC","24112","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","24112NC0030002","EHB High Passive","24112NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","24112NC0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NC","24112","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","24112NC0030001","EHB Low Passive","24112NC003",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","24112NC0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0070002","Delta Dental Group PPO , EHB Certified (Exchange)","56891NC007",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0070002-01","Delta Dental Group PPO , EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_SHOP_Low_2017","http://www.deltadentalnc.com/NC_EHB_SHOP_Low_2017"
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0050002","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0050002-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0060001","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0060001-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","Individual","Yes","56-1018068","56891NC0040001","Delta Dental Individual Pediatric-Only, EHB","56891NC004",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0040001-00","Delta Dental Individual Pediatric-Only, EHB","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","Individual","Yes","56-1018068","56891NC0040002","Delta Dental Individual Pediatric-Only, EHB","56891NC004",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0040002-00","Delta Dental Individual Pediatric-Only, EHB","Standard Low Off Exchange Plan","70.00%",,,,"Yes","75%","25%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0060002","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0060002-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0060003","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0060003-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0060004","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0060004-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56964","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","56964NC0040002","EHB High PPO","56964NC004",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","56964NC0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NC","25741","HIOS","2016-08-10 02:51:42","SHOP (Small Group)","Yes","47-0397286","25741NC0030001","Renaissance Group Dental PPO, EHB Certified","25741NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0030001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","25741","HIOS","2016-08-10 02:51:42","Individual","Yes","47-0397286","25741NC0010001","Delta Dental Individual PPO, EHB Certified","25741NC001",,"NCN002","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0010001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","25741","HIOS","2016-08-10 02:51:42","Individual","Yes","47-0397286","25741NC0010002","Delta Dental Individual PPO, EHB Certified","25741NC001",,"NCN002","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0010002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","25741","HIOS","2016-08-10 02:51:42","SHOP (Small Group)","Yes","47-0397286","25741NC0030002","Renaissance Group Dental PPO, EHB Certified","25741NC003",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0030002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","25741","HIOS","2016-08-10 02:51:42","SHOP (Small Group)","Yes","47-0397286","25741NC0050001","Renaissance Group Dental Indemnity, EHB Certified","25741NC005",,"NCN001","NCS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0050001-00","Renaissance Group Dental Indemnity, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","25741","HIOS","2016-08-10 02:51:42","Individual","Yes","47-0397286","25741NC0060001","Delta Dental Individual PPO, EHB Certified (Exchange)","25741NC006",,"NCN002","NCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0060001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_High_2017","http://www.deltadentalnc.com/NC_EHB_High_2017"
"2017","NC","25741","HIOS","2016-08-10 02:51:42","Individual","Yes","47-0397286","25741NC0060002","Delta Dental Individual PPO, EHB Certified (Exchange)","25741NC006",,"NCN002","NCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0060002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_Low_2017","http://www.deltadentalnc.com/NC_EHB_Low_2017"
"2017","NC","25741","HIOS","2016-08-10 02:51:42","SHOP (Small Group)","Yes","47-0397286","25741NC0050002","Renaissance Group Dental Indemnity, EHB Certified","25741NC005",,"NCN001","NCS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0050002-00","Renaissance Group Dental Indemnity, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","25741","HIOS","2016-08-10 02:51:42","Individual","Yes","47-0397286","25741NC0070001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","25741NC007",,"NCN002","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0070001-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","25741","HIOS","2016-08-10 02:51:42","Individual","Yes","47-0397286","25741NC0070002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","25741NC007",,"NCN002","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0070002-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","25741","HIOS","2016-08-10 02:51:42","Individual","Yes","47-0397286","25741NC0080001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","25741NC008",,"NCN002","NCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0080001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_Ped_High_2017","http://www.deltadentalnc.com/NC_Ped_High_2017"
"2017","NC","25741","HIOS","2016-08-10 02:51:42","Individual","Yes","47-0397286","25741NC0080002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","25741NC008",,"NCN002","NCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0080002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_Ped_Low_2017","http://www.deltadentalnc.com/NC_Ped_Low_2017"
"2017","NC","37576","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","37576NC0010007","Dentegra Dental PPO Pediatric Basic Plan","37576NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010007-17"
"2017","NC","37576","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","37576NC0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","37576NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0020007-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0020007-17"
"2017","NC","37576","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","37576NC0020012","Dentegra Dental PPO for Small Businesses Family Preferred Plan","37576NC002",,"NCN001","NCS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0020012-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0020012-17"
"2017","NC","37576","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","37576NC0010012","Dentegra Dental PPO Family Preferred Plan","37576NC001",,"NCN001","NCS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010012-17"
"2017","NC","37576","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","37576NC0010011","Dentegra Dental PPO Family Basic Plan","37576NC001",,"NCN001","NCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010011-17"
"2017","NC","37576","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","37576NC0020011","Dentegra Dental PPO for Small Businesses Family Basic Plan","37576NC002",,"NCN001","NCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0020011-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0020011-17"
"2017","NC","40411","HIOS","2016-06-26 07:33:26","Individual","Yes","59-1031071","40411NC0030001","Cigna Dental Pediatric","40411NC003","7730182962","NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Services","Yes",,"","40411NC0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","NC","40435","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","40435NC0170001","EHB Basic Dental Plan (Low)","40435NC017",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0170001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","40435","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","40435NC0190001","Family Basic Dental Plan (Low)","40435NC019",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.88","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0190001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49097"
"2017","NC","40435","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","40435NC0190001","Family Basic Dental Plan (Low)","40435NC019",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.88","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0190001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49097"
"2017","NC","40435","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","40435NC0200001","Family Enhanced Dental Plan (High)","40435NC020",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0200001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49099"
"2017","NC","40435","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","40435NC0200001","Family Enhanced Dental Plan (High)","40435NC020",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0200001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49099"
"2017","NC","55440","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","55440NC0210001","Guardian Essentials for Families and Individuals","55440NC021",,"NCN002","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","55440NC0210001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NC","55440","HIOS","2016-06-23 03:05:53","SHOP (Small Group)","Yes","13-5123390","55440NC0180004","Guardian Family Advantage","55440NC018",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","55440NC0180004-01","Guardian Family Advantage","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NC","55440","HIOS","2016-06-23 03:05:53","SHOP (Small Group)","Yes","13-5123390","55440NC0200005","Guardian Family Essentials","55440NC020",,"NCN001","NCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","55440NC0200005-01","Guardian Family Essentials","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NC","55440","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","55440NC0210001","Guardian Essentials for Families and Individuals","55440NC021",,"NCN002","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","55440NC0210001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NC","55440","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","55440NC0220001","Guardian Select for Families and Individuals","55440NC022",,"NCN002","NCS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","55440NC0220001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NC","55440","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","55440NC0220001","Guardian Select for Families and Individuals","55440NC022",,"NCN002","NCS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","55440NC0220001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0050001","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0050001-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","Individual","Yes","56-1018068","56891NC0030001","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0030001-00","Delta Dental Individual and Family Plans, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","Individual","Yes","56-1018068","56891NC0030002","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0030002-00","Delta Dental Individual and Family Plans, EHB Certified","Standard Low Off Exchange Plan","71.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0050003","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0050003-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0050004","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0050004-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","Individual","Yes","56-1018068","56891NC0030003","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0030003-00","Delta Dental Individual and Family Plans, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","Individual","Yes","56-1018068","56891NC0030004","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0030004-00","Delta Dental Individual and Family Plans, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","56891","HIOS","2016-08-09 02:37:57","SHOP (Small Group)","Yes","56-1018068","56891NC0070001","Delta Dental Group PPO, EHB Certified (Exchange)","56891NC007",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0070001-01","Delta Dental Group PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_SHOP_High_2017","http://www.deltadentalnc.com/NC_EHB_SHOP_High_2017"
"2017","NC","56964","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","56964NC0030001","EHB Low Passive","56964NC003",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","56964NC0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070004","Cigna US-NC Connect 6650","73943NC007",,"NCN001","NCS001","NCF004","New","HMO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070004-00","Cigna US-NC Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-6650-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-6650-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070004","Cigna US-NC Connect 6650","73943NC007",,"NCN001","NCS001","NCF004","New","HMO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070004-01","Cigna US-NC Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-6650-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-6650-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070004","Cigna US-NC Connect 6650","73943NC007",,"NCN001","NCS001","NCF004","New","HMO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070004-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nc","http://www.cigna.com/2017/sob/cigna-connect-0-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070004","Cigna US-NC Connect 6650","73943NC007",,"NCN001","NCS001","NCF004","New","HMO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070004-03","Cigna US-NC Connect 6650-1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-6650-1-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-6650-1-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070007","Cigna US-NC Connect 3500","73943NC007",,"NCN001","NCS001","NCF005","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070007-00","Cigna US-NC Connect 3500","Standard Silver Off Exchange Plan","70.78%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-3500-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-3500-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070007","Cigna US-NC Connect 3500","73943NC007",,"NCN001","NCS001","NCF005","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070007-01","Cigna US-NC Connect 3500","Standard Silver On Exchange Plan","70.78%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-3500-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-3500-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070007","Cigna US-NC Connect 3500","73943NC007",,"NCN001","NCS001","NCF005","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070007-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nc","http://www.cigna.com/2017/sob/cigna-connect-0-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070007","Cigna US-NC Connect 3500","73943NC007",,"NCN001","NCS001","NCF005","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070007-03","Cigna US-NC Connect 3500-1","Limited Cost Sharing Plan Variation","70.78%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-3500-1-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-3500-1-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070007","Cigna US-NC Connect 3500","73943NC007",,"NCN001","NCS001","NCF005","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070007-04","Cigna US-NC Connect 3000-2","73% AV Level Silver Plan","73.60%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-3000-2-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-3000-2-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070007","Cigna US-NC Connect 3500","73943NC007",,"NCN001","NCS001","NCF005","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070007-05","Cigna US-NC Connect 700-3","87% AV Level Silver Plan","87.51%","0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-700-3-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-700-3-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070007","Cigna US-NC Connect 3500","73943NC007",,"NCN001","NCS001","NCF005","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070007-06","Cigna US-NC Connect 250-4","94% AV Level Silver Plan","94.32%","0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$350","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-nc-connect-250-4-nc","http://www.cigna.com/2017/sob/cigna-us-nc-connect-250-4-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070001","Cigna Connect 4500","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070001-00","Cigna Connect 4500","Standard Bronze Off Exchange Plan","61.80%","0.618114054203033","Yes","Yes","No","100%",,"$4,500","$50","$1,430","$30","$4,500","$90","$200","$280","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-nc","http://www.cigna.com/2017/sob/cigna-connect-4500-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070001","Cigna Connect 4500","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070001-01","Cigna Connect 4500","Standard Bronze On Exchange Plan","61.80%","0.618114054203033","Yes","Yes","No","100%",,"$4,500","$50","$1,430","$30","$4,500","$90","$200","$280","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-nc","http://www.cigna.com/2017/sob/cigna-connect-4500-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070001","Cigna Connect 4500","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070001-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nc","http://www.cigna.com/2017/sob/cigna-connect-0-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070001","Cigna Connect 4500","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070001-03","Cigna Connect 4500-1","Limited Cost Sharing Plan Variation","61.80%","0.618114054203033","Yes","Yes","No","100%",,"$4,500","$50","$1,430","$30","$4,500","$90","$200","$280","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-1-nc","http://www.cigna.com/2017/sob/cigna-connect-4500-1-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070003","Cigna Connect 6400","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070003-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","61.06%","0.6106236577034","Yes","Yes","No","100%",,"$6,400","$50","$480","$30","$4,860","$90","$0","$280","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-nc","http://www.cigna.com/2017/sob/cigna-connect-6400-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070003","Cigna Connect 6400","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070003-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","61.06%","0.6106236577034","Yes","Yes","No","100%",,"$6,400","$50","$480","$30","$4,860","$90","$0","$280","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-nc","http://www.cigna.com/2017/sob/cigna-connect-6400-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070003","Cigna Connect 6400","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070003-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nc","http://www.cigna.com/2017/sob/cigna-connect-0-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070003","Cigna Connect 6400","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070003-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","61.06%","0.6106236577034","Yes","Yes","No","100%",,"$6,400","$50","$480","$30","$4,860","$90","$0","$280","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-1-nc","http://www.cigna.com/2017/sob/cigna-connect-6400-1-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070002","Cigna Connect 6000","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070002-00","Cigna Connect 6000","Standard Bronze Off Exchange Plan",,"0.619805574417114","Yes","Yes","No","100%",,"$6,000","$40","$680","$30","$4,170","$320","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6000-nc","http://www.cigna.com/2017/sob/cigna-connect-6000-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070002","Cigna Connect 6000","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070002-01","Cigna Connect 6000","Standard Bronze On Exchange Plan",,"0.619805574417114","Yes","Yes","No","100%",,"$6,000","$40","$680","$30","$4,170","$320","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6000-nc","http://www.cigna.com/2017/sob/cigna-connect-6000-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070002","Cigna Connect 6000","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nc","http://www.cigna.com/2017/sob/cigna-connect-0-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070002","Cigna Connect 6000","73943NC007",,"NCN001","NCS001","NCF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070002-03","Cigna Connect 6000-1","Limited Cost Sharing Plan Variation",,"0.619805574417114","Yes","Yes","No","100%",,"$6,000","$40","$680","$30","$4,170","$320","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6000-1-nc","http://www.cigna.com/2017/sob/cigna-connect-6000-1-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070005","Cigna Connect 2000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070005-00","Cigna Connect 2000","Standard Silver Off Exchange Plan","71.38%","0.71900475025177","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$790","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-nc","http://www.cigna.com/2017/sob/cigna-connect-2000-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070005","Cigna Connect 2000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070005-01","Cigna Connect 2000","Standard Silver On Exchange Plan","71.38%","0.71900475025177","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$790","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-nc","http://www.cigna.com/2017/sob/cigna-connect-2000-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070005","Cigna Connect 2000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070005-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nc","http://www.cigna.com/2017/sob/cigna-connect-0-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070005","Cigna Connect 2000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070005-03","Cigna Connect 2000-1","Limited Cost Sharing Plan Variation","71.38%","0.71900475025177","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$790","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-1-nc","http://www.cigna.com/2017/sob/cigna-connect-2000-1-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070005","Cigna Connect 2000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070005-04","Cigna Connect 1800-2","73% AV Level Silver Plan","73.63%","0.741439044475555","Yes","Yes","No","100%",,"$1,800","$70","$1,630","$30","$140","$790","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1800-2-nc","http://www.cigna.com/2017/sob/cigna-connect-1800-2-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070005","Cigna Connect 2000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070005-05","Cigna Connect 500-3","87% AV Level Silver Plan","86.56%","0.867498874664307","Yes","Yes","No","100%",,"$500","$60","$1,350","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-500-3-nc","http://www.cigna.com/2017/sob/cigna-connect-500-3-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070005","Cigna Connect 2000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070005-06","Cigna Connect 50-4","94% AV Level Silver Plan","93.02%","0.932272791862488","Yes","Yes","No","100%",,"$50","$40","$720","$30","$50","$390","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-50-4-nc","http://www.cigna.com/2017/sob/cigna-connect-50-4-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-01","Cigna Connect 4000","Standard Silver On Exchange Plan","68.21%","0.68929523229599","Yes","Yes","No","100%",,"$4,000","$80","$490","$30","$660","$730","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-nc","http://www.cigna.com/2017/sob/cigna-connect-4000-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nc","http://www.cigna.com/2017/sob/cigna-connect-0-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-03","Cigna Connect 4000-1","Limited Cost Sharing Plan Variation","68.21%","0.68929523229599","Yes","Yes","No","100%",,"$4,000","$80","$490","$30","$660","$730","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-1-nc","http://www.cigna.com/2017/sob/cigna-connect-4000-1-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-04","Cigna Connect 3000-2","73% AV Level Silver Plan","72.02%","0.726869940757751","Yes","Yes","No","100%",,"$3,000","$80","$640","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-2-nc","http://www.cigna.com/2017/sob/cigna-connect-3000-2-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-05","Cigna Connect 800-3","87% AV Level Silver Plan","86.48%","0.866679608821869","Yes","Yes","No","100%",,"$800","$60","$970","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-800-3-nc","http://www.cigna.com/2017/sob/cigna-connect-800-3-nc"
"2017","NC","73943","HIOS","2016-08-24 02:30:21","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.16%","0.933160603046417","Yes","Yes","No","100%",,"$100","$40","$720","$30","$100","$390","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4-nc","http://www.cigna.com/2017/sob/cigna-connect-100-4-nc"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010012","BESTDental Value","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Value_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010012","BESTDental Value","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Value_Plan.pdf"
"2017","ND","29278","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","29278ND0040002","EHB High PPO","29278ND004",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","29278ND0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","ND","29278","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","29278ND0040001","EHB Low PPO","29278ND004",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","29278ND0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NC","76994","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","76994NC0040002","EHB High PPO","76994NC004",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76994NC0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NC","76994","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","76994NC0040001","EHB Low PPO","76994NC004",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76994NC0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NC","76994","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","76994NC0030002","EHB High Passive","76994NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76994NC0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NC","76994","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","76994NC0030001","EHB Low Passive","76994NC003",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76994NC0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NC","82612","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","82612NC0010001","TruAssure Basic Adult or Child Dental Plan","82612NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$155","$155 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC"
"2017","NC","82612","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","82612NC0030001","TruAssure Dental Small Group Basic Plan","82612NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82612NC0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","82612","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","82612NC0040001","TruAssure Dental Small Group Preferred Plan","82612NC004",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82612NC0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NC","82612","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","82612NC0010001","TruAssure Basic Adult or Child Dental Plan","82612NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$155","$155 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC"
"2017","NC","82612","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","82612NC0020001","TruAssure Preferred Adult or Child Dental Plan","82612NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC"
"2017","NC","82612","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","82612NC0020001","TruAssure Preferred Adult or Child Dental Plan","82612NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","94482NC0020003","BESTOne Advantage Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/2017/NC_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010007","BESTDental Premium","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Premium_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010007","BESTDental Premium","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Premium_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","94482NC0020003","BESTOne Advantage Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/2017/NC_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","94482NC0020004","BESTOne Plus Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/2017/NC_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010008","BESTDental Standard - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Standard-H_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010008","BESTDental Standard - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Standard-H_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","94482NC0020004","BESTOne Plus Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/2017/NC_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010010","BESTDental Choice - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Choice-H_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010010","BESTDental Choice - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Choice-H_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010009","BESTDental Standard - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Standard-L_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","94482NC0020005","BESTOne Plus Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/2017/NC_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","94482NC0020005","BESTOne Plus Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/2017/NC_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010009","BESTDental Standard - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Standard-L_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010011","BESTDental Choice - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Choice-L_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","94482NC0020006","BESTOne Basic Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/2017/NC_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","94482NC0020006","BESTOne Basic Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/2017/NC_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","NC","94482","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","94482NC0010011","BESTDental Choice - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2017/NC_BESTDental_Choice-L_Plan.pdf"
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0010001","Delta Dental Pediatric Low","27882ND001",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0010001-00","Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0170001","Delta Dental Pediatric Low","27882ND017",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0170001-00","Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0010001","Delta Dental Pediatric Low","27882ND001",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0010001-01","Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0020001","Delta Dental Bronze + Delta Dental Pediatric Low","27882ND002",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.62","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0020001-00","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0180001","Delta Dental Bronze + Delta Dental Pediatric Low","27882ND018",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.62","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0180001-00","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0020001","Delta Dental Bronze + Delta Dental Pediatric Low","27882ND002",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.62","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0020001-01","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0040001","Delta Dental Silver + Delta Dental Pediatric Low","27882ND004",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.48","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0040001-00","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0200001","Delta Dental Silver + Delta Dental Pediatric Low","27882ND020",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.48","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0200001-00","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0040001","Delta Dental Silver + Delta Dental Pediatric Low","27882ND004",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.48","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0040001-01","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0060001","Delta Dental Gold + Delta Dental Pediatric Low","27882ND006",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.37","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0060001-00","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0220001","Delta Dental Gold + Delta Dental Pediatric Low","27882ND022",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.37","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0220001-00","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0060001","Delta Dental Gold + Delta Dental Pediatric Low","27882ND006",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.37","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0060001-01","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0080001","Delta Dental Platinum + Delta Dental Pediatric Low","27882ND008",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.33","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0080001-00","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0240001","Delta Dental Platinum + Delta Dental Pediatric Low","27882ND024",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.33","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0240001-00","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0080001","Delta Dental Platinum + Delta Dental Pediatric Low","27882ND008",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.33","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0080001-01","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0090001","Delta Dental Pediatric High","27882ND009",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0090001-00","Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0250001","Delta Dental Pediatric High","27882ND025",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0250001-00","Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0090001","Delta Dental Pediatric High","27882ND009",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0090001-01","Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0100001","Delta Dental Bronze + Delta Dental Pediatric High","27882ND010",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.68","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0100001-00","Delta Dental Bronze + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0260001","Delta Dental Bronze + Delta Dental Pediatric High","27882ND026",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.68","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0260001-00","Delta Dental Bronze + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0100001","Delta Dental Bronze + Delta Dental Pediatric High","27882ND010",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.68","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0100001-01","Delta Dental Bronze + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0120001","Delta Dental Silver + Delta Dental Pediatric High","27882ND012",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0120001-00","Delta Dental Silver + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0280001","Delta Dental Silver + Delta Dental Pediatric High","27882ND028",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0280001-00","Delta Dental Silver + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0120001","Delta Dental Silver + Delta Dental Pediatric High","27882ND012",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0120001-01","Delta Dental Silver + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0140001","Delta Dental Gold + Delta Dental Pediatric High","27882ND014",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0140001-00","Delta Dental Gold + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0300001","Delta Dental Gold + Delta Dental Pediatric High","27882ND030",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0300001-00","Delta Dental Gold + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0140001","Delta Dental Gold + Delta Dental Pediatric High","27882ND014",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0140001-01","Delta Dental Gold + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0160001","Delta Dental Platinum + Delta Dental Pediatric High","27882ND016",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.39","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0160001-00","Delta Dental Platinum + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","SHOP (Small Group)","Yes","41-0952670","27882ND0320001","Delta Dental Platinum + Delta Dental Pediatric High","27882ND032",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.39","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0320001-00","Delta Dental Platinum + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","27882","HIOS","2016-08-11 02:30:27","Individual","Yes","41-0952670","27882ND0160001","Delta Dental Platinum + Delta Dental Pediatric High","27882ND016",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.39","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0160001-01","Delta Dental Platinum + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2017HCR-ND.pdf",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080009-06","Medica Applause Silver H S A","94% AV Level Silver Plan",,"0.941599547863007","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASHND94&uid=FFM",
"2017","ND","29278","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","29278ND0030002","EHB High Passive","29278ND003",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","29278ND0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","ND","29278","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","29278ND0030001","EHB Low Passive","29278ND003",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","29278ND0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410023","SimplyBlue 60","37160ND241","7194728540","NDN002","NDS001","NDF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410023-00","SimplyBlue 60","Standard Bronze Off Exchange Plan",,"0.595099925994873","Yes","Yes","No","100%",,"$4,470","$20","$1,100","$200","$2,260","$1,570","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"$13,600","$13600 per person","$27200 per group","$20,400","$20400 per person","$40800 per group","No",,,"https://www.bcbsnd.com/2017-simplyblue-40-6800","https://www.bcbsnd.com/2017-ind-simply-blue-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410023","SimplyBlue 60","37160ND241","7194728540","NDN002","NDS001","NDF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410023-01","SimplyBlue 60","Standard Bronze On Exchange Plan",,"0.595099925994873","Yes","Yes","No","100%",,"$4,470","$20","$1,100","$200","$2,260","$1,570","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"$13,600","$13600 per person","$27200 per group","$20,400","$20400 per person","$40800 per group","No",,,"https://www.bcbsnd.com/2017-simplyblue-40-6800","https://www.bcbsnd.com/2017-ind-simply-blue-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410023","SimplyBlue 60","37160ND241","7194728540","NDN002","NDS001","NDF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410023-02","SimplyBlue 60","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2017-american-indian-alaska-native","https://www.bcbsnd.com/2017-ind-american-indian/alaska-native-300-fpl-zero-cs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410023","SimplyBlue 60","37160ND241","7194728540","NDN002","NDS001","NDF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410023-03","SimplyBlue 60","Limited Cost Sharing Plan Variation",,"0.595099925994873","Yes","Yes","No","100%",,"$4,470","$20","$1,100","$200","$2,260","$1,570","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"$13,600","$13600 per person","$27200 per group","$20,400","$20400 per person","$40800 per group","No",,,"https://www.bcbsnd.com/2017-simplyblue-40-6800-his","https://www.bcbsnd.com/2017-ind-simply-blue-ihs-brochure"
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100003-03","Altru Prime by Medica Silver Copay","Limited Cost Sharing Plan Variation",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSCNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100003-04","Altru Prime by Medica Silver Copay","73% AV Level Silver Plan",,"0.73963475227356","Yes","Yes","No","100%",,"$2,400","$10","$900","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSCND73&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100003-05","Altru Prime by Medica Silver Copay","87% AV Level Silver Plan",,"0.875553548336029","Yes","Yes","No","100%",,"$400","$10","$1,000","$1,000","$400","$400","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSCND87&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100003-06","Altru Prime by Medica Silver Copay","94% AV Level Silver Plan",,"0.934451282024384","Yes","Yes","No","100%",,"$100","$10","$300","$1,000","$100","$400","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSCND94&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100009-00","Altru Prime by Medica Silver H S A","Standard Silver Off Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSHND&uid=FFM",
"2017","ND","33011","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","33011ND0040002","EHB High PPO","33011ND004",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","33011ND0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","ND","33011","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","33011ND0040001","EHB Low PPO","33011ND004",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","33011ND0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","ND","33011","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","33011ND0030002","EHB High Passive","33011ND003",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","33011ND0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","ND","33011","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","33011ND0030001","EHB Low Passive","33011ND003",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","33011ND0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-00","BlueCare 70 Silver","Standard Silver Off Exchange Plan",,"0.694325923919678","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$200","$800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-70-3000-silver","https://www.bcbsnd.com/2017-ind-bluecare-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","45-0173185","37160ND2440001","BlueDirect 100 Gold","37160ND244","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2440001-00","BlueDirect 100 Gold","Standard Gold Off Exchange Plan",,"0.794665277004242","Yes","Yes","No","100%",,"$2,300","$0","$0","$200","$2,300","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$6,900","$13800 per person","$13800 per group","$9,200","$18400 per person","$18400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"https://www.bcbsnd.com/2017-grp-bluedirect-100-2300-gold","https://www.bcbsnd.com/2017-grp-bluedirect-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","45-0173185","37160ND2440001","BlueDirect 100 Gold","37160ND244","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2440001-01","BlueDirect 100 Gold","Standard Gold On Exchange Plan",,"0.794665277004242","Yes","Yes","No","100%",,"$2,300","$0","$0","$200","$2,300","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$6,900","$13800 per person","$13800 per group","$9,200","$18400 per person","$18400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"https://www.bcbsnd.com/2017-grp-bluedirect-100-2300-gold","https://www.bcbsnd.com/2017-grp-bluedirect-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-01","BlueCare 70 Silver","Standard Silver On Exchange Plan",,"0.694325923919678","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$200","$800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-70-3000-silver","https://www.bcbsnd.com/2017-ind-bluecare-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-02","BlueCare 70 Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2017-american-indian-alaska-native","https://www.bcbsnd.com/2017-ind-american-indian/alaska-native-300-fpl-zero-cs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","45-0173185","37160ND2440004","BlueDirect 80 Silver","37160ND244","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2440004-00","BlueDirect 80 Silver","Standard Silver Off Exchange Plan",,"0.691098868846893","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"$11,800","$11800 per person","$23600 per group","$17,700","$17700 per person","$35400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","Yes","No",,"https://www.bcbsnd.com/2017-grp-bluedirect-80-2600-silver","https://www.bcbsnd.com/2017-grp-bluecare-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","SHOP (Small Group)","No","45-0173185","37160ND2440004","BlueDirect 80 Silver","37160ND244","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2440004-01","BlueDirect 80 Silver","Standard Silver On Exchange Plan",,"0.691098868846893","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"$11,800","$11800 per person","$23600 per group","$17,700","$17700 per person","$35400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","Yes","No",,"https://www.bcbsnd.com/2017-grp-bluedirect-80-2600-silver","https://www.bcbsnd.com/2017-grp-bluecare-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-03","BlueCare 70 Silver","Limited Cost Sharing Plan Variation",,"0.694325923919678","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$200","$800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-70-3000-silver-his","https://www.bcbsnd.com/2017-ind-bluecare-70-3000-ihs-silver-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-04","BlueCare 70 Silver","73% AV Level Silver Plan",,"0.729866325855255","Yes","Yes","No","100%",,"$2,800","$20","$900","$200","$200","$800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-80-2800-silver-70-3000-csr73","https://www.bcbsnd.com/2017-ind-bluecare-80-2800-csr-73-silver-at-a-glance"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-05","BlueCare 70 Silver","87% AV Level Silver Plan",,"0.868746697902679","Yes","Yes","No","100%",,"$500","$0","$1,100","$200","$200","$800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,800","$4800 per person","$9600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-80-500-silver-70-3000-csr87","https://www.bcbsnd.com/2017-ind-bluecare-80-500-csr-87-silver-at-a-glance"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-06","BlueCare 70 Silver","94% AV Level Silver Plan",,"0.935154676437378","Yes","Yes","No","100%",,"$0","$20","$700","$200","$0","$730","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-90-0-deductible-silver-70-3000-csr94","https://www.bcbsnd.com/2017-ind-bluecare-90-0-csr-94-silver-at-a-glance"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410005","BlueCare 70 Gold","37160ND241",,"NDN001","NDS001","NDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410005-00","BlueCare 70 Gold","Standard Gold Off Exchange Plan",,"0.784357726573944","Yes","Yes","No","100%",,"$500","$10","$2,000","$200","$200","$360","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-70-500-gold","https://www.bcbsnd.com/2017-ind-bluecare-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410005","BlueCare 70 Gold","37160ND241",,"NDN001","NDS001","NDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410005-01","BlueCare 70 Gold","Standard Gold On Exchange Plan",,"0.784357726573944","Yes","Yes","No","100%",,"$500","$10","$2,000","$200","$200","$360","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-70-500-gold","https://www.bcbsnd.com/2017-ind-bluecare-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410005","BlueCare 70 Gold","37160ND241",,"NDN001","NDS001","NDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410005-02","BlueCare 70 Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2017-american-indian-alaska-native","https://www.bcbsnd.com/2017-ind-american-indian/alaska-native-300-fpl-zero-cs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410005","BlueCare 70 Gold","37160ND241",,"NDN001","NDS001","NDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410005-03","BlueCare 70 Gold","Limited Cost Sharing Plan Variation",,"0.784357726573944","Yes","Yes","No","100%",,"$500","$10","$2,000","$200","$200","$360","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/2017-bluecare-70-500-his","https://www.bcbsnd.com/2017-ind-bluecare-70-500-ihs-gold-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-00","BlueDirect 80 Silver","Standard Silver Off Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","Yes",,,"https://www.bcbsnd.com/2017-bluedirect-80-2600-silver","https://www.bcbsnd.com/2017-ind-bluedirect-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-01","BlueDirect 80 Silver","Standard Silver On Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","Yes",,,"https://www.bcbsnd.com/2017-bluedirect-80-2600-silver","https://www.bcbsnd.com/2017-ind-bluedirect-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-02","BlueDirect 80 Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2017-american-indian-alaska-native","https://www.bcbsnd.com/2017-ind-american-indian/alaska-native-300-fpl-zero-cs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-03","BlueDirect 80 Silver","Limited Cost Sharing Plan Variation",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No",,,"https://www.bcbsnd.com/2017-bluedirect-80-2600-silver-ihs","https://www.bcbsnd.com/2017-ind-bluedirect-80-2600-silver-ihs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-04","BlueDirect 80 Silver","73% AV Level Silver Plan",,"0.731699228286743","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$200","$1,800","$0","$700","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No",,,"https://www.bcbsnd.com/2017-bluedirect-80-1800-silver-80-2600-csr73","https://www.bcbsnd.com/2017-ind-bluedirect-80-1800-csr-73-silver-at-a-glance"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-05","BlueDirect 80 Silver","87% AV Level Silver Plan",,"0.868453860282898","Yes","Yes","No","100%",,"$700","$0","$600","$200","$700","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","$6,750","$6750 per person","$13500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10%",,,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","No",,,"https://www.bcbsnd.com/2017-bluedirect-90-700-silver-80-2600-csr87","https://www.bcbsnd.com/2017-ind-bluedirect-90-700-csr-87-silver-at-a-glance"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-06","BlueDirect 80 Silver","94% AV Level Silver Plan",,"0.932106196880341","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2017-bluedirect-90-0-deductible-silver-80-2600-csr94","https://www.bcbsnd.com/2017-ind-bluedirect-90-0-csr-94-silver-at-a-glance"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410022","BlueDirect 90 Gold","37160ND241","7194728540","NDN001","NDS001","NDF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410022-00","BlueDirect 90 Gold","Standard Gold Off Exchange Plan",,"0.781566739082336","Yes","Yes","No","100%",,"$2,000","$0","$500","$200","$2,000","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$5800 per person","$5800 per group",,,,"$5,800","$11600 per person","$11600 per group","$8,700","$17400 per person","$17400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","10.00%",,,,,"$4,000","$8000 per person","$8000 per group","$6,000","$12000 per person","$12000 per group","Yes",,,"https://www.bcbsnd.com/2017-bluedirect-90-2000-gold","https://www.bcbsnd.com/2017-ind-bluedirect-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410022","BlueDirect 90 Gold","37160ND241","7194728540","NDN001","NDS001","NDF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410022-01","BlueDirect 90 Gold","Standard Gold On Exchange Plan",,"0.781566739082336","Yes","Yes","No","100%",,"$2,000","$0","$500","$200","$2,000","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$5800 per person","$5800 per group",,,,"$5,800","$11600 per person","$11600 per group","$8,700","$17400 per person","$17400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","10.00%",,,,,"$4,000","$8000 per person","$8000 per group","$6,000","$12000 per person","$12000 per group","Yes",,,"https://www.bcbsnd.com/2017-bluedirect-90-2000-gold","https://www.bcbsnd.com/2017-ind-bluedirect-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410022","BlueDirect 90 Gold","37160ND241","7194728540","NDN001","NDS001","NDF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410022-02","BlueDirect 90 Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2017-american-indian-alaska-native","https://www.bcbsnd.com/2017-ind-american-indian/alaska-native-300-fpl-zero-cs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410022","BlueDirect 90 Gold","37160ND241","7194728540","NDN001","NDS001","NDF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410022-03","BlueDirect 90 Gold","Limited Cost Sharing Plan Variation",,"0.781566739082336","Yes","Yes","No","100%",,"$2,000","$0","$500","$200","$2,000","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$5800 per person","$5800 per group",,,,"$5,800","$11600 per person","$11600 per group","$8,700","$17400 per person","$17400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","10.00%",,,,,"$4,000","$8000 per person","$8000 per group","$6,000","$12000 per person","$12000 per group","No",,,"https://www.bcbsnd.com/2017-bluedirect-90-2000-gold-ihs","https://www.bcbsnd.com/2017-ind-bluedirect-90-2000-gold-ihs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410020","BlueDirect 100 Bronze","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410020-00","BlueDirect 100 Bronze","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,110","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.bcbsnd.com/2017-bluedirect-100-6550-bronze","https://www.bcbsnd.com/2017-ind-bluedirect-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410020","BlueDirect 100 Bronze","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410020-01","BlueDirect 100 Bronze","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,110","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.bcbsnd.com/2017-bluedirect-100-6550-bronze","https://www.bcbsnd.com/2017-ind-bluedirect-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410020","BlueDirect 100 Bronze","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410020-02","BlueDirect 100 Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2017-american-indian-alaska-native","https://www.bcbsnd.com/2017-ind-american-indian/alaska-native-300-fpl-zero-cs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410020","BlueDirect 100 Bronze","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410020-03","BlueDirect 100 Bronze","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,110","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","No",,,"https://www.bcbsnd.com/2017-bluedirect-100-6550-bronze-ihs","https://www.bcbsnd.com/2017-ind-bluedirect-100-6550-bronze-ihs-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410021","BlueEssential 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410021-00","BlueEssential 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,560","$0","$0","$200","$5,110","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"https://www.bcbsnd.com/2017-blueessential-100-7150","https://www.bcbsnd.com/2017-ind-blueessential-brochure"
"2017","ND","37160","HIOS","2016-10-19 02:44:25","Individual","No","45-0173185","37160ND2410021","BlueEssential 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410021-01","BlueEssential 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,560","$0","$0","$200","$5,110","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"https://www.bcbsnd.com/2017-blueessential-100-7150","https://www.bcbsnd.com/2017-ind-blueessential-brochure"
"2017","ND","71860","HIOS","2016-08-12 02:50:28","SHOP (Small Group)","Yes","57-0523959","71860ND0020001","Group Dental Policy","71860ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","71860ND0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080001-00","Medica Applause Gold Copay","Standard Gold Off Exchange Plan",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4AGCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080001-01","Medica Applause Gold Copay","Standard Gold On Exchange Plan",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4AGCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080001-02","Medica Applause Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4AGCNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080001-03","Medica Applause Gold Copay","Limited Cost Sharing Plan Variation",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4AGCNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080019","Medica Applause Gold Copay Plus","73751ND008",,"NDN002","NDS002","NDF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080019-00","Medica Applause Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2AGPCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080019","Medica Applause Gold Copay Plus","73751ND008",,"NDN002","NDS002","NDF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080019-01","Medica Applause Gold Copay Plus","Standard Gold On Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2AGPCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080019","Medica Applause Gold Copay Plus","73751ND008",,"NDN002","NDS002","NDF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080019-02","Medica Applause Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2AGPCNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080019","Medica Applause Gold Copay Plus","73751ND008",,"NDN002","NDS002","NDF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080019-03","Medica Applause Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2AGPCNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100001","Altru Prime by Medica Gold Copay","73751ND010",,"NDN003","NDS003","NDF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100001-00","Altru Prime by Medica Gold Copay","Standard Gold Off Exchange Plan",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APGCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100001","Altru Prime by Medica Gold Copay","73751ND010",,"NDN003","NDS003","NDF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100001-01","Altru Prime by Medica Gold Copay","Standard Gold On Exchange Plan",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APGCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100001","Altru Prime by Medica Gold Copay","73751ND010",,"NDN003","NDS003","NDF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100001-02","Altru Prime by Medica Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APGCNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100001","Altru Prime by Medica Gold Copay","73751ND010",,"NDN003","NDS003","NDF001","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100001-03","Altru Prime by Medica Gold Copay","Limited Cost Sharing Plan Variation",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APGCNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100019","Altru Prime by Medica Gold Copay Plus","73751ND010",,"NDN003","NDS003","NDF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100019-00","Altru Prime by Medica Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APGPCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100019","Altru Prime by Medica Gold Copay Plus","73751ND010",,"NDN003","NDS003","NDF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100019-01","Altru Prime by Medica Gold Copay Plus","Standard Gold On Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APGPCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100019","Altru Prime by Medica Gold Copay Plus","73751ND010",,"NDN003","NDS003","NDF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100019-02","Altru Prime by Medica Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APGPCNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100019","Altru Prime by Medica Gold Copay Plus","73751ND010",,"NDN003","NDS003","NDF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100019-03","Altru Prime by Medica Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APGPCNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080003-00","Medica Applause Silver Copay","Standard Silver Off Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080003-01","Medica Applause Silver Copay","Standard Silver On Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080003-02","Medica Applause Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASCNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080003-03","Medica Applause Silver Copay","Limited Cost Sharing Plan Variation",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASCNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080003-04","Medica Applause Silver Copay","73% AV Level Silver Plan",,"0.73963475227356","Yes","Yes","No","100%",,"$2,400","$10","$900","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASCND73&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080003-05","Medica Applause Silver Copay","87% AV Level Silver Plan",,"0.875553548336029","Yes","Yes","No","100%",,"$400","$10","$1,000","$1,000","$400","$400","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASCND87&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080003-06","Medica Applause Silver Copay","94% AV Level Silver Plan",,"0.934451282024384","Yes","Yes","No","100%",,"$100","$10","$300","$1,000","$100","$400","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASCND94&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080009-00","Medica Applause Silver H S A","Standard Silver Off Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASHND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080009-01","Medica Applause Silver H S A","Standard Silver On Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASHND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080009-02","Medica Applause Silver H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASHNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080009-03","Medica Applause Silver H S A","Limited Cost Sharing Plan Variation",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASHNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080009-04","Medica Applause Silver H S A","73% AV Level Silver Plan",,"0.738642454147339","Yes","Yes","No","100%",,"$1,100","$0","$1,300","$1,000","$1,100","$0","$1,300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$3300 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASHND73&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080009-05","Medica Applause Silver H S A","87% AV Level Silver Plan",,"0.87436580657959","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ASHND87&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100003-00","Altru Prime by Medica Silver Copay","Standard Silver Off Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100003-01","Altru Prime by Medica Silver Copay","Standard Silver On Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100003-02","Altru Prime by Medica Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSCNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100009-01","Altru Prime by Medica Silver H S A","Standard Silver On Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSHND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100009-02","Altru Prime by Medica Silver H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSHNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100009-03","Altru Prime by Medica Silver H S A","Limited Cost Sharing Plan Variation",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSHNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100009-04","Altru Prime by Medica Silver H S A","73% AV Level Silver Plan",,"0.738642454147339","Yes","Yes","No","100%",,"$1,100","$0","$1,300","$1,000","$1,100","$0","$1,300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$3300 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSHND73&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100009-05","Altru Prime by Medica Silver H S A","87% AV Level Silver Plan",,"0.87436580657959","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSHND87&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100009-06","Altru Prime by Medica Silver H S A","94% AV Level Silver Plan",,"0.941599547863007","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APSHND94&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080005-00","Medica Applause Bronze Copay","Standard Bronze Off Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ABCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080005-01","Medica Applause Bronze Copay","Standard Bronze On Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ABCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080005-02","Medica Applause Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ABCNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080005-03","Medica Applause Bronze Copay","Limited Cost Sharing Plan Variation",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ABCNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze H S A","73751ND008",,"NDN002","NDS002","NDF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080011-00","Medica Applause Bronze H S A","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ABHND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze H S A","73751ND008",,"NDN002","NDS002","NDF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080011-01","Medica Applause Bronze H S A","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ABHND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze H S A","73751ND008",,"NDN002","NDS002","NDF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080011-02","Medica Applause Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ABHNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze H S A","73751ND008",,"NDN002","NDS002","NDF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080011-03","Medica Applause Bronze H S A","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ABHNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100005","Altru Prime by Medica Bronze Copay","73751ND010",,"NDN003","NDS003","NDF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100005-00","Altru Prime by Medica Bronze Copay","Standard Bronze Off Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APBCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100005","Altru Prime by Medica Bronze Copay","73751ND010",,"NDN003","NDS003","NDF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100005-01","Altru Prime by Medica Bronze Copay","Standard Bronze On Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APBCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100005","Altru Prime by Medica Bronze Copay","73751ND010",,"NDN003","NDS003","NDF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100005-02","Altru Prime by Medica Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APBCNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100005","Altru Prime by Medica Bronze Copay","73751ND010",,"NDN003","NDS003","NDF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100005-03","Altru Prime by Medica Bronze Copay","Limited Cost Sharing Plan Variation",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APBCNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100011","Altru Prime by Medica Bronze H S A","73751ND010",,"NDN003","NDS003","NDF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100011-00","Altru Prime by Medica Bronze H S A","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APBHND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100011","Altru Prime by Medica Bronze H S A","73751ND010",,"NDN003","NDS003","NDF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100011-01","Altru Prime by Medica Bronze H S A","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APBHND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100011","Altru Prime by Medica Bronze H S A","73751ND010",,"NDN003","NDS003","NDF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100011-02","Altru Prime by Medica Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APBHNDZ&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100011","Altru Prime by Medica Bronze H S A","73751ND010",,"NDN003","NDS003","NDF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100011-03","Altru Prime by Medica Bronze H S A","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APBHNDL&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080013","Medica Applause Catastrophic","73751ND008",,"NDN002","NDS002","NDF006","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080013-00","Medica Applause Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ACND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0080013","Medica Applause Catastrophic","73751ND008",,"NDN002","NDS002","NDF006","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0080013-01","Medica Applause Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=4ACND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100013","Altru Prime by Medica Catastrophic","73751ND010",,"NDN003","NDS003","NDF006","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100013-00","Altru Prime by Medica Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APCND&uid=FFM",
"2017","ND","73751","HIOS","2016-11-19 04:47:33","Individual","No","41-1242261","73751ND0100013","Altru Prime by Medica Catastrophic","73751ND010",,"NDN003","NDS003","NDF006","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","73751ND0100013-01","Altru Prime by Medica Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2APCND&uid=FFM",
"2017","ND","75329","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","75329ND0020003","BESTOne Advantage Gold","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010007","BESTDental Premium","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Premium_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010007","BESTDental Premium","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Premium_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","75329ND0020003","BESTOne Advantage Gold","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","75329ND0020004","BESTOne Plus Gold","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010008","BESTDental Standard - H","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Standard-H_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010008","BESTDental Standard - H","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Standard-H_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","75329ND0020004","BESTOne Plus Gold","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010010","BESTDental Choice - H","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Standard-H_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010010","BESTDental Choice - H","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Standard-H_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010009","BESTDental Standard - L","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Standard-L_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","75329ND0020005","BESTOne Plus Silver","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","75329ND0020005","BESTOne Plus Silver","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010009","BESTDental Standard - L","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Standard-L_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010011","BESTDental Choice - L","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Choice-L_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","75329ND0020006","BESTOne Basic Silver","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","75329ND0020006","BESTOne Basic Silver","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010011","BESTDental Choice - L","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Choice-L_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010012","BESTDental Value","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010012-00","BESTDental Value","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Value_Plan.pdf"
"2017","ND","75329","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","75329ND0010012","BESTDental Value","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010012-01","BESTDental Value","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/2017/ND_BESTDental_Value_Plan.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100008","Sanford Simplicity $6,000","89364ND010",,"NDN001","NDS001","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100008-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan",,"0.618448674678802","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090003","Sanford Simplicity $5,000","89364ND009",,"NDN001","NDS001","NDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090003-00","Sanford Simplicity $5,000","Standard Bronze Off Exchange Plan",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090003","Sanford Simplicity $5,000","89364ND009",,"NDN001","NDS001","NDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090003-01","Sanford Simplicity $5,000","Standard Bronze On Exchange Plan",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100008","Sanford Simplicity $6,000","89364ND010",,"NDN001","NDS001","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100008-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan",,"0.618448674678802","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100004","Sanford Simplicity $4,500","89364ND010",,"NDN001","NDS001","NDF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100004-00","Sanford Simplicity $4,500","Standard Bronze Off Exchange Plan",,"0.61933034658432","Yes","Yes","No","100%",,"$4,500","$0","$400","$200","$4,500","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090003","Sanford Simplicity $5,000","89364ND009",,"NDN001","NDS001","NDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090003-02","Sanford Simplicity $5,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_5000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090003","Sanford Simplicity $5,000","89364ND009",,"NDN001","NDS001","NDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090003-03","Sanford Simplicity $5,000","Limited Cost Sharing Plan Variation",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_5000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100004","Sanford Simplicity $4,500","89364ND010",,"NDN001","NDS001","NDF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100004-01","Sanford Simplicity $4,500","Standard Bronze On Exchange Plan",,"0.61933034658432","Yes","Yes","No","100%",,"$4,500","$0","$400","$200","$4,500","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090005","Sanford Simplicity $6,000","89364ND009",,"NDN001","NDS001","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090005-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan",,"0.618883550167084","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090005","Sanford Simplicity $6,000","89364ND009",,"NDN001","NDS001","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090005-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan",,"0.618883550167084","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090005","Sanford Simplicity $6,000","89364ND009",,"NDN001","NDS001","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090005-02","Sanford Simplicity $6,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090005","Sanford Simplicity $6,000","89364ND009",,"NDN001","NDS001","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090005-03","Sanford Simplicity $6,000","Limited Cost Sharing Plan Variation",,"0.618883550167084","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000","89364ND009",,"NDN002","NDS002","NDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-00","Sanford TRUE $5,000","Standard Bronze Off Exchange Plan",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6559 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100003","Sanford Simplicity $3,500","89364ND010",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100003-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.703381419181824","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100003","Sanford Simplicity $3,500","89364ND010",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100003-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.703381419181824","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000","89364ND009",,"NDN002","NDS002","NDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-01","Sanford TRUE $5,000","Standard Bronze On Exchange Plan",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6559 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000","89364ND009",,"NDN002","NDS002","NDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-02","Sanford TRUE $5,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_5000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100009","Sanford Simplicity $2,700","89364ND010",,"NDN001","NDS001","NDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100009-00","Sanford Simplicity $2,700","Standard Silver Off Exchange Plan",,"0.697891533374786","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100009","Sanford Simplicity $2,700","89364ND010",,"NDN001","NDS001","NDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100009-01","Sanford Simplicity $2,700","Standard Silver On Exchange Plan",,"0.697891533374786","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000","89364ND009",,"NDN002","NDS002","NDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-03","Sanford TRUE $5,000","Limited Cost Sharing Plan Variation",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6559 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_5000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-00","Sanford TRUE $6,000","Standard Bronze Off Exchange Plan",,"0.618883550167084","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-01","Sanford TRUE $6,000","Standard Bronze On Exchange Plan",,"0.618883550167084","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-02","Sanford TRUE $6,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-03","Sanford TRUE $6,000","Limited Cost Sharing Plan Variation",,"0.618883550167084","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100010","Sanford TRUE Small Group $4,500","89364ND010",,"NDN002","NDS002","NDF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100010-01","Sanford TRUE Small Group $4,500","Standard Bronze On Exchange Plan",,"0.61933034658432","Yes","Yes","No","100%",,"$3,600","$0","$400","$200","$4,500","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_true_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000","89364ND009",,"NDN002","NDS002","NDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-03","Sanford TRUE $4,000","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_4000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000","89364ND009",,"NDN002","NDS002","NDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-04","Sanford TRUE $4,000","73% AV Level Silver Plan",,"0.720419943332672","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,550","$3550 per person","$7100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,550","$3550 per person","$7100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_4000_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000","89364ND009",,"NDN002","NDS002","NDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-05","Sanford TRUE $4,000","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$1,400","$0","$0","$200","$1,400","$0","$0","$80","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_4000_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100001","Sanford Simplicity $500","89364ND010",,"NDN001","NDS001","NDF004","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100001-00","Sanford Simplicity $500","Standard Platinum Off Exchange Plan",,"0.904879629611969","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100001","Sanford Simplicity $500","89364ND010",,"NDN001","NDS001","NDF004","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100001-01","Sanford Simplicity $500","Standard Platinum On Exchange Plan",,"0.904879629611969","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","NJ","51791","HIOS","2016-06-22 03:04:47","SHOP (Small Group)","Yes","93-0242990","51791NJ0030001","EHB Low Passive","51791NJ003",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NJ","52095","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","22-2321226","52095NJ0020001","NJ Affordable Smiles","52095NJ002",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","52095NJ0020001-01","NJ Affordable Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BROCHURE"
"2017","NJ","52095","HIOS","2016-08-23 02:28:31","Individual","Yes","22-2321226","52095NJ0010001","NJ Young Smiles","52095NJ001",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0010001-00","NJ Young Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE"
"2017","NJ","52095","HIOS","2016-08-23 02:28:31","Individual","Yes","22-2321226","52095NJ0010001","NJ Young Smiles","52095NJ001",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0010001-01","NJ Young Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE"
"2017","NJ","52095","HIOS","2016-08-23 02:28:31","Individual","Yes","22-2321226","52095NJ0010002","NJ Family Smiles","52095NJ001",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0010002-00","NJ Family Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE"
"2017","NJ","52095","HIOS","2016-08-23 02:28:31","SHOP (Small Group)","Yes","22-2321226","52095NJ0020002","NJ Affordable Smiles","52095NJ002",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","52095NJ0020002-00","NJ Affordable Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BROCHURE"
"2017","NJ","52095","HIOS","2016-08-23 02:28:31","Individual","Yes","22-2321226","52095NJ0010002","NJ Family Smiles","52095NJ001",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0010002-01","NJ Family Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE"
"2017","NJ","53877","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","53877NJ0230001","EHB Basic Dental Plan (Low)","53877NJ023",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0230001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","53877","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","53877NJ0210001","Family Basic Dental Plan (Low)","53877NJ021",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.91","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0210001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49103"
"2017","NJ","53877","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","53877NJ0210001","Family Basic Dental Plan (Low)","53877NJ021",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.91","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0210001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49103"
"2017","NJ","53877","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","53877NJ0220001","Family Enhanced Dental Plan (High)","53877NJ022",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.89","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0220001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49105"
"2017","NJ","53877","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","53877NJ0220001","Family Enhanced Dental Plan (High)","53877NJ022",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.89","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0220001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49105"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-00","Horizon Advantage EPO Silver","Standard Silver Off Exchange Plan",,"0.719408333301544","No","Yes","No","100%",,"$2,000","$20","$990","$150","$2,000","$620","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-advantage-epo-silver-standard","http://horizonblue.com/2017/brochure-advantage-epo-silver"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-02","Sanford Simplicity $3,500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100006","Sanford Simplicity $1,250","89364ND010",,"NDN001","NDS001","NDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100006-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.797590732574463","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$700","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100006","Sanford Simplicity $1,250","89364ND010",,"NDN001","NDS001","NDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100006-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.797590732574463","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$700","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-03","Sanford Simplicity $3,500","Limited Cost Sharing Plan Variation",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-04","Sanford Simplicity $3,500","73% AV Level Silver Plan",,"0.735015869140625","Yes","Yes","No","100%",,"$3,000","$20","$300","$200","$400","$900","$0","$80","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-05","Sanford Simplicity $3,500","87% AV Level Silver Plan",,"0.874877214431763","Yes","Yes","No","100%",,"$700","$10","$800","$200","$400","$500","$0","$80","$900","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-06","Sanford Simplicity $3,500","94% AV Level Silver Plan",,"0.942311346530914","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$300","$200","$80","$300","$70","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090011","Sanford Simplicity $4,000","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090011-00","Sanford Simplicity $4,000","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090011","Sanford Simplicity $4,000","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090011-01","Sanford Simplicity $4,000","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090011","Sanford Simplicity $4,000","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090011-02","Sanford Simplicity $4,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_4000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090011","Sanford Simplicity $4,000","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090011-03","Sanford Simplicity $4,000","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_4000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090011","Sanford Simplicity $4,000","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090011-04","Sanford Simplicity $4,000","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,550","$3550 per person","$7100 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7100 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_4000_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090011","Sanford Simplicity $4,000","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090011-05","Sanford Simplicity $4,000","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$1,400","$0","$0","$200","$1,400","$0","$0","$80","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_4000_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090011","Sanford Simplicity $4,000","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090011-06","Sanford Simplicity $4,000","94% AV Level Silver Plan",,"0.932620525360107","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_4000_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000","89364ND009",,"NDN002","NDS002","NDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-00","Sanford TRUE $4,000","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100011","Sanford TRUE Small Group $6,000","89364ND010",,"NDN002","NDS002","NDF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100011-00","Sanford TRUE Small Group $6,000","Standard Bronze Off Exchange Plan",,"0.618985414505005","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100011","Sanford TRUE Small Group $6,000","89364ND010",,"NDN002","NDS002","NDF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100011-01","Sanford TRUE Small Group $6,000","Standard Bronze On Exchange Plan",,"0.618985414505005","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000","89364ND009",,"NDN002","NDS002","NDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-01","Sanford TRUE $4,000","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000","89364ND009",,"NDN002","NDS002","NDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-02","Sanford TRUE $4,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_4000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100010","Sanford TRUE Small Group $4,500","89364ND010",,"NDN002","NDS002","NDF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100010-00","Sanford TRUE Small Group $4,500","Standard Bronze Off Exchange Plan",,"0.61933034658432","Yes","Yes","No","100%",,"$3,600","$0","$400","$200","$4,500","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_true_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000","89364ND009",,"NDN002","NDS002","NDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-06","Sanford TRUE $4,000","94% AV Level Silver Plan",,"0.932620525360107","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_4000_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-00","Sanford TRUE $3,500","Standard Silver Off Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-01","Sanford TRUE $3,500","Standard Silver On Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-02","Sanford TRUE $3,500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-03","Sanford TRUE $3,500","Limited Cost Sharing Plan Variation",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-04","Sanford TRUE $3,500","73% AV Level Silver Plan",,"0.735015869140625","Yes","Yes","No","100%",,"$3,000","$20","$300","$200","$400","$900","$0","$80","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-05","Sanford TRUE $3,500","87% AV Level Silver Plan",,"0.874877214431763","Yes","Yes","No","100%",,"$700","$10","$800","$200","$400","$500","$0","$80","$900","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-06","Sanford TRUE $3,500","94% AV Level Silver Plan",,"0.942311346530914","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$300","$200","$80","$300","$70","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_true_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090001","Sanford Simplicity $1,250","89364ND009",,"NDN001","NDS001","NDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090001-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.798427879810333","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$600","$800","$0","$80","$1,300","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100013","Sanford TRUE Small Group $3,500","89364ND010",,"NDN002","NDS002","NDF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100013-00","Sanford TRUE Small Group $3,500","Standard Silver Off Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100013","Sanford TRUE Small Group $3,500","89364ND010",,"NDN002","NDS002","NDF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100013-01","Sanford TRUE Small Group $3,500","Standard Silver On Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090001","Sanford Simplicity $1,250","89364ND009",,"NDN001","NDS001","NDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090001-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.798427879810333","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$600","$800","$0","$80","$1,300","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090001","Sanford Simplicity $1,250","89364ND009",,"NDN001","NDS001","NDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090001-02","Sanford Simplicity $1,250","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_1250_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100012","Sanford TRUE Small Group $2,700","89364ND010",,"NDN002","NDS002","NDF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100012-00","Sanford TRUE Small Group $2,700","Standard Silver Off Exchange Plan",,"0.697891533374786","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_true_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","91-1842494","89364ND0100012","Sanford TRUE Small Group $2,700","89364ND010",,"NDN002","NDS002","NDF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100012-01","Sanford TRUE Small Group $2,700","Standard Silver On Exchange Plan",,"0.697891533374786","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/sg_nd_true_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090001","Sanford Simplicity $1,250","89364ND009",,"NDN001","NDS001","NDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090001-03","Sanford Simplicity $1,250","Limited Cost Sharing Plan Variation",,"0.798427879810333","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$600","$800","$0","$80","$1,300","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_1250_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090004","Sanford Simplicity $7,150","89364ND009",,"NDN001","NDS001","NDF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090004-00","Sanford Simplicity $7,150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,900","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_7150.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","89364","HIOS","2017-04-26 02:48:20","Individual","No","91-1842494","89364ND0090004","Sanford Simplicity $7,150","89364ND009",,"NDN001","NDS001","NDF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090004-01","Sanford Simplicity $7,150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,900","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2017/i_nd_simplicity_7150.pdf","http://www.sanfordhealthplan.com/policy/HP-0346-2017.pdf"
"2017","ND","93236","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","93236ND0040002","EHB High PPO","93236ND004",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","93236ND0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","ND","93236","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","93236ND0040001","EHB Low PPO","93236ND004",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","93236ND0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","ND","93236","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","93236ND0030002","EHB High Passive","93236ND003",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","93236ND0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","ND","93236","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","93236ND0030001","EHB Low Passive","93236ND003",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","93236ND0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NJ","15720","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","15720NJ0020001","Renaissance Individual Dental PPO, EHB Certified","15720NJ002",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","15720NJ0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","15720","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","15720NJ0020002","Renaissance Individual Dental PPO, EHB Certified","15720NJ002",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","15720NJ0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","15720","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","15720NJ0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","15720NJ004",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_EHB_High_2017","http://www.renaissancedental.com/NJ_EHB_High_2017"
"2017","NJ","15720","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","15720NJ0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","15720NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_EHB_Low_2017","http://www.renaissancedental.com/NJ_EHB_Low_2017"
"2017","NJ","15720","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","15720NJ0050001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","15720NJ005",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0050001-01","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_Ped_High_2017","http://www.renaissancedental.com/NJ_Ped_High_2017"
"2017","NJ","15720","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","15720NJ0050002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","15720NJ005",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0050002-01","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_Ped_Low_2017","http://www.renaissancedental.com/NJ_Ped_Low_2017"
"2017","NJ","15720","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","15720NJ0060001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","15720NJ006",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","15720NJ0060001-00","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","15720","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","15720NJ0060002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","15720NJ006",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","15720NJ0060002-00","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","40704","HIOS","2016-06-22 03:04:47","SHOP (Small Group)","Yes","47-0098400","40704NJ0040002","EHB High PPO","40704NJ004",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NJ","40704","HIOS","2016-06-22 03:04:47","SHOP (Small Group)","Yes","47-0098400","40704NJ0040001","EHB Low PPO","40704NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NJ","40704","HIOS","2016-06-22 03:04:47","SHOP (Small Group)","Yes","47-0098400","40704NJ0030002","EHB High Passive","40704NJ003",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NJ","40704","HIOS","2016-06-22 03:04:47","SHOP (Small Group)","Yes","47-0098400","40704NJ0030001","EHB Low Passive","40704NJ003",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NJ","44811","HIOS","2016-07-01 08:12:23","Individual","Yes","22-3849572","44811NJ0120001","Managed DentalGuard NJ Essentials 1","44811NJ012",,"NJN002","NJS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.999","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/payments","","44811NJ0120001-00","Managed DentalGuard NJ Essentials 1","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NJ","44811","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","22-3849572","44811NJ0050003","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.999","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","44811NJ0050003-00","Managed DentalGuard NJ 10 Family Plan","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","44811","HIOS","2016-07-01 08:12:23","Individual","Yes","22-3849572","44811NJ0120001","Managed DentalGuard NJ Essentials 1","44811NJ012",,"NJN002","NJS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.999","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/payments","","44811NJ0120001-01","Managed DentalGuard NJ Essentials 1","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NJ","44811","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","22-3849572","44811NJ0070003","Managed DentalGuard NJ 20 Family Plan","44811NJ007",,"NJN001","NJS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.999","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","44811NJ0070003-00","Managed DentalGuard NJ 20 Family Plan","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","44811","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","22-3849572","44811NJ0080003","Managed DentalGuard NJ 30 Family Plan","44811NJ008",,"NJN001","NJS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.999","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","44811NJ0080003-00","Managed DentalGuard NJ 30 Family Plan","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","44811","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","22-3849572","44811NJ0050004","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.999","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","44811NJ0050004-00","Managed DentalGuard NJ 10 Family Plan","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","44811","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","22-3849572","44811NJ0050004","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.999","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","44811NJ0050004-01","Managed DentalGuard NJ 10 Family Plan","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","48608","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","48608NJ0010001","Dentegra Dental PPO Pediatric Basic Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010001-17"
"2017","NJ","48608","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","48608NJ0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","48608NJ002",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0020001-17"
"2017","NJ","48608","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","48608NJ0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","48608NJ002",,"NJN001","NJS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0020008-17"
"2017","NJ","48608","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","48608NJ0010008","Dentegra Dental PPO Family Preferred Plan","48608NJ001",,"NJN001","NJS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010008-17"
"2017","NJ","48608","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","48608NJ0010007","Dentegra Dental PPO Family Basic Plan","48608NJ001",,"NJN001","NJS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010007-17"
"2017","NJ","48608","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","48608NJ0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","48608NJ002",,"NJN001","NJS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0020007-17"
"2017","NJ","72667","HIOS","2016-06-18 03:07:04","SHOP (Small Group)","Yes","36-0883760","72667NJ0040002","EHB High PPO","72667NJ004",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NJ","72667","HIOS","2016-06-18 03:07:04","SHOP (Small Group)","Yes","36-0883760","72667NJ0040001","EHB Low PPO","72667NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NJ","79422","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","33-0733552","79422NJ0030001","Family Basic Dental Plan (Low)","79422NJ003",,"NJN001","NJS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0030001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49109"
"2017","NJ","79422","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","33-0733552","79422NJ0030001","Family Basic Dental Plan (Low)","79422NJ003",,"NJN001","NJS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0030001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49109"
"2017","NJ","79422","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","33-0733552","79422NJ0040001","Family Enhanced Dental Plan (High)","79422NJ004",,"NJN001","NJS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0040001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49111"
"2017","NJ","79422","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","33-0733552","79422NJ0040001","Family Enhanced Dental Plan (High)","79422NJ004",,"NJN001","NJS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0040001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49111"
"2017","NJ","51791","HIOS","2016-06-22 03:04:47","SHOP (Small Group)","Yes","93-0242990","51791NJ0040002","EHB High PPO","51791NJ004",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NJ","51791","HIOS","2016-06-22 03:04:47","SHOP (Small Group)","Yes","93-0242990","51791NJ0040001","EHB Low PPO","51791NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NJ","51791","HIOS","2016-06-22 03:04:47","SHOP (Small Group)","Yes","93-0242990","51791NJ0030002","EHB High Passive","51791NJ003",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NJ","72667","HIOS","2016-06-18 03:07:04","SHOP (Small Group)","Yes","36-0883760","72667NJ0030002","EHB High Passive","72667NJ003",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NJ","72667","HIOS","2016-06-18 03:07:04","SHOP (Small Group)","Yes","36-0883760","72667NJ0030001","EHB Low Passive","72667NJ003",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-00","IHC Silver HMO Local Value $50/$75","Standard Silver Off Exchange Plan",,"0.715730249881744","No","Yes","No","100%",,"$2,500","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","23-2314460","77606NJ0050001","SEH Silver HMO Local Value $50/$75","77606NJ005",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","77606NJ0050001-00","SEH Silver HMO Local Value $50/$75","Standard Silver Off Exchange Plan",,"0.718057692050934","No","Yes","No","100%",,"$2,000","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH216V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","23-2314460","77606NJ0050001","SEH Silver HMO Local Value $50/$75","77606NJ005",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","77606NJ0050001-01","SEH Silver HMO Local Value $50/$75","Standard Silver On Exchange Plan",,"0.718057692050934","No","Yes","No","100%",,"$2,000","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH216V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-01","IHC Silver HMO Local Value $50/$75","Standard Silver On Exchange Plan",,"0.715730249881744","No","Yes","No","100%",,"$2,500","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-02","IHC Silver HMO Local Value Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCVZERO217.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-03","IHC Silver HMO Local Value $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.715730249881744","No","Yes","No","100%",,"$2,500","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217VLTD.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-04","IHC Silver HMO Local Value $50/$75","73% AV Level Silver Plan",,"0.739400506019592","No","Yes","No","100%",,"$2,500","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217V73.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-05","IHC Silver HMO Local Value $30/$60","87% AV Level Silver Plan",,"0.87815260887146","No","Yes","No","100%",,"$400","$100","$2,250","$150","$160","$240","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217V87.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-06","IHC Silver HMO Local Value $15/$30","94% AV Level Silver Plan",,"0.941376328468323","No","Yes","No","100%",,"$280","$100","$2,250","$150","$160","$120","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$275","$275 per person","$550 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217V94.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-00","IHC Silver HMO Regional Preferred  $50/$75","Standard Silver Off Exchange Plan",,"0.715730249881744","No","Yes","No","100%",,"$2,500","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-01","IHC Silver HMO Regional Preferred  $50/$75","Standard Silver On Exchange Plan",,"0.715730249881744","No","Yes","No","100%",,"$2,500","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-02","IHC Silver HMO Regional Preferred  Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCPZERO217.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-03","IHC Silver HMO Regional Preferred  $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.715730249881744","No","Yes","No","100%",,"$2,500","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217PLTD.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-04","IHC Silver HMO Regional Preferred  $50/$75","73% AV Level Silver Plan",,"0.739400506019592","No","Yes","No","100%",,"$2,500","$100","$1,370","$150","$160","$350","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217P73.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-05","IHC Silver HMO Regional Preferred  $30/$60","87% AV Level Silver Plan",,"0.87815260887146","No","Yes","No","100%",,"$400","$100","$2,250","$150","$160","$240","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217P87.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-06","IHC Silver HMO Regional Preferred  $15/$30","94% AV Level Silver Plan",,"0.941376328468323","No","Yes","No","100%",,"$280","$100","$2,250","$150","$160","$120","$1,360","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$275","$275 per person","$550 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC217P94.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040002","IHC Gold HMO Local Value $15/$30","77606NJ004",,"NJN002","NJS002","NJF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040002-00","IHC Gold HMO Local Value $15/$30","Standard Gold Off Exchange Plan",,"0.781636476516724","No","Yes","No","100%",,"$2,000","$110","$1,090","$150","$160","$210","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC315V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","23-2314460","77606NJ0050016","SEH Gold HMO Local Value $15/$30","77606NJ005",,"NJN002","NJS002","NJF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","77606NJ0050016-00","SEH Gold HMO Local Value $15/$30","Standard Gold Off Exchange Plan",,"0.798763990402222","No","Yes","No","100%",,"$2,000","$120","$1,090","$150","$160","$1,470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH316V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","23-2314460","77606NJ0050016","SEH Gold HMO Local Value $15/$30","77606NJ005",,"NJN002","NJS002","NJF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","77606NJ0050016-01","SEH Gold HMO Local Value $15/$30","Standard Gold On Exchange Plan",,"0.798763990402222","No","Yes","No","100%",,"$2,000","$120","$1,090","$150","$160","$1,470","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH316V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040002","IHC Gold HMO Local Value $15/$30","77606NJ004",,"NJN002","NJS002","NJF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040002-01","IHC Gold HMO Local Value $15/$30","Standard Gold On Exchange Plan",,"0.781636476516724","No","Yes","No","100%",,"$2,000","$110","$1,090","$150","$160","$210","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC315V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040002","IHC Gold HMO Local Value $15/$30","77606NJ004",,"NJN002","NJS002","NJF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040002-02","IHC Gold HMO Local Value Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCVZERO315.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040002","IHC Gold HMO Local Value $15/$30","77606NJ004",,"NJN002","NJS002","NJF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040002-03","IHC Gold HMO Local Value $15/$30 Limited","Limited Cost Sharing Plan Variation",,"0.781636476516724","No","Yes","No","100%",,"$2,000","$110","$1,090","$150","$160","$210","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC315VLTD.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040066-00","IHC Gold HMO Regional Preferred $15/$30","Standard Gold Off Exchange Plan",,"0.781636476516724","No","Yes","No","100%",,"$2,000","$110","$1,090","$150","$160","$210","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC315P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040066-01","IHC Gold HMO Regional Preferred $15/$30","Standard Gold On Exchange Plan",,"0.781636476516724","No","Yes","No","100%",,"$2,000","$110","$1,090","$150","$160","$210","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC315P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040066-02","IHC Gold HMO Regional Preferred Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC315PZERO315.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040066-03","IHC Gold HMO Regional Preferred $15/$30 Limited","Limited Cost Sharing Plan Variation",,"0.781636476516724","No","Yes","No","100%",,"$2,000","$110","$1,090","$150","$160","$210","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC315PLTD.pdf",
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","23-2314460","77606NJ0050017","SEH Platinum HMO Local Value $15/$30","77606NJ005",,"NJN002","NJS002","NJF002","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","All Specialist",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","77606NJ0050017-00","SEH Platinum HMO Local Value $15/$30","Standard Platinum Off Exchange Plan","90.03%","0","No","Yes","No","100%",,"$0","$680","$0","$150","$0","$1,980","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH404V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","77606","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","23-2314460","77606NJ0050017","SEH Platinum HMO Local Value $15/$30","77606NJ005",,"NJN002","NJS002","NJF002","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","All Specialist",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","77606NJ0050017-01","SEH Platinum HMO Local Value $15/$30","Standard Platinum On Exchange Plan","90.03%","0","No","Yes","No","100%",,"$0","$680","$0","$150","$0","$1,980","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH404V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","79370","HIOS","2016-08-18 02:41:03","SHOP (Small Group)","Yes","42-0127290","79370NJ0040001","Principal Plan Dental 70","79370NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"0.88","Estimated Rate","2017-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","79370NJ0040001-00","Principal Plan Dental 70","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","79422","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","33-0733552","79422NJ0010001","EHB Basic Dental Plan (Low)","79422NJ001",,"NJN001","NJS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0010001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2290002","Direct Access Gold 100/80/60 BlueCard","91661NJ229",,"NJN001","NJS001","NJF008","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9986",,,"2017-01-01",,"No",,"Yes","Offers out of network coverage","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2290002-00","Direct Access Gold 100/80/60 BlueCard","Standard Gold Off Exchange Plan",,"0.814426243305206","Yes","Yes","No","100%",,"$1,500","$20","$590","$150","$1,130","$600","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"$2,500","per person not applicable","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-advantage-Direct-access-100-80-60",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","Yes","22-0999690","91661NJ2330001","Horizon Young Grins","91661NJ233",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2330001-00","Horizon Young Grins","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","Yes","22-0999690","91661NJ2310001","Horizon Young Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2310001-00","Horizon Young Grins","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","Yes","22-0999690","91661NJ2310001","Horizon Young Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2310001-01","Horizon Young Grins","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2290002","Direct Access Gold 100/80/60 BlueCard","91661NJ229",,"NJN001","NJS001","NJF008","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9986",,,"2017-01-01",,"No",,"Yes","Offers out of network coverage","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2290002-01","Direct Access Gold 100/80/60 BlueCard","Standard Gold On Exchange Plan",,"0.814426243305206","Yes","Yes","No","100%",,"$1,500","$20","$590","$150","$1,130","$600","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"$2,500","per person not applicable","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-advantage-Direct-access-100-80-60",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-01","Horizon Advantage EPO Silver","Standard Silver On Exchange Plan",,"0.719408333301544","No","Yes","No","100%",,"$2,000","$20","$990","$150","$2,000","$620","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-advantage-epo-silver-standard","http://horizonblue.com/2017/brochure-advantage-epo-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-02","Horizon Advantage EPO Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-advantage-epo-silver-Zero-cost","http://horizonblue.com/2017/brochure-advantage-epo-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-03","Horizon Advantage EPO Silver","Limited Cost Sharing Plan Variation",,"0.719408333301544","No","Yes","No","100%",,"$2,000","$0","$2,040","$150","$2,000","$0","$1,320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-advantage-epo-silver-limited-cost","http://horizonblue.com/2017/brochure-advantage-epo-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-04","Horizon Advantage EPO Silver","73% AV Level Silver Plan",,"0.739703357219696","No","Yes","No","100%",,"$2,000","$20","$1,060","$150","$2,000","$620","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,225","$5225 per person","$10450 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-advantage-epo-silver-73av-level","http://horizonblue.com/2017/brochure-advantage-epo-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-05","Horizon Advantage EPO Silver","87% AV Level Silver Plan",,"0.874453902244568","No","Yes","No","100%",,"$750","$10","$740","$150","$750","$360","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","per person not applicable","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-advantage-epo-silver-87av-level","http://horizonblue.com/2017/brochure-advantage-epo-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-06","Horizon Advantage EPO Silver","94% AV Level Silver Plan",,"0.936303198337555","No","Yes","No","100%",,"$0","$40","$450","$150","$0","$400","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-advantage-epo-silver-94av-level","http://horizonblue.com/2017/brochure-advantage-epo-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270002-00","Horizon Advantage EPO Bronze","Standard Bronze Off Exchange Plan",,"0.609789192676544","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$0","$1,070","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-advantage-epo-bronze-standard","http://horizonblue.com/2017/brochure-advantage-epo-bronze"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2300001","Advantage EPO Gold 100  $25/$45","91661NJ230",,"NJN001","NJS001","NJF009","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9985",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300001-00","Advantage EPO Gold 100  $25/$45","Standard Gold Off Exchange Plan",,"0.817851603031158","No","Yes","No","100%",,"$0","$520","$0","$150","$0","$1,450","$640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2017/sbc-advantage-epo-100-25-45",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","Yes","22-0999690","91661NJ2310003","Horizon Family Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.256","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2310003-00","Horizon Family Grins","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","Yes","22-0999690","91661NJ2330003","Horizon Family Grins","91661NJ233",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.453","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2330003-00","Horizon Family Grins","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","Yes","22-0999690","91661NJ2310003","Horizon Family Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.256","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2310003-01","Horizon Family Grins","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2300001","Advantage EPO Gold 100  $25/$45","91661NJ230",,"NJN001","NJS001","NJF009","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9985",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300001-01","Advantage EPO Gold 100  $25/$45","Standard Gold On Exchange Plan",,"0.817851603031158","No","Yes","No","100%",,"$0","$520","$0","$150","$0","$1,450","$640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2017/sbc-advantage-epo-100-25-45",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270002-01","Horizon Advantage EPO Bronze","Standard Bronze On Exchange Plan",,"0.609789192676544","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$0","$1,070","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-advantage-epo-bronze-standard","http://horizonblue.com/2017/brochure-advantage-epo-bronze"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270002-02","Horizon Advantage EPO Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-advantage-epo-bronze-zero-cost","http://horizonblue.com/2017/brochure-advantage-epo-bronze"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270002-03","Horizon Advantage EPO Bronze","Limited Cost Sharing Plan Variation",,"0.609789192676544","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$0","$1,070","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-advantage-epo-bronze-limited-cost","http://horizonblue.com/2017/brochure-advantage-epo-bronze"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze","91661NJ234",,"NJN002","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340001-00","OMNIA Bronze","Standard Bronze Off Exchange Plan",,"0.618803143501282","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$0","$1,070","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-bronze-standard","http://horizonblue.com/2017/brochure-omnia-bronze"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2300003","Advantage EPO Gold 100/80","91661NJ230",,"NJN001","NJS001","NJF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Pregnancy","0.9984",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300003-00","Advantage EPO Gold 100/80","Standard Gold Off Exchange Plan",,"0.807793736457825","Yes","Yes","No","100%",,"$1,000","$20","$690","$150","$770","$480","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-advantage-epo-100-80",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","Yes","22-0999690","91661NJ2310004","Horizon Family Grins Plus","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.106","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2310004-00","Horizon Family Grins Plus","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","Yes","22-0999690","91661NJ2330004","Horizon Family Grins Plus","91661NJ233",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.261","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2330004-00","Horizon Family Grins Plus","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","Yes","22-0999690","91661NJ2310004","Horizon Family Grins Plus","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.106","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2310004-01","Horizon Family Grins Plus","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2300003","Advantage EPO Gold 100/80","91661NJ230",,"NJN001","NJS001","NJF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Pregnancy","0.9984",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300003-01","Advantage EPO Gold 100/80","Standard Gold On Exchange Plan",,"0.807793736457825","Yes","Yes","No","100%",,"$1,000","$20","$690","$150","$770","$480","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-advantage-epo-100-80",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze","91661NJ234",,"NJN002","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340001-01","OMNIA Bronze","Standard Bronze On Exchange Plan",,"0.618803143501282","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$0","$1,070","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-bronze-standard","http://horizonblue.com/2017/brochure-omnia-bronze"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze","91661NJ234",,"NJN002","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340001-02","OMNIA Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-bronze-zero-cost","http://horizonblue.com/2017/brochure-omnia-bronze"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze","91661NJ234",,"NJN002","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340001-03","OMNIA Bronze","Limited Cost Sharing Plan Variation",,"0.618803143501282","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$0","$1,070","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-bronze-limited-cost","http://horizonblue.com/2017/brochure-omnia-bronze"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-00","OMNIA Silver","Standard Silver Off Exchange Plan",,"0.719822108745575","No","Yes","Yes","52%","48%","$0","$570","$0","$150","$0","$1,100","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","per person not applicable","$1800 per group","0%","$2,500","per person not applicable","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-omnia-silver-standard","http://horizonblue.com/2017/brochure-omnia-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2300007","Advantage EPO HSA Bronze 100 Compatible","91661NJ230",,"NJN001","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9977",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300007-00","Advantage EPO HSA Bronze 100 Compatible","Standard Bronze Off Exchange Plan",,"0.619912981987","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2017/sbc-advantage-epo-100-30-50-bronze",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2300007","Advantage EPO HSA Bronze 100 Compatible","91661NJ230",,"NJN001","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9977",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300007-01","Advantage EPO HSA Bronze 100 Compatible","Standard Bronze On Exchange Plan",,"0.619912981987","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2017/sbc-advantage-epo-100-30-50-bronze",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-01","OMNIA Silver","Standard Silver On Exchange Plan",,"0.719822108745575","No","Yes","Yes","52%","48%","$0","$570","$0","$150","$0","$1,100","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","per person not applicable","$1800 per group","0%","$2,500","per person not applicable","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-omnia-silver-standard","http://horizonblue.com/2017/brochure-omnia-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-02","OMNIA Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-omnia-silver-zero-cost","http://horizonblue.com/2017/brochure-omnia-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-03","OMNIA Silver","Limited Cost Sharing Plan Variation",,"0.719822108745575","No","Yes","Yes","52%","48%","$0","$570","$0","$150","$0","$1,100","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","per person not applicable","$1800 per group","0%","$2,500","per person not applicable","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-omnia-silver-limited-cost","http://horizonblue.com/2017/brochure-omnia-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-04","OMNIA Silver","73% AV Level Silver Plan",,"0.739888548851013","No","Yes","Yes","52%","48%","$0","$520","$0","$150","$0","$800","$1,270","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$820","per person not applicable","$1640 per group","0%","$2,500","per person not applicable","$5000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-omnia-silver-73av-level","http://horizonblue.com/2017/brochure-omnia-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-05","OMNIA Silver","87% AV Level Silver Plan",,"0.878705680370331","No","Yes","Yes","52%","48%","$0","$260","$0","$150","$0","$250","$1,270","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%","$2,250","per person not applicable","$4500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-omnia-silver-87av-level","http://horizonblue.com/2017/brochure-omnia-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-06","OMNIA Silver","94% AV Level Silver Plan",,"0.944930613040924","No","Yes","Yes","52%","48%","$0","$160","$0","$150","$0","$70","$430","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%","$750","per person not applicable","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2017/sbc-omnia-silver-94av-level","http://horizonblue.com/2017/brochure-omnia-silver"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9978",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-00","OMNIA Silver HSA","Standard Silver Off Exchange Plan",,"0.719860017299652","Yes","Yes","Yes","52%","48%","$3,000","$0","$170","$150","$3,000","$20","$300","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-standard","http://horizonblue.com/2017/brochure-omnia-silver-hsa"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2300004","Advantage EPO Silver 100/70","91661NJ230",,"NJN001","NJS001","NJF011","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9981",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300004-00","Advantage EPO Silver 100/70","Standard Silver Off Exchange Plan",,"0.719601929187775","Yes","Yes","No","100%",,"$1,500","$20","$890","$150","$1,010","$800","$640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-advantage-epo-100-70",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2300004","Advantage EPO Silver 100/70","91661NJ230",,"NJN001","NJS001","NJF011","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9981",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300004-01","Advantage EPO Silver 100/70","Standard Silver On Exchange Plan",,"0.719601929187775","Yes","Yes","No","100%",,"$1,500","$20","$890","$150","$1,010","$800","$640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-advantage-epo-100-70",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9978",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-01","OMNIA Silver HSA","Standard Silver On Exchange Plan",,"0.719860017299652","Yes","Yes","Yes","52%","48%","$3,000","$0","$170","$150","$3,000","$20","$300","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-standard","http://horizonblue.com/2017/brochure-omnia-silver-hsa"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9978",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-02","OMNIA Silver HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-zero-cost","http://horizonblue.com/2017/brochure-omnia-silver-hsa"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9978",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-03","OMNIA Silver HSA","Limited Cost Sharing Plan Variation",,"0.719860017299652","Yes","Yes","Yes","52%","48%","$3,000","$0","$170","$150","$3,000","$20","$300","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-limited-cost","http://horizonblue.com/2017/brochure-omnia-silver-hsa"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9978",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-04","OMNIA Silver HSA","73% AV Level Silver Plan",,"0.739932477474213","Yes","Yes","Yes","52%","48%","$1,200","$0","$340","$150","$1,200","$80","$1,210","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$5,650","$5650 per person","$11300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$2600 per group","10%","$2,250","per person not applicable","$4500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-73av-level","http://horizonblue.com/2017/brochure-omnia-silver-hsa"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9978",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-05","OMNIA Silver HSA","87% AV Level Silver Plan",,"0.875662803649902","Yes","Yes","Yes","52%","48%","$500","$0","$400","$150","$500","$110","$390","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","10%","$1,000","per person not applicable","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-87av-level","http://horizonblue.com/2017/brochure-omnia-silver-hsa"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9978",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-06","OMNIA Silver HSA","94% AV Level Silver Plan",,"0.939149379730225","Yes","Yes","Yes","52%","48%","$250","$0","$150","$150","$250","$80","$80","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$500 per group","10%","$500","per person not applicable","$1000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-94av-level","http://horizonblue.com/2017/brochure-omnia-silver-hsa"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340004-00","OMNIA Gold","Standard Gold Off Exchange Plan",,"0.819183945655823","Yes","Yes","Yes","57%","43%","$0","$540","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-gold-standard","http://horizonblue.com/2017/brochure-omnia-gold"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350001","OMNIA Bronze","91661NJ235",,"NJN002","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350001-00","OMNIA Bronze","Standard Bronze Off Exchange Plan",,"0.618803143501282","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$140","$960","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-omnia-bronze-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350001","OMNIA Bronze","91661NJ235",,"NJN002","NJS001","NJF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350001-01","OMNIA Bronze","Standard Bronze On Exchange Plan",,"0.618803143501282","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$140","$960","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-omnia-bronze-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340004-01","OMNIA Gold","Standard Gold On Exchange Plan",,"0.819183945655823","Yes","Yes","Yes","57%","43%","$0","$540","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-gold-standard","http://horizonblue.com/2017/brochure-omnia-gold"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340004-02","OMNIA Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","57%","43%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-gold-zero-cost","http://horizonblue.com/2017/brochure-omnia-gold"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340004-03","OMNIA Gold","Limited Cost Sharing Plan Variation",,"0.819183945655823","Yes","Yes","Yes","57%","43%","$0","$540","$0","$150","$0","$650","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-omnia-gold-limited-cost","http://horizonblue.com/2017/brochure-omnia-gold"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350002","OMNIA Silver","91661NJ235",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9977",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350002-00","OMNIA Silver","Standard Silver Off Exchange Plan",,"0.719822108745575","No","Yes","Yes","52%","48%","$0","$570","$0","$150","$0","$1,100","$640","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","per person not applicable","$1800 per group","0%","$2,500","per person not applicable","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2017/sbc-omnia-silver-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350002","OMNIA Silver","91661NJ235",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9977",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350002-01","OMNIA Silver","Standard Silver On Exchange Plan",,"0.719822108745575","No","Yes","Yes","52%","48%","$0","$570","$0","$150","$0","$1,100","$640","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","per person not applicable","$1800 per group","0%","$2,500","per person not applicable","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2017/sbc-omnia-silver-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350003","OMNIA Silver HSA","91661NJ235",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9975",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350003-00","OMNIA Silver HSA","Standard Silver Off Exchange Plan",,"0.719860017299652","Yes","Yes","Yes","52%","48%","$3,000","$0","$170","$150","$3,000","$60","$540","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%","$2,500","per person not applicable","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2280001","Horizon Advantage EPO Essentials","91661NJ228",,"NJN001","NJS001","NJF007","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9971",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2280001-00","Horizon Advantage EPO Essentials","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$4,490","$0","$0","$150","$5,130","$0","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-advantage-epo-catastrophic","http://horizonblue.com/2017/brochure-advantage-epo-catastrophic"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","Individual","No","22-0999690","91661NJ2280001","Horizon Advantage EPO Essentials","91661NJ228",,"NJN001","NJS001","NJF007","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9971",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2280001-01","Horizon Advantage EPO Essentials","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$4,490","$0","$0","$150","$5,130","$0","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2017/sbc-advantage-epo-catastrophic","http://horizonblue.com/2017/brochure-advantage-epo-catastrophic"
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350003","OMNIA Silver HSA","91661NJ235",,"NJN002","NJS001","NJF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9975",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350003-01","OMNIA Silver HSA","Standard Silver On Exchange Plan",,"0.719860017299652","Yes","Yes","Yes","52%","48%","$3,000","$0","$170","$150","$3,000","$60","$540","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%","$2,500","per person not applicable","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2017/sbc-omnia-silver-hsa-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350004","OMNIA Gold","91661NJ235",,"NJN002","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9979",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350004-00","OMNIA Gold","Standard Gold Off Exchange Plan",,"0.819183945655823","Yes","Yes","Yes","57%","43%","$0","$540","$0","$150","$0","$650","$640","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-omnia-gold-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350004","OMNIA Gold","91661NJ235",,"NJN002","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9979",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350004-01","OMNIA Gold","Standard Gold On Exchange Plan",,"0.819183945655823","Yes","Yes","Yes","57%","43%","$0","$540","$0","$150","$0","$650","$640","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-omnia-gold-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350005","OMNIA Platinum","91661NJ235",,"NJN002","NJS001","NJF001","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350005-00","OMNIA Platinum","Standard Platinum Off Exchange Plan",,"0.915622591972351","Yes","Yes","Yes","62%","38%","$0","$330","$0","$150","$0","$350","$640","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","per person not applicable","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-omnia-platinum-standard-sg",
"2017","NJ","91661","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","22-0999690","91661NJ2350005","OMNIA Platinum","91661NJ235",,"NJN002","NJS001","NJF001","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350005-01","OMNIA Platinum","Standard Platinum On Exchange Plan",,"0.915622591972351","Yes","Yes","Yes","62%","38%","$0","$330","$0","$150","$0","$350","$640","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","per person not applicable","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2017/sbc-omnia-platinum-standard-sg",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","Yes","22-3338404","91762NJ0120001","IHC Pediatric Dental","91762NJ012",,"NJN005","NJS005",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Same coverage as In-Service","Yes",,"","91762NJ0120001-00","IHC Pediatric Dental","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","Yes","22-3338404","91762NJ0130001","SEH Pediatric Dental","91762NJ013",,"NJN005","NJS005",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Same coverage as In-Service","Yes",,"","91762NJ0130001-00","SEH Pediatric Dental","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070001","IHC Bronze EPO H.S.A Local Value  $50/$75","91762NJ007",,"NJN002","NJS002","NJF004","Existing","EPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070001-00","IHC Bronze EPO H.S.A Local Value  $50/$75","Standard Bronze Off Exchange Plan","61.99%",,"Yes","Yes","No","100%",,"$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC102V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080004","SEH Bronze EPO Tier 1 Advantage  $50/$75","91762NJ008",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080004-00","SEH Bronze EPO Tier 1 Advantage  $50/$75","Standard Bronze Off Exchange Plan",,"0.619235694408417","Yes","Yes","Yes","50%","50%","$3,000","$500","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH161TIER_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080004","SEH Bronze EPO Tier 1 Advantage  $50/$75","91762NJ008",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080004-01","SEH Bronze EPO Tier 1 Advantage  $50/$75","Standard Bronze On Exchange Plan",,"0.619235694408417","Yes","Yes","Yes","50%","50%","$3,000","$500","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH161TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070001","IHC Bronze EPO H.S.A Local Value  $50/$75","91762NJ007",,"NJN002","NJS002","NJF004","Existing","EPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070001-01","IHC Bronze EPO H.S.A Local Value  $50/$75","Standard Bronze On Exchange Plan","61.99%",,"Yes","Yes","No","100%",,"$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC102V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070001","IHC Bronze EPO H.S.A Local Value  $50/$75","91762NJ007",,"NJN002","NJS002","NJF004","Existing","EPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070001-02","IHC Bronze EPO Local Value Zero Dollar","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCVZERO102.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070001","IHC Bronze EPO H.S.A Local Value  $50/$75","91762NJ007",,"NJN002","NJS002","NJF004","Existing","EPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070001-03","IHC Bronze EPO H.S.A Local Value $50/$75 Limited","Limited Cost Sharing Plan Variation","61.99%",,"Yes","Yes","No","100%",,"$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC102VLTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070002","IHC Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ007",,"NJN001","NJS001","NJF004","Existing","EPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070002-00","IHC Bronze EPO H.S.A Regional Preferred $50/$75","Standard Bronze Off Exchange Plan","61.99%",,"Yes","Yes","No","100%",,"$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC102P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070002","IHC Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ007",,"NJN001","NJS001","NJF004","Existing","EPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070002-01","IHC Bronze EPO H.S.A Regional Preferred $50/$75","Standard Bronze On Exchange Plan","61.99%",,"Yes","Yes","No","100%",,"$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC102P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-04","IHC Silver EPO H.S.A Tier 1 Advantage $30/$60","73% AV Level Silver Plan",,"0.737671136856079","Yes","Yes","Yes","50%","50%","$1,300","$10","$450","$150","$1,300","$170","$700","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","10.00%","$1,300","$2600 per person","$2600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC251TIER73.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-05","IHC Silver EPO Tier 1 Advantage $20/$40","87% AV Level Silver Plan",,"0.875148773193359","Yes","Yes","Yes","50%","50%","$300","$10","$620","$150","$300","$250","$910","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%","$300","$300 per person","$600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC251TIER87.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO  Tier 1 Advantage  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070004-02","IHC Bronze EPO Tier 1 Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCTIERZERO151.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO  Tier 1 Advantage  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070004-03","IHC Bronze EPO  Tier 1 Advantage $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.616564810276031","Yes","Yes","Yes","50%","50%","$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC151TIERLTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO AmeriHealth Advantage $25/$50","91762NJ007",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070097-00","IHC Bronze EPO AmeriHealth Advantage $25/$50","Standard Bronze Off Exchange Plan",,"0.613925755023956","Yes","Yes","Yes","50%","50%","$3,000","$400","$10","$150","$3,000","$30","$290","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC156MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","Yes","22-3338404","91762NJ0130003","SEH Family Dental","91762NJ013",,"NJN005","NJS005",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Same coverage as In-Service","Yes",,"","91762NJ0130003-00","SEH Family Dental","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080018","SEH Silver EPO H.S.A Tier 1 Advantage  $50/$75","91762NJ008",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080018-00","SEH Silver EPO H.S.A Tier 1 Advantage  $50/$75","Standard Silver Off Exchange Plan",,"0.695068359375","Yes","Yes","Yes","50%","50%","$1,350","$10","$450","$150","$1,350","$230","$690","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","50.00%","$1,350","$2700 per person","$2700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH261TIER_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080018","SEH Silver EPO H.S.A Tier 1 Advantage  $50/$75","91762NJ008",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080018-01","SEH Silver EPO H.S.A Tier 1 Advantage  $50/$75","Standard Silver On Exchange Plan",,"0.695068359375","Yes","Yes","Yes","50%","50%","$1,350","$10","$450","$150","$1,350","$230","$690","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","50.00%","$1,350","$2700 per person","$2700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH261TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO AmeriHealth Advantage $25/$50","91762NJ007",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070097-01","IHC Bronze EPO AmeriHealth Advantage $25/$50","Standard Bronze On Exchange Plan",,"0.613925755023956","Yes","Yes","Yes","50%","50%","$3,000","$400","$10","$150","$3,000","$30","$290","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC156MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070002","IHC Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ007",,"NJN001","NJS001","NJF004","Existing","EPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070002-02","IHC Bronze EPO Regional Preferred Zero Dollar","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCPZERO102.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070002","IHC Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ007",,"NJN001","NJS001","NJF004","Existing","EPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070002-03","IHC Bronze EPO H.S.A Regional Preferred $50/$75 Limited","Limited Cost Sharing Plan Variation","61.99%",,"Yes","Yes","No","100%",,"$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC102PLTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO  Tier 1 Advantage  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070004-00","IHC Bronze EPO  Tier 1 Advantage $50/$75","Standard Bronze Off Exchange Plan",,"0.616564810276031","Yes","Yes","Yes","50%","50%","$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC151TIER_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","Yes","22-3338404","91762NJ0130002","SEH Pediatric Dental with Adult Preventive","91762NJ013",,"NJN005","NJS005",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Same coverage as In-Service","Yes",,"","91762NJ0130002-00","SEH Pediatric Dental with Adult Preventive","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","Yes","22-3338404","91762NJ0120002","IHC Pediatric Dental with Adult Preventive","91762NJ012",,"NJN005","NJS005",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Same coverage as In-Service","Yes",,"","91762NJ0120002-00","IHC Pediatric Dental with Adult Preventive","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080064","SEH Bronze EPO AmeriHealth Advantage  $25/$50","91762NJ008",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080064-00","SEH Bronze EPO AmeriHealth Advantage  $25/$50","Standard Bronze Off Exchange Plan",,"0.613925755023956","Yes","Yes","Yes","50%","50%","$3,000","$400","$10","$150","$3,000","$30","$290","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH166MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080064","SEH Bronze EPO AmeriHealth Advantage  $25/$50","91762NJ008",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080064-01","SEH Bronze EPO AmeriHealth Advantage  $25/$50","Standard Bronze On Exchange Plan",,"0.613925755023956","Yes","Yes","Yes","50%","50%","$3,000","$400","$10","$150","$3,000","$30","$290","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH166MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO  Tier 1 Advantage  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070004-01","IHC Bronze EPO  Tier 1 Advantage $50/$75","Standard Bronze On Exchange Plan",,"0.616564810276031","Yes","Yes","Yes","50%","50%","$3,000","$1,000","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC151TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO AmeriHealth Advantage $25/$50","91762NJ007",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070097-02","IHC Bronze EPO AmeriHealth Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCMAZERO156.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO AmeriHealth Advantage $25/$50","91762NJ007",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070097-03","IHC Bronze EPO  AmeriHealth Advantage $25/$50 Limited","Limited Cost Sharing Plan Variation",,"0.613925755023956","Yes","Yes","Yes","50%","50%","$3,000","$400","$10","$150","$3,000","$30","$290","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC156MALTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-00","IHC Silver EPO H.S.A Local Value $50/$75","Standard Silver Off Exchange Plan",,"0.68980461359024","Yes","Yes","No","100%",,"$1,800","$1,010","$0","$150","$1,800","$160","$580","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC220V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080065","SEH Silver EPO AmeriHealth Advantage $15/$35","91762NJ008",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080065-00","SEH Silver EPO AmeriHealth Advantage $15/$35","Standard Silver Off Exchange Plan",,"0.7178093791008","No","Yes","Yes","50%","50%","$2,000","$10","$540","$150","$160","$220","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH266MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080065","SEH Silver EPO AmeriHealth Advantage $15/$35","91762NJ008",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080065-01","SEH Silver EPO AmeriHealth Advantage $15/$35","Standard Silver On Exchange Plan",,"0.7178093791008","No","Yes","Yes","50%","50%","$2,000","$10","$540","$150","$160","$220","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH266MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-01","IHC Silver EPO H.S.A Local Value $50/$75","Standard Silver On Exchange Plan",,"0.68980461359024","Yes","Yes","No","100%",,"$1,800","$1,010","$0","$150","$1,800","$160","$580","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC220V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-02","IHC Silver EPO Local Value Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCVZERO220.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-03","IHC Silver EPO H.S.A Local Value $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.68980461359024","Yes","Yes","No","100%",,"$1,800","$1,010","$0","$150","$1,800","$160","$580","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC220VLTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-04","IHC Silver EPO H.S.A Local Value $50/$75","73% AV Level Silver Plan",,"0.737700164318085","Yes","Yes","No","100%",,"$1,500","$1,010","$0","$150","$1,500","$170","$700","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC220V73.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-05","IHC Silver EPO Local Value $35/$60","87% AV Level Silver Plan",,"0.872303307056427","Yes","Yes","No","100%",,"$400","$810","$0","$150","$400","$350","$850","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC220V87.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-06","IHC Silver EPO Local Value $15/$30","94% AV Level Silver Plan",,"0.945098459720612","Yes","Yes","No","100%",,"$150","$510","$0","$150","$150","$210","$980","$80","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC220V94.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-00","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","Standard Silver Off Exchange Plan",,"0.685947477817535","Yes","Yes","Yes","50%","50%","$1,500","$10","$450","$150","$1,500","$170","$680","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","50.00%","$1,500","$3000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC251TIER_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080050","SEH Silver EPO H.S.A Local Value 100%/100%","91762NJ008",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080050-00","SEH Silver EPO H.S.A Local Value 100%/100%","Standard Silver Off Exchange Plan",,"0.71897566318512","Yes","Yes","No","100%",,"$2,500","$10","$0","$150","$2,500","$40","$420","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH299V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080050","SEH Silver EPO H.S.A Local Value 100%/100%","91762NJ008",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080050-01","SEH Silver EPO H.S.A Local Value 100%/100%","Standard Silver On Exchange Plan",,"0.71897566318512","Yes","Yes","No","100%",,"$2,500","$10","$0","$150","$2,500","$40","$420","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH299V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-01","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","Standard Silver On Exchange Plan",,"0.685947477817535","Yes","Yes","Yes","50%","50%","$1,500","$10","$450","$150","$1,500","$170","$680","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","50.00%","$1,500","$3000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC251TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-02","IHC Silver EPO Tier 1 Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCTIERZERO251.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-03","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.685947477817535","Yes","Yes","Yes","50%","50%","$1,500","$10","$450","$150","$1,500","$170","$680","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","50.00%","$1,500","$3000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC251TIERLTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-06","IHC Silver EPO Tier 1 Advantage $15/$30","94% AV Level Silver Plan",,"0.938236653804779","Yes","Yes","Yes","50%","50%","$50","$10","$620","$150","$50","$210","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%","$50","$50 per person","$100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC251TIER94.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-00","IHC Silver EPO AmeriHealth Advantage $15/$35","Standard Silver Off Exchange Plan",,"0.708751142024994","No","Yes","Yes","50%","50%","$2,500","$10","$540","$150","$160","$220","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC256MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080001","SEH Bronze EPO H.S.A Local Value $50/$75","91762NJ008",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080001-00","SEH Bronze EPO H.S.A Local Value  $50/$75","Standard Bronze Off Exchange Plan",,"0.619761347770691","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH101V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080001","SEH Bronze EPO H.S.A Local Value $50/$75","91762NJ008",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080001-01","SEH Bronze EPO H.S.A Local Value  $50/$75","Standard Bronze On Exchange Plan",,"0.619761347770691","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH101V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070014","IHC Local Value Simple Saver","91762NJ007",,"NJN002","NJS002","NJF005","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070014-01","IHC Local Value Simple Saver","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,090","$0","$0","$150","$3,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC501VSMPS.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070015","IHC Regional Preferred Simple Saver","91762NJ007",,"NJN001","NJS001","NJF005","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070015-00","IHC Regional Preferred Simple Saver","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,090","$0","$0","$150","$3,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC501PSMPS_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070015","IHC Regional Preferred Simple Saver","91762NJ007",,"NJN001","NJS001","NJF005","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070015-01","IHC Regional Preferred Simple Saver","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,090","$0","$0","$150","$3,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC501PSMPS.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070100","IHC Silver EPO Regional Preferred $25/$50","91762NJ007",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emegency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070100-01","IHC Silver EPO Regional Preferred $25/$50","Standard Silver On Exchange Plan",,"0.714682281017303","No","Yes","No","100%",,"$2,500","$110","$1,360","$150","$160","$290","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC292P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080003","SEH Bronze EPO H.S.A National Access $50/$75","91762NJ008",,"NJN003","NJS003","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0080003-01","SEH Bronze EPO H.S.A National Access $50/$75","Standard Bronze On Exchange Plan",,"0.619761347770691","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH101N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-01","IHC Silver EPO AmeriHealth Advantage $15/$35","Standard Silver On Exchange Plan",,"0.708751142024994","No","Yes","Yes","50%","50%","$2,500","$10","$540","$150","$160","$220","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC256MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-02","IHC Silver EPO AmeriHealth Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCMAZERO256.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080002","SEH Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ008",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080002-00","SEH Bronze EPO H.S.A Regional Preferred $50/$75","Standard Bronze Off Exchange Plan",,"0.619761347770691","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH101P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080002","SEH Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ008",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080002-01","SEH Bronze EPO H.S.A Regional Preferred $50/$75","Standard Bronze On Exchange Plan",,"0.619761347770691","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH101P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-03","IHC Silver EPO AmeriHealth Advantage $15/$35 Limited","Limited Cost Sharing Plan Variation",,"0.708751142024994","No","Yes","Yes","50%","50%","$2,500","$10","$540","$150","$160","$220","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC256MALTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-04","IHC Silver EPO AmeriHealth Advantage $15/$35","73% AV Level Silver Plan",,"0.735289633274078","No","Yes","Yes","50%","50%","$2,000","$10","$540","$150","$160","$220","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC256MA73.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080003","SEH Bronze EPO H.S.A National Access $50/$75","91762NJ008",,"NJN003","NJS003","NJF001","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0080003-00","SEH Bronze EPO H.S.A National Access $50/$75","Standard Bronze Off Exchange Plan",,"0.619761347770691","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$50","$290","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH101N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-05","IHC Silver EPO AmeriHealth Advantage $15/$35","87% AV Level Silver Plan",,"0.868906438350677","No","Yes","Yes","50%","50%","$300","$10","$890","$150","$160","$220","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20.00%","$300","$300 per person","$600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC256MA87.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-06","IHC Silver EPO AmeriHealth Advantage $10/$30","94% AV Level Silver Plan",,"0.936941385269165","No","Yes","Yes","50%","50%","$100","$10","$620","$150","$100","$190","$1,020","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%","$100","$100 per person","$200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC256MA94.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ007",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070010-00","IHC Gold EPO Regional Preferred $30/$50/80% Coins","Standard Gold Off Exchange Plan",,"0.787324130535126","No","Yes","No","100%",,"$1,000","$110","$710","$150","$160","$310","$810","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC303P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100005","SEH Silver POS Plus National Access $50/$75","91762NJ010",,"NJN003","NJS003","NJF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0100005-00","SEH Silver POS Plus National Access $50/$75","Standard Silver Off Exchange Plan",,"0.719531655311584","No","Yes","No","100%",,"$2,350","$110","$540","$150","$160","$440","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","20.00%",,,,,"$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH213N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100005","SEH Silver POS Plus National Access $50/$75","91762NJ010",,"NJN003","NJS003","NJF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0100005-01","SEH Silver POS Plus National Access $50/$75","Standard Silver On Exchange Plan",,"0.719531655311584","No","Yes","No","100%",,"$2,350","$110","$540","$150","$160","$440","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","20.00%",,,,,"$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH213N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ007",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070010-01","IHC Gold EPO Regional Preferred $30/$50/80% Coins","Standard Gold On Exchange Plan",,"0.787324130535126","No","Yes","No","100%",,"$1,000","$110","$710","$150","$160","$310","$810","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC303P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ007",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070010-02","IHC Gold EPO Regional Preferred Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCPZERO303.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ007",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070010-03","IHC Gold EPO Regional Preferred $30/$50/80% Coins Limited","Limited Cost Sharing Plan Variation",,"0.787324130535126","No","Yes","No","100%",,"$1,000","$110","$710","$150","$160","$310","$810","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC303PLTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070012","IHC Gold EPO H.S.A Local Value 80%/80%","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070012-00","IHC Gold EPO H.S.A Local Value 80%/80%","Standard Gold Off Exchange Plan",,"0.800901532173157","Yes","Yes","No","100%",,"$1,300","$10","$890","$150","$1,300","$80","$770","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC305V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080069","SEH Silver EPO Regional Preferred $30/$50/50% Coins","91762NJ008",,"NJN001","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080069-00","SEH Silver EPO Regional Preferred $30/$50/50% Coins","Standard Silver Off Exchange Plan",,"0.719316303730011","No","Yes","No","100%",,"$2,500","$110","$1,360","$150","$160","$310","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH296P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080069","SEH Silver EPO Regional Preferred $30/$50/50% Coins","91762NJ008",,"NJN001","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080069-01","SEH Silver EPO Regional Preferred $30/$50/50% Coins","Standard Silver On Exchange Plan",,"0.719316303730011","No","Yes","No","100%",,"$2,500","$110","$1,360","$150","$160","$310","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH296P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070012","IHC Gold EPO H.S.A Local Value 80%/80%","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070012-01","IHC Gold EPO H.S.A Local Value 80%/80%","Standard Gold On Exchange Plan",,"0.800901532173157","Yes","Yes","No","100%",,"$1,300","$10","$890","$150","$1,300","$80","$770","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC305V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070012","IHC Gold EPO H.S.A Local Value 80%/80%","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070012-02","IHC Gold EPO Local Value Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCVZERO305.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070012","IHC Gold EPO H.S.A Local Value 80%/80%","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070012-03","IHC Gold EPO H.S.A Local Value 80%/80% Limited","Limited Cost Sharing Plan Variation",,"0.800901532173157","Yes","Yes","No","100%",,"$1,300","$10","$890","$150","$1,300","$80","$770","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC305VLTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070096","IHC Gold EPO AmeriHealth Advantage  $10/$20","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070096-00","IHC Gold EPO AmeriHealth Advantage $10/$20","Standard Gold Off Exchange Plan",,"0.789424121379852","No","Yes","Yes","50%","50%","$1,200","$110","$360","$150","$160","$170","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%","$1,200","$1200 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC356MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080060","SEH Silver EPO H.S.A Regional Preferred 90%/90%","91762NJ008",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080060-00","SEH Silver EPO H.S.A Regional Preferred 90%/90%","Standard Silver Off Exchange Plan",,"0.718973934650421","Yes","Yes","No","100%",,"$2,400","$20","$270","$150","$2,400","$590","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$4800 per person","$4800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH298P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080060","SEH Silver EPO H.S.A Regional Preferred 90%/90%","91762NJ008",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080060-01","SEH Silver EPO H.S.A Regional Preferred 90%/90%","Standard Silver On Exchange Plan",,"0.718973934650421","Yes","Yes","No","100%",,"$2,400","$20","$270","$150","$2,400","$590","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$4800 per person","$4800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH298P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070096","IHC Gold EPO AmeriHealth Advantage  $10/$20","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070096-01","IHC Gold EPO AmeriHealth Advantage $10/$20","Standard Gold On Exchange Plan",,"0.789424121379852","No","Yes","Yes","50%","50%","$1,200","$110","$360","$150","$160","$170","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%","$1,200","$1200 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC356MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070096","IHC Gold EPO AmeriHealth Advantage  $10/$20","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070096-02","IHC Gold EPO AmeriHealth Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCMAZERO356.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070096","IHC Gold EPO AmeriHealth Advantage  $10/$20","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070096-03","IHC Gold EPO AmeriHealth Advantage $10/$20 Limited","Limited Cost Sharing Plan Variation",,"0.789424121379852","No","Yes","Yes","50%","50%","$1,200","$110","$360","$150","$160","$170","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%","$1,200","$1200 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC356MALTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070014","IHC Local Value Simple Saver","91762NJ007",,"NJN002","NJS002","NJF005","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070014-00","IHC Local Value Simple Saver","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,090","$0","$0","$150","$3,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC501VSMPS_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080075","SEH Gold EPO H.S.A Regional Preferred 100%/100%","91762NJ008",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080075-00","SEH Gold EPO H.S.A Regional Preferred 100%/100%","Standard Gold Off Exchange Plan",,"0.816522598266602","Yes","Yes","No","100%",,"$1,550","$20","$0","$150","$1,550","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$3100 per person","$3100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH320P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080075","SEH Gold EPO H.S.A Regional Preferred 100%/100%","91762NJ008",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080075-01","SEH Gold EPO H.S.A Regional Preferred 100%/100%","Standard Gold On Exchange Plan",,"0.816522598266602","Yes","Yes","No","100%",,"$1,550","$20","$0","$150","$1,550","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$3100 per person","$3100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH320P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100002","SEH Platinum POS Plus National Access $10/$25","91762NJ010",,"NJN003","NJS003","NJF002","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0100002-00","SEH Platinum POS Plus National Access $10/$25","Standard Platinum Off Exchange Plan","90.87%","0","No","Yes","No","100%",,"$0","$670","$0","$150","$0","$1,950","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH406N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120020","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120020-01","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_pedbasic.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0130018","Delta Dental-Enhanced PPO Pediatric Essential Health Benefit Addendum","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130018-00","Delta Dental-Enhanced PPO Pediatric Essential Health Benefit Addendum","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120021","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120021-00","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_pedenh.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0140013","Delta Dental -Basic PPO Plus Premier Pediatric Essential Health Benefit Addendum","99708NJ014",,"NJN001","NJS001",,"Existing","POS","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140013-00","Delta Dental -Basic PPO Plus Premier Pediatric Essential Health Benefit Addendum","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0140014","Delta Dental-Enhanced PPO Plus Premier Pediatric Essential Health Benefit Addendum","99708NJ014",,"NJN001","NJS001",,"Existing","POS","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140014-00","Delta Dental-Enhanced PPO Plus Premier Pediatric Essential Health Benefit Addendum","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120021","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120021-01","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","Standard High On Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_pedenh.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0130022","Delta Dental-Basic PPO Pediatric Plan","99708NJ013",,"NJN002","NJS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130022-00","Delta Dental-Basic PPO Pediatric Plan","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0130023","Delta Dental-Enhanced PPO Pediatric Plan","99708NJ013",,"NJN002","NJS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130023-00","Delta Dental-Enhanced PPO Pediatric Plan","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120023","Delta Dental Individual - Basic Family PPO Plan II","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120023-01","Delta Dental Individual - Basic Family PPO Plan II","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120024","Delta Dental Individual - Enhanced Family PPO Plan III","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120024-00","Delta Dental Individual - Enhanced Family PPO Plan III","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famIII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120024","Delta Dental Individual - Enhanced Family PPO Plan III","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120024-01","Delta Dental Individual - Enhanced Family PPO Plan III","Standard High On Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famIII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","OK","12513","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","12513OK0030001","TruAssure Dental Small Group Basic Plan","12513OK003",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"","12513OK0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","12513","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","12513OK0010001","TruAssure Basic Adult or Child Dental Plan","12513OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK"
"2017","OK","12513","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","12513OK0010001","TruAssure Basic Adult or Child Dental Plan","12513OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0140015","Delta Dental-Basic PPO Plus Premier Pediatric Plan","99708NJ014",,"NJN001","NJS001",,"New","POS","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140015-00","Delta Dental-Basic PPO Plus Premier Pediatric Plan","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0140016","Delta Dental-Enhanced PPO Plus Premier Pediatric Plan","99708NJ014",,"NJN001","NJS001",,"New","POS","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140016-00","Delta Dental-Enhanced PPO Plus Premier Pediatric Plan","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0130019","Delta Dental - Basic Family PPO Plan I","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130019-00","Delta Dental - Basic Family PPO Plan I","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120022","Delta Dental Individual - Basic Family PPO Plan I","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120022-00","Delta Dental Individual - Basic Family PPO Plan I","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famI.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120022","Delta Dental Individual - Basic Family PPO Plan I","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120022-01","Delta Dental Individual - Basic Family PPO Plan I","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famI.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120023","Delta Dental Individual - Basic Family PPO Plan II","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120023-00","Delta Dental Individual - Basic Family PPO Plan II","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0130020","Delta Dental  - Basic Family PPO Plan II","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130020-00","Delta Dental  - Basic Family PPO Plan II","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0130021","Delta Dental  - Enhanced Family PPO Plan III","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130021-00","Delta Dental  - Enhanced Family PPO Plan III","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$135 per person","$405 per group",,,,,,"$35","$135 per person","$405 per group","$35","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100002","SEH Platinum POS Plus National Access $10/$25","91762NJ010",,"NJN003","NJS003","NJF002","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0100002-01","SEH Platinum POS Plus National Access $10/$25","Standard Platinum On Exchange Plan","90.87%","0","No","Yes","No","100%",,"$0","$670","$0","$150","$0","$1,950","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH406N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070100","IHC Silver EPO Regional Preferred $25/$50","91762NJ007",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emegency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070100-02","IHC Silver EPO Regional Preferred Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHCPZERO292.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070100","IHC Silver EPO Regional Preferred $25/$50","91762NJ007",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emegency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070100-03","IHC Silver EPO Regional Preferred $25/$50 Limited","Limited Cost Sharing Plan Variation",,"0.714682281017303","No","Yes","No","100%",,"$2,500","$110","$1,360","$150","$160","$290","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC292PLTD.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070100","IHC Silver EPO Regional Preferred $25/$50","91762NJ007",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emegency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070100-04","IHC Silver EPO Regional Preferred $25/$50","73% AV Level Silver Plan",,"0.739242136478424","No","Yes","No","100%",,"$2,500","$110","$1,360","$150","$160","$290","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC292P73.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070100","IHC Silver EPO Regional Preferred $25/$50","91762NJ007",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emegency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070100-05","IHC Silver EPO Regional Preferred $20/$40","87% AV Level Silver Plan",,"0.872643172740936","No","Yes","No","100%",,"$750","$110","$2,240","$150","$160","$250","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC292P87.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","Individual","No","22-3338404","91762NJ0070100","IHC Silver EPO Regional Preferred $25/$50","91762NJ007",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emegency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070100-06","IHC Silver EPO Regional Preferred $15/$30","94% AV Level Silver Plan",,"0.935834348201752","No","Yes","No","100%",,"$150","$110","$2,240","$150","$150","$210","$1,050","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_IHC292P94.pdf",
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100023","SEH Platinum POS Plus Regional Preferred $30/$40","91762NJ010",,"NJN001","NJS001","NJF006","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0100023-00","SEH Platinum POS Plus Regional Preferred $30/$40","Standard Platinum Off Exchange Plan","89.23%","0","No","Yes","No","100%",,"$0","$690","$0","$150","$0","$1,930","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH410P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100023","SEH Platinum POS Plus Regional Preferred $30/$40","91762NJ010",,"NJN001","NJS001","NJF006","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0100023-01","SEH Platinum POS Plus Regional Preferred $30/$40","Standard Platinum On Exchange Plan","89.23%","0","No","Yes","No","100%",,"$0","$690","$0","$150","$0","$1,930","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH410P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080023","SEH Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ008",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080023-00","SEH Gold EPO Regional Preferred $30/$50/80% Coins","Standard Gold Off Exchange Plan",,"0.805129945278168","No","Yes","No","100%",,"$1,000","$120","$710","$150","$160","$1,570","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH304P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080023","SEH Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ008",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080023-01","SEH Gold EPO Regional Preferred $30/$50/80% Coins","Standard Gold On Exchange Plan",,"0.805129945278168","No","Yes","No","100%",,"$1,000","$120","$710","$150","$160","$1,570","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH304P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100001","SEH Gold POS Plus National Access $30/$50","91762NJ010",,"NJN003","NJS003","NJF003","Existing","POS","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0100001-00","SEH Gold POS Plus National Access $30/$50","Standard Gold Off Exchange Plan",,"0.818002164363861","No","Yes","No","100%",,"$1,000","$110","$710","$150","$160","$310","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH317N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100001","SEH Gold POS Plus National Access $30/$50","91762NJ010",,"NJN003","NJS003","NJF003","Existing","POS","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0100001-01","SEH Gold POS Plus National Access $30/$50","Standard Gold On Exchange Plan",,"0.818002164363861","No","Yes","No","100%",,"$1,000","$110","$710","$150","$160","$310","$1,010","$80","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH317N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100018","SEH Gold POS Plus Regional Preferred  $20/$40","91762NJ010",,"NJN001","NJS001","NJF006","Existing","POS","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0100018-00","SEH Gold POS Plus Regional Preferred  $20/$40","Standard Gold Off Exchange Plan",,"0.816719472408295","No","Yes","No","100%",,"$1,500","$90","$710","$150","$160","$1,420","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH318P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0100018","SEH Gold POS Plus Regional Preferred  $20/$40","91762NJ010",,"NJN001","NJS001","NJF006","Existing","POS","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0100018-01","SEH Gold POS Plus Regional Preferred  $20/$40","Standard Gold On Exchange Plan",,"0.816719472408295","No","Yes","No","100%",,"$1,500","$90","$710","$150","$160","$1,420","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH318P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080090","SEH Gold EPO AmeriHealth Advantage $10/$20","91762NJ008",,"NJN004","NJS004","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080090-00","SEH Gold EPO AmeriHealth Advantage  $10/$20","Standard Gold Off Exchange Plan",,"0.810150325298309","No","Yes","Yes","50%","50%","$1,200","$120","$360","$150","$160","$1,430","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%","$1,200","$1200 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH366MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080090","SEH Gold EPO AmeriHealth Advantage $10/$20","91762NJ008",,"NJN004","NJS004","NJF002","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080090-01","SEH Gold EPO AmeriHealth Advantage  $10/$20","Standard Gold On Exchange Plan",,"0.810150325298309","No","Yes","Yes","50%","50%","$1,200","$120","$360","$150","$160","$1,430","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%","$1,200","$1200 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH366MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080091","SEH Platinum EPO  Regional Preferred $20/$40","91762NJ008",,"NJN001","NJS001","NJF006","Existing","EPO","Platinum","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080091-00","SEH Platinum EPO  Regional Preferred $20/$40","Standard Platinum Off Exchange Plan","89.68%",,"No","Yes","No","100%",,"$0","$110","$0","$150","$0","$1,730","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH409P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080091","SEH Platinum EPO  Regional Preferred $20/$40","91762NJ008",,"NJN001","NJS001","NJF006","Existing","EPO","Platinum","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No",,"http://www.amerihealthnj.com/formulary","91762NJ0080091-01","SEH Platinum EPO  Regional Preferred $20/$40","Standard Platinum On Exchange Plan","89.68%",,"No","Yes","No","100%",,"$0","$110","$0","$150","$0","$1,730","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH409P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080092","SEH Platinum EPO  National Access $20/$40","91762NJ008",,"NJN003","NJS003","NJF006","Existing","EPO","Platinum","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0080092-00","SEH Platinum EPO  National Access $20/$40","Standard Platinum Off Exchange Plan","89.68%",,"No","Yes","No","100%",,"$0","$110","$0","$150","$0","$1,730","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH409N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","91762","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","22-3338404","91762NJ0080092","SEH Platinum EPO  National Access $20/$40","91762NJ008",,"NJN003","NJS003","NJF006","Existing","EPO","Platinum","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"2017-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes",,"http://www.amerihealthnj.com/formulary","91762NJ0080092-01","SEH Platinum EPO  National Access $20/$40","Standard Platinum On Exchange Plan","89.68%",,"No","Yes","No","100%",,"$0","$110","$0","$150","$0","$1,730","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2017_SEH409N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH_BAAGS_2017.pdf"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","93627NJ0020002","Guardian Pediatric Advantage","93627NJ002",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","93627NJ0020002-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","93627NJ0140001","Guardian Essentials for Families and Individuals","93627NJ014",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","93627NJ0140001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","93627NJ0140001","Guardian Essentials for Families and Individuals","93627NJ014",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","93627NJ0140001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","93627NJ0030002","Guardian Pediatric Essentials","93627NJ003",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","93627NJ0030002-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","93627NJ0050002","Guardian Family Advantage","93627NJ005",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","93627NJ0050002-00","Guardian Family Advantage","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","93627NJ0150001","Guardian Select for Families and Individuals","93627NJ015",,"NJN002","NJS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","93627NJ0150001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","93627NJ0150001","Guardian Select for Families and Individuals","93627NJ015",,"NJN002","NJS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","93627NJ0150001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","93627NJ0050002","Guardian Family Advantage","93627NJ005",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","93627NJ0050002-01","Guardian Family Advantage","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","93627NJ0070002","Guardian Family Essentials","93627NJ007",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","93627NJ0070002-00","Guardian Family Essentials","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","93627","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","93627NJ0070002","Guardian Family Essentials","93627NJ007",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","93627NJ0070002-01","Guardian Family Essentials","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","Yes","22-1896118","99708NJ0130017","Delta Dental -Basic PPO Pediatric Essential Health Benefit Addendum","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130017-00","Delta Dental -Basic PPO Pediatric Essential Health Benefit Addendum","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2017","NJ","99708","HIOS","2016-11-15 02:20:22","Individual","Yes","22-1896118","99708NJ0120020","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120020-00","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_pedbasic.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2017","OK","12513","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","12513OK0040001","TruAssure Dental Small Group Preferred Plan","12513OK004",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"","12513OK0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","12513","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","12513OK0020001","TruAssure Preferred Adult or Child Dental Plan","12513OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK"
"2017","OK","12513","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","12513OK0020001","TruAssure Preferred Adult or Child Dental Plan","12513OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK"
"2017","OK","13711","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","13711OK0020001","Renaissance Individual Dental PPO, EHB Certified","13711OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","13711OK0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","13711","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","13711OK0020002","Renaissance Individual Dental PPO, EHB Certified","13711OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","13711OK0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","13711","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","13711OK0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","13711OK004",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_EHB_High_2017","http://www.renaissancedental.com/OK_EHB_High_2017"
"2017","OK","13711","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","13711OK0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","13711OK004",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_EHB_Low_2017","http://www.renaissancedental.com/OK_EHB_Low_2017"
"2017","OK","13711","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","13711OK0050001","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","13711OK005",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0050001-01","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_Ped_High_2017","http://www.renaissancedental.com/OK_Ped_High_2017"
"2017","OK","13711","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","13711OK0050002","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","13711OK005",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0050002-01","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_Ped_Low_2017","http://www.renaissancedental.com/OK_Ped_Low_2017"
"2017","OK","13711","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","13711OK0060001","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","13711OK006",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","13711OK0060001-00","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","13711","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","13711OK0060002","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","13711OK006",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","13711OK0060002-00","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","17595","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","57-0523959","17595OK0020001","Group Dental Policy","17595OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traidiitional with inside maximum","Yes",,"","17595OK0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","31125","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","31125OK0040002","EHB High PPO","31125OK004",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31125OK0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010012","BESTDental Value","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Value_Plan.pdf"
"2017","OK","45689","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","45689OK0010001","Dentegra Dental PPO Pediatric Basic Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010001-17"
"2017","OK","45689","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","45689OK0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","45689OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0020001-17"
"2017","OK","45689","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","45689OK0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","45689OK002",,"OKN001","OKS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","per person not applicable","per group not applicable",,,,,,"$30","per person not applicable","per group not applicable","$30","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0020008-17"
"2017","OK","45689","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","45689OK0010008","Dentegra Dental PPO Family Preferred Plan","45689OK001",,"OKN001","OKS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","per person not applicable","per group not applicable",,,,,,"$30","per person not applicable","per group not applicable","$30","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010008-17"
"2017","OK","45689","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","45689OK0010007","Dentegra Dental PPO Family Basic Plan","45689OK001",,"OKN001","OKS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010007-17"
"2017","OK","45689","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","45689OK0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","45689OK002",,"OKN001","OKS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0020007-17"
"2017","OK","50184","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","44-0308260","50184OK0010001","KCL EHB Low PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","50184","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","44-0308260","50184OK0010003","KCL EHB Low PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010003-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","50184","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","44-0308260","50184OK0010005","KCL EHB Low PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010005-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","31125","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","31125OK0040001","EHB Low PPO","31125OK004",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31125OK0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","OK","31125","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","31125OK0030002","EHB High Passive","31125OK003",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31125OK0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","OK","77760","HIOS","2017-01-25 02:20:17","Individual","Yes","23-7322578","77760OK0010006","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010006-01","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low2017","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2017"
"2017","OK","77760","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","Yes","23-7322578","77760OK0040005","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN002","OKS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"This plan covers children ages 0-18 only.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes",,"","77760OK0040005-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/High2017","https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/High2017"
"2017","OK","77760","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","Yes","23-7322578","77760OK0040006","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN002","OKS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"This plan covers children ages 0-18 only.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes",,"","77760OK0040006-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/Low2017","https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/Low2017"
"2017","OK","31125","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","31125OK0030001","EHB Low Passive","31125OK003",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31125OK0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","OK","36845","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0083760","36845OK0040002","EHB High PPO","36845OK004",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36845OK0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","OK","36845","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0083760","36845OK0040001","EHB Low PPO","36845OK004",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36845OK0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","OK","36845","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0083760","36845OK0030002","EHB High Passive","36845OK003",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36845OK0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","OK","36845","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0083760","36845OK0030001","EHB Low Passive","36845OK003",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36845OK0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","40254OK0020003","BESTOne Advantage Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010007","BESTDental Premium","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Premium_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010007","BESTDental Premium","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Premium_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","40254OK0020003","BESTOne Advantage Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","40254OK0020004","BESTOne Plus Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010008","BESTDental Standard - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Standard-H_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010008","BESTDental Standard - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Standard-H_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","40254OK0020004","BESTOne Plus Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010010","BESTDental Choice - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Choice-H_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010010","BESTDental Choice - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Choice-H_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010009","BESTDental Standard - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Standard-L_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","40254OK0020005","BESTOne Plus Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","40254OK0020005","BESTOne Plus Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010009","BESTDental Standard - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Standard-L_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010011","BESTDental Choice - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Choice-L_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","40254OK0020006","BESTOne Basic Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","40254OK0020006","BESTOne Basic Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010011","BESTDental Choice - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Choice-L_Plan.pdf"
"2017","OK","40254","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","40254OK0010012","BESTDental Value","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/2017/OK_BESTDental_Value_Plan.pdf"
"2017","OK","50184","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","44-0308260","50184OK0010007","KCL EHB Low PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010007-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","50184","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","44-0308260","50184OK0010002","KCL EHB High PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","50184","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","44-0308260","50184OK0010004","KCL EHB High PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010004-00","KCL EHB High PPO","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","50184","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","44-0308260","50184OK0010006","KCL EHB High PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010006-00","KCL EHB High PPO","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","50184","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","44-0308260","50184OK0010008","KCL EHB High PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010008-00","KCL EHB High PPO","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","60283","HIOS","2016-06-24 02:40:05","SHOP (Small Group)","Yes","13-5581829","60283OK0130001","EHB Basic Dental Plan (Low)","60283OK013",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","60283OK0130001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OK","61858","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","61858OK0040002","EHB High PPO","61858OK004",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","61858OK0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","OK","61858","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","61858OK0040001","EHB Low PPO","61858OK004",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","61858OK0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","OK","61858","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","61858OK0030002","EHB High Passive","61858OK003",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","61858OK0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","OK","61858","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","61858OK0030001","EHB Low Passive","61858OK003",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","61858OK0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","OK","77760","HIOS","2017-01-25 02:20:17","Individual","Yes","23-7322578","77760OK0010005","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"New","PPO","High","Not Applicable",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010005-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High2017","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2017"
"2017","OK","77760","HIOS","2017-01-25 02:20:17","Individual","Yes","23-7322578","77760OK0010005","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"New","PPO","High","Not Applicable",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010005-01","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High2017","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2017"
"2017","OK","77760","HIOS","2017-01-25 02:20:17","Individual","Yes","23-7322578","77760OK0010006","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010006-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low2017","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2017"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320071","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS031","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320071-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320071","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS031","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320071-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360052","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS012","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360052-00","Blue Advantage Bronze PPO 011","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330031","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS041","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330031-01","Blue Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","77760","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","Yes","23-7322578","77760OK0020005","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN002","OKS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes",,"","77760OK0020005-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/High2017","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2017"
"2017","OK","77760","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","Yes","23-7322578","77760OK0020006","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN002","OKS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes",,"","77760OK0020006-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/Low2017","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2017"
"2017","OK","81457","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","81457OK0010003","Guardian Pediatric Advantage","81457OK001",,"OKN001","OKS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","81457OK0010003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","OK","81457","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","81457OK0020003","Guardian Pediatric Essentials","81457OK002",,"OKN001","OKS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","81457OK0020003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320048","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS011","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320048-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","87571OK0390001","BlueCare Dental? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360047","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS012","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360047-00","Blue Advantage Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360047","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS012","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360047-01","Blue Advantage Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360034","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS032","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360034-00","Blue Advantage Bronze PPO 011","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360034","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS032","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360034-01","Blue Advantage Bronze PPO 011","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320072","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS041","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320072-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320073","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS051","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320073-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","87571OK0390001","BlueCare Dental? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320048","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS011","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320048-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320048","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS011","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320048-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360006","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS022","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360006-00","Blue Advantage Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360006","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS022","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360006-01","Blue Advantage Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320048","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS011","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320048-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320070","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS021","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320070-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360023","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS032","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360023-00","Blue Advantage Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360023","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS032","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360023-01","Blue Advantage Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320070","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS021","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320070-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320070","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS021","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320070-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360024","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS042","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360024-00","Blue Advantage Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360024","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS042","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360024-01","Blue Advantage Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320070","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS021","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320070-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320071","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS031","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320071-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360025","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS052","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360025-00","Blue Advantage Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360025","Blue Advantage Bronze PPO 006","87571OK036",,"OKN012","OKS052","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360025-01","Blue Advantage Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360052","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS012","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360052-01","Blue Advantage Bronze PPO 011","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320071","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS031","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320071-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320072","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS041","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320072-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360030","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS022","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360030-00","Blue Advantage Bronze PPO 011","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360030","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS022","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360030-01","Blue Advantage Bronze PPO 011","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320072","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS041","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320072-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320072","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS041","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320072-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360035","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS042","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360035-00","Blue Advantage Bronze PPO 011","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320030","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS021","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320030-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360043","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS042","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360043-01","Blue Advantage Gold PPO 023","Standard Gold On Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360044","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS052","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360044-00","Blue Advantage Gold PPO 023","Standard Gold Off Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320031","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS031","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320031-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320031","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS031","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320031-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350023","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS042","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350023-03","Blue Advantage Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360026","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS032","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360026-01","Blue Advantage Silver PPO 007","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360035","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS042","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360035-01","Blue Advantage Bronze PPO 011","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320073","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS051","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320073-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320073","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS051","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320073-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360036","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS052","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360036-00","Blue Advantage Bronze PPO 011","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360036","Blue Advantage Bronze PPO 011","87571OK036",,"OKN012","OKS052","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360036-01","Blue Advantage Bronze PPO 011","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360030-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320073","Blue Preferred Bronze PPO? 102","87571OK032",,"OKN001","OKS051","OKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320073-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617584884166718","Yes","Yes","Yes","60%","40%","$7,000","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$21,000","$21000 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320048-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330030","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS011","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330030-00","Blue Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330030","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS011","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330030-01","Blue Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330029","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS021","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330029-00","Blue Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330029","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS021","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330029-01","Blue Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330006","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS031","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330006-00","Blue Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330006","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS031","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330006-01","Blue Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330031","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS041","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330031-00","Blue Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330032","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS051","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330032-00","Blue Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330032","Blue Preferred Bronze PPO 006","87571OK033",,"OKN011","OKS051","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330032-01","Blue Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330042","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS011","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330042-00","Blue Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330042","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS011","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330042-01","Blue Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330047","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS021","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330047-00","Blue Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330047","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS021","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330047-01","Blue Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330048","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS031","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330048-00","Blue Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330048","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS031","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330048-01","Blue Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330049","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS041","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330049-00","Blue Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330049","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS041","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330049-01","Blue Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330050","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS051","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330050-00","Blue Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330050","Blue Preferred Bronze PPO 022","87571OK033",,"OKN011","OKS051","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330050-01","Blue Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330042-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300006","Blue Choice Bronze PPO 006","87571OK030",,"OKN013","OKS003","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300006-00","Blue Choice Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300006","Blue Choice Bronze PPO 006","87571OK030",,"OKN013","OKS003","OKF010","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300006-01","Blue Choice Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300019","Blue Choice Bronze PPO 023","87571OK030",,"OKN013","OKS003","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300019-00","Blue Choice Bronze PPO 023","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300019-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300019","Blue Choice Bronze PPO 023","87571OK030",,"OKN013","OKS003","OKF009","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300019-01","Blue Choice Bronze PPO 023","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$13100 per group","30.00%","$5,500","$5500 per person","$13100 per group","30.00%","$11,000","$11000 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300019-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360050","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS012","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360050-00","Blue Advantage Gold PPO 023","Standard Gold Off Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","87571OK0390003","BlueCare Dental 4 Kids? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320033","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS011","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320033-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320033","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS011","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320033-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","87571OK0390003","BlueCare Dental 4 Kids? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360050","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS012","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360050-01","Blue Advantage Gold PPO 023","Standard Gold On Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360038","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS022","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360038-00","Blue Advantage Gold PPO 023","Standard Gold Off Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320033","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS011","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320033-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320033","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS011","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320033-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360038","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS022","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360038-01","Blue Advantage Gold PPO 023","Standard Gold On Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360042","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS032","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360042-00","Blue Advantage Gold PPO 023","Standard Gold Off Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320030","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS021","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320030-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360014","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS032","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360014-00","Blue Advantage Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320032","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS041","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320032-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330014","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS011","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330014-00","Blue Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","87571OK0390002","BlueCare Dental? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320030","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS021","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320030-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360042","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS032","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360042-01","Blue Advantage Gold PPO 023","Standard Gold On Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360043","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS042","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360043-00","Blue Advantage Gold PPO 023","Standard Gold Off Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320030","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS021","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320030-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360044","Blue Advantage Gold PPO 023","87571OK036",,"OKN012","OKS052","OKF012","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360044-01","Blue Advantage Gold PPO 023","Standard Gold On Exchange Plan","80.09%","0","No","Yes","Yes","60%","40%","$2,500","$200","$60","$200","$2,500","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","20.00%","$2,500","$2500 per person","$7500 per group","20.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360038-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360045","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS012","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360045-00","Blue Advantage Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320031","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS031","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320031-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320031","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS031","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320031-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360045","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS012","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360045-01","Blue Advantage Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360003","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS022","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360003-00","Blue Advantage Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320032","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS041","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320032-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320032","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS041","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320032-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360003","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS022","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360003-01","Blue Advantage Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320032","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS041","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320032-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360014","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS032","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360014-01","Blue Advantage Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360015","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS042","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360015-00","Blue Advantage Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS051","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320006-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS051","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320006-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360015","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS042","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360015-01","Blue Advantage Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360016","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS052","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360016-00","Blue Advantage Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS051","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320006-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO? 006","87571OK032",,"OKN001","OKS051","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320006-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360016","Blue Advantage Silver PPO 003","87571OK036",,"OKN012","OKS052","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360016-01","Blue Advantage Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360046","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS012","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360046-00","Blue Advantage Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350057","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS012","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350057-00","Blue Advantage Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350057","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS012","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350057-01","Blue Advantage Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360046","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS012","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360046-01","Blue Advantage Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360004","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS022","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360004-00","Blue Advantage Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350057","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS012","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350057-02","Blue Advantage Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350057","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS012","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350057-03","Blue Advantage Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360004","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS022","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360004-01","Blue Advantage Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360017","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS032","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360017-00","Blue Advantage Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350022","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS022","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350022-00","Blue Advantage Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350022","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS022","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350022-01","Blue Advantage Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360017","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS032","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360017-01","Blue Advantage Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360018","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS042","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360018-00","Blue Advantage Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350022","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS022","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350022-02","Blue Advantage Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350022","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS022","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350022-03","Blue Advantage Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360018","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS042","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360018-01","Blue Advantage Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360019","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS052","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360019-00","Blue Advantage Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS032","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350006-00","Blue Advantage Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS032","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350006-01","Blue Advantage Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360019","Blue Advantage Silver PPO 004","87571OK036",,"OKN012","OKS052","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360019-01","Blue Advantage Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360048","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS012","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360048-00","Blue Advantage Silver PPO 007","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS032","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350006-02","Blue Advantage Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS032","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350006-03","Blue Advantage Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360048","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS012","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360048-01","Blue Advantage Silver PPO 007","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360007","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS022","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360007-00","Blue Advantage Silver PPO 007","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350023","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS042","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350023-00","Blue Advantage Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350023","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS042","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350023-01","Blue Advantage Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360007","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS022","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360007-01","Blue Advantage Silver PPO 007","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360026","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS032","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360026-00","Blue Advantage Silver PPO 007","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350023","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS042","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350023-02","Blue Advantage Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360027","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS042","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360027-00","Blue Advantage Silver PPO 007","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350024","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS052","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350024-00","Blue Advantage Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350024","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS052","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350024-01","Blue Advantage Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350041","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS052","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350041-02","Blue Advantage Bronze PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350041","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS052","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350041-03","Blue Advantage Bronze PPO? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330020","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS051","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330020-01","Blue Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330022","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS011","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330022-00","Blue Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$200","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330022","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS011","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330022-01","Blue Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360027","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS042","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360027-01","Blue Advantage Silver PPO 007","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360028","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS052","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360028-00","Blue Advantage Silver PPO 007","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350024","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS052","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350024-02","Blue Advantage Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350024","Blue Advantage Bronze PPO? 006","87571OK035",,"OKN002","OKS052","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350024-03","Blue Advantage Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$19,500","$19500 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350006-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0360028","Blue Advantage Silver PPO 007","87571OK036",,"OKN012","OKS052","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0360028-01","Blue Advantage Silver PPO 007","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,300","$200","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0360007-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350061","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS012","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350061-00","Blue Advantage Bronze PPO? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350061","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS012","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350061-01","Blue Advantage Bronze PPO? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","87571OK0390002","BlueCare Dental? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330014","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS011","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330014-01","Blue Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330013","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS021","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330013-00","Blue Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350061","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS012","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350061-02","Blue Advantage Bronze PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350061","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS012","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350061-03","Blue Advantage Bronze PPO? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330013","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS021","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330013-01","Blue Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330002","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS031","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330002-00","Blue Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350028","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS022","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350028-00","Blue Advantage Bronze PPO? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350028","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS022","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350028-01","Blue Advantage Bronze PPO? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330002","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS031","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330002-01","Blue Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330015","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS041","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330015-00","Blue Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350028","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS022","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350028-02","Blue Advantage Bronze PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350028","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS022","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350028-03","Blue Advantage Bronze PPO? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330015","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS041","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330015-01","Blue Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330016","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS051","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330016-00","Blue Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350039","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS032","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350039-00","Blue Advantage Bronze PPO? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350039","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS032","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350039-01","Blue Advantage Bronze PPO? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330016","Blue Preferred Gold PPO 002","87571OK033",,"OKN011","OKS051","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330016-01","Blue Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330018","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS011","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330018-00","Blue Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350039","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS032","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350039-02","Blue Advantage Bronze PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350039","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS032","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350039-03","Blue Advantage Bronze PPO? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330018","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS011","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330018-01","Blue Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330017","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS021","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330017-00","Blue Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350040","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS042","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350040-00","Blue Advantage Bronze PPO? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330004","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS031","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330004-00","Blue Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$200","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300004","Blue Choice Silver PPO 004","87571OK030",,"OKN013","OKS003","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300004-00","Blue Choice Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320063","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS031","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320063-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320077","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS051","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320077-01","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350059","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350059-02","Blue Advantage Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350059","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350059-03","Blue Advantage Silver PPO? 102","Limited Cost Sharing Plan Variation","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350059","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350059-04","Blue Advantage Silver PPO? 102","73% AV Level Silver Plan","73.20%","0","Yes","Yes","Yes","60%","40%","$2,900","$400","$0","$200","$2,900","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$8,700","$8700 per person","$26100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350040","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS042","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350040-01","Blue Advantage Bronze PPO? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330017","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS021","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330017-01","Blue Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330003","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS031","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330003-00","Blue Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350040","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS042","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350040-02","Blue Advantage Bronze PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350040","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS042","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350040-03","Blue Advantage Bronze PPO? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330003","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS031","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330003-01","Blue Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330019","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS041","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330019-00","Blue Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350041","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS052","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350041-00","Blue Advantage Bronze PPO? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350041","Blue Advantage Bronze PPO? 104","87571OK035",,"OKN002","OKS052","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350041-01","Blue Advantage Bronze PPO? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350028-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330019","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS041","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330019-01","Blue Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330020","Blue Preferred Silver PPO 003","87571OK033",,"OKN011","OKS051","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330020-00","Blue Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330021","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS021","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330021-00","Blue Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$200","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330021","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS021","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330021-01","Blue Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330004","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS031","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330004-01","Blue Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330023","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS041","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330023-00","Blue Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$200","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330023","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS041","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330023-01","Blue Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330024","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS051","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330024-00","Blue Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$200","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330024","Blue Preferred Silver PPO 004","87571OK033",,"OKN011","OKS051","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330024-01","Blue Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330038","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS011","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330038-00","Blue Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330038","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS011","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330038-01","Blue Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330037","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS021","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330037-00","Blue Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330037","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS021","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330037-01","Blue Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330008","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS031","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330008-00","Blue Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330008","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS031","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330008-01","Blue Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330039","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS041","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330039-00","Blue Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330039","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS041","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330039-01","Blue Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330040","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS051","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330040-00","Blue Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0330040","Blue Preferred Silver PPO 008","87571OK033",,"OKN011","OKS051","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0330040-01","Blue Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0330008-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300002","Blue Choice Gold PPO 002","87571OK030",,"OKN013","OKS003","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300002-00","Blue Choice Gold PPO 002","Standard Gold Off Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300002-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","87571OK0390004","BlueCare Dental 4 Kids? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320046","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS011","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320046-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320046","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS011","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320046-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","87571OK0390004","BlueCare Dental 4 Kids? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300002","Blue Choice Gold PPO 002","87571OK030",,"OKN013","OKS003","OKF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300002-01","Blue Choice Gold PPO 002","Standard Gold On Exchange Plan","81.04%","0","No","Yes","Yes","60%","40%","$1,500","$200","$100","$200","$1,500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300003","Blue Choice Silver PPO 003","87571OK030",,"OKN013","OKS003","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300003-00","Blue Choice Silver PPO 003","Standard Silver Off Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300003-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320062","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS021","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320062-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320062","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS021","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320062-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300003","Blue Choice Silver PPO 003","87571OK030",,"OKN013","OKS003","OKF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300003-01","Blue Choice Silver PPO 003","Standard Silver On Exchange Plan","69.76%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$3,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320063","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS031","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320063-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300004","Blue Choice Silver PPO 004","87571OK030",,"OKN013","OKS003","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300004-01","Blue Choice Silver PPO 004","Standard Silver On Exchange Plan","71.44%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,000","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300004-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300016","Blue Choice Silver PPO 016","87571OK030",,"OKN013","OKS003","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300016-00","Blue Choice Silver PPO 016","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300016-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320064","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS041","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320064-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320064","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS041","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320064-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","87571OK0300016","Blue Choice Silver PPO 016","87571OK030",,"OKN013","OKS003","OKF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0300016-01","Blue Choice Silver PPO 016","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","60%","40%","$2,500","$400","$30","$200","$2,500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%","$2,500","$2500 per person","$7500 per group","30.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0300016-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320065","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS051","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320065-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320065","Blue Preferred Security PPO? 100","87571OK032",,"OKN001","OKS051","OKF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320065-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320049","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS011","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320049-00","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320049","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS011","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320049-01","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320049","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS011","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320049-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320049","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS011","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320049-03","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320074","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS021","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320074-00","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320074","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS021","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320074-01","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320074","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS021","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320074-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320074","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS021","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320074-03","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320075","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS031","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320075-00","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320075","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS031","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320075-01","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320075","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS031","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320075-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320075","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS031","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320075-03","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320076","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS041","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320076-00","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320076","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS041","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320076-01","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320076","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS041","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320076-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320076","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS041","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320076-03","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320077","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS051","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320077-00","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320077","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS051","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320077-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320077","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS051","OKF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320077-03","Blue Preferred Bronze PPO? 103 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616387844085693","Yes","Yes","Yes","60%","40%","$6,800","$0","$200","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","30.00%","$6,750","$6750 per person","$14300 per group","30.00%","$20,250","$20250 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320049-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350034-06","Blue Advantage Silver PPO? 102","94% AV Level Silver Plan","93.57%","0","Yes","Yes","Yes","60%","40%","$0","$0","$700","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350035-00","Blue Advantage Silver PPO? 102","Standard Silver Off Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350035-01","Blue Advantage Silver PPO? 102","Standard Silver On Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350058","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350058-00","Blue Advantage Gold PPO? 101","Standard Gold Off Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350058","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350058-01","Blue Advantage Gold PPO? 101","Standard Gold On Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350058","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350058-02","Blue Advantage Gold PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350058","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350058-03","Blue Advantage Gold PPO? 101","Limited Cost Sharing Plan Variation","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350025","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350025-00","Blue Advantage Gold PPO? 101","Standard Gold Off Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350025","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350025-01","Blue Advantage Gold PPO? 101","Standard Gold On Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350025","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350025-02","Blue Advantage Gold PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350025","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350025-03","Blue Advantage Gold PPO? 101","Limited Cost Sharing Plan Variation","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350030","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350030-00","Blue Advantage Gold PPO? 101","Standard Gold Off Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350030","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350030-01","Blue Advantage Gold PPO? 101","Standard Gold On Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350030","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350030-02","Blue Advantage Gold PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350030","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350030-03","Blue Advantage Gold PPO? 101","Limited Cost Sharing Plan Variation","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350031","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350031-00","Blue Advantage Gold PPO? 101","Standard Gold Off Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350031","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350031-01","Blue Advantage Gold PPO? 101","Standard Gold On Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350031","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350031-02","Blue Advantage Gold PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350031","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350031-03","Blue Advantage Gold PPO? 101","Limited Cost Sharing Plan Variation","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350032","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350032-00","Blue Advantage Gold PPO? 101","Standard Gold Off Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350032","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350032-01","Blue Advantage Gold PPO? 101","Standard Gold On Exchange Plan","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350032","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350032-02","Blue Advantage Gold PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350032","Blue Advantage Gold PPO? 101","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350032-03","Blue Advantage Gold PPO? 101","Limited Cost Sharing Plan Variation","79.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350025-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350059","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350059-00","Blue Advantage Silver PPO? 102","Standard Silver Off Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350059","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350059-01","Blue Advantage Silver PPO? 102","Standard Silver On Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350059","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350059-05","Blue Advantage Silver PPO? 102","87% AV Level Silver Plan","86.98%","0","Yes","Yes","Yes","60%","40%","$200","$400","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350034-03","Blue Advantage Silver PPO? 102","Limited Cost Sharing Plan Variation","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350034-04","Blue Advantage Silver PPO? 102","73% AV Level Silver Plan","73.20%","0","Yes","Yes","Yes","60%","40%","$2,900","$400","$0","$200","$2,900","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$8,700","$8700 per person","$26100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320047-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320066-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320069-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350064","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS012","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350064-03","Blue Advantage Silver PPO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350064","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS012","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350064-04","Blue Advantage Silver PPO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350059","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350059-06","Blue Advantage Silver PPO? 102","94% AV Level Silver Plan","93.57%","0","Yes","Yes","Yes","60%","40%","$0","$0","$700","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350026-00","Blue Advantage Silver PPO? 102","Standard Silver Off Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350026-01","Blue Advantage Silver PPO? 102","Standard Silver On Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350026-02","Blue Advantage Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350026-03","Blue Advantage Silver PPO? 102","Limited Cost Sharing Plan Variation","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350026-04","Blue Advantage Silver PPO? 102","73% AV Level Silver Plan","73.20%","0","Yes","Yes","Yes","60%","40%","$2,900","$400","$0","$200","$2,900","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$8,700","$8700 per person","$26100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350026-05","Blue Advantage Silver PPO? 102","87% AV Level Silver Plan","86.98%","0","Yes","Yes","Yes","60%","40%","$200","$400","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350026-06","Blue Advantage Silver PPO? 102","94% AV Level Silver Plan","93.57%","0","Yes","Yes","Yes","60%","40%","$0","$0","$700","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350033-00","Blue Advantage Silver PPO? 102","Standard Silver Off Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350033-01","Blue Advantage Silver PPO? 102","Standard Silver On Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350033-02","Blue Advantage Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350033-03","Blue Advantage Silver PPO? 102","Limited Cost Sharing Plan Variation","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350033-04","Blue Advantage Silver PPO? 102","73% AV Level Silver Plan","73.20%","0","Yes","Yes","Yes","60%","40%","$2,900","$400","$0","$200","$2,900","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$8,700","$8700 per person","$26100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350033-05","Blue Advantage Silver PPO? 102","87% AV Level Silver Plan","86.98%","0","Yes","Yes","Yes","60%","40%","$200","$400","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350033-06","Blue Advantage Silver PPO? 102","94% AV Level Silver Plan","93.57%","0","Yes","Yes","Yes","60%","40%","$0","$0","$700","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350034-00","Blue Advantage Silver PPO? 102","Standard Silver Off Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350034-01","Blue Advantage Silver PPO? 102","Standard Silver On Exchange Plan","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350034-02","Blue Advantage Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350034-05","Blue Advantage Silver PPO? 102","87% AV Level Silver Plan","86.98%","0","Yes","Yes","Yes","60%","40%","$200","$400","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350035-02","Blue Advantage Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350035-03","Blue Advantage Silver PPO? 102","Limited Cost Sharing Plan Variation","70.26%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320066-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320067-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320067-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320067-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320067-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090006","CommunityCare PPO Gold C Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090006-00","CommunityCare PPO Gold C Select","Standard Gold Off Exchange Plan",,"0.788877904415131","Yes","Yes","No","100%",,"$2,900","$30","$1,300","$200","$0","$800","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090006-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090006-00"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350035-04","Blue Advantage Silver PPO? 102","73% AV Level Silver Plan","73.20%","0","Yes","Yes","Yes","60%","40%","$2,900","$400","$0","$200","$2,900","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$8,700","$8700 per person","$26100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350035-05","Blue Advantage Silver PPO? 102","87% AV Level Silver Plan","86.98%","0","Yes","Yes","Yes","60%","40%","$200","$400","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO? 102","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350035-06","Blue Advantage Silver PPO? 102","94% AV Level Silver Plan","93.57%","0","Yes","Yes","Yes","60%","40%","$0","$0","$700","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350026-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350060","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350060-00","Blue Advantage Silver PPO? 103","Standard Silver Off Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350060","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350060-01","Blue Advantage Silver PPO? 103","Standard Silver On Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350060","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350060-02","Blue Advantage Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350060","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350060-03","Blue Advantage Silver PPO? 103","Limited Cost Sharing Plan Variation","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350060","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350060-04","Blue Advantage Silver PPO? 103","73% AV Level Silver Plan","73.15%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$0","$200","$3,800","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$11400 per group","20.00%","$3,800","$3800 per person","$11400 per group","20.00%","$11,400","$11400 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350060","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350060-05","Blue Advantage Silver PPO? 103","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$100","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350060","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS012","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350060-06","Blue Advantage Silver PPO? 103","94% AV Level Silver Plan","94.15%","0","Yes","Yes","Yes","60%","40%","$300","$300","$100","$200","$300","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20.00%","$250","$250 per person","$750 per group","20.00%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350027-00","Blue Advantage Silver PPO? 103","Standard Silver Off Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350027-01","Blue Advantage Silver PPO? 103","Standard Silver On Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350027-02","Blue Advantage Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350027-03","Blue Advantage Silver PPO? 103","Limited Cost Sharing Plan Variation","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350027-04","Blue Advantage Silver PPO? 103","73% AV Level Silver Plan","73.15%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$0","$200","$3,800","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$11400 per group","20.00%","$3,800","$3800 per person","$11400 per group","20.00%","$11,400","$11400 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350027-05","Blue Advantage Silver PPO? 103","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$100","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS022","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350027-06","Blue Advantage Silver PPO? 103","94% AV Level Silver Plan","94.15%","0","Yes","Yes","Yes","60%","40%","$300","$300","$100","$200","$300","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20.00%","$250","$250 per person","$750 per group","20.00%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350036-00","Blue Advantage Silver PPO? 103","Standard Silver Off Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350036-01","Blue Advantage Silver PPO? 103","Standard Silver On Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350036-02","Blue Advantage Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350036-03","Blue Advantage Silver PPO? 103","Limited Cost Sharing Plan Variation","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350036-04","Blue Advantage Silver PPO? 103","73% AV Level Silver Plan","73.15%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$0","$200","$3,800","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$11400 per group","20.00%","$3,800","$3800 per person","$11400 per group","20.00%","$11,400","$11400 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350036-05","Blue Advantage Silver PPO? 103","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$100","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS032","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350036-06","Blue Advantage Silver PPO? 103","94% AV Level Silver Plan","94.15%","0","Yes","Yes","Yes","60%","40%","$300","$300","$100","$200","$300","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20.00%","$250","$250 per person","$750 per group","20.00%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350037-00","Blue Advantage Silver PPO? 103","Standard Silver Off Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350037-01","Blue Advantage Silver PPO? 103","Standard Silver On Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350037-02","Blue Advantage Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350037-03","Blue Advantage Silver PPO? 103","Limited Cost Sharing Plan Variation","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350037-04","Blue Advantage Silver PPO? 103","73% AV Level Silver Plan","73.15%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$0","$200","$3,800","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$11400 per group","20.00%","$3,800","$3800 per person","$11400 per group","20.00%","$11,400","$11400 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350037-05","Blue Advantage Silver PPO? 103","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$100","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS042","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350037-06","Blue Advantage Silver PPO? 103","94% AV Level Silver Plan","94.15%","0","Yes","Yes","Yes","60%","40%","$300","$300","$100","$200","$300","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20.00%","$250","$250 per person","$750 per group","20.00%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350038-00","Blue Advantage Silver PPO? 103","Standard Silver Off Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350038-01","Blue Advantage Silver PPO? 103","Standard Silver On Exchange Plan","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350038-02","Blue Advantage Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350038-03","Blue Advantage Silver PPO? 103","Limited Cost Sharing Plan Variation","71.06%","0","Yes","Yes","Yes","60%","40%","$4,000","$300","$0","$200","$4,000","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350038-04","Blue Advantage Silver PPO? 103","73% AV Level Silver Plan","73.15%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$0","$200","$3,800","$20","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$11400 per group","20.00%","$3,800","$3800 per person","$11400 per group","20.00%","$11,400","$11400 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350038-05","Blue Advantage Silver PPO? 103","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$300","$100","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO? 103","87571OK035",,"OKN002","OKS052","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350038-06","Blue Advantage Silver PPO? 103","94% AV Level Silver Plan","94.15%","0","Yes","Yes","Yes","60%","40%","$300","$300","$100","$200","$300","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20.00%","$250","$250 per person","$750 per group","20.00%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350027-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320047-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320047-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320047-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320047-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320047-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","73.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$3,000","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320047-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320066-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320066-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320066-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320066-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","73.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$3,000","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320066-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320067-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","73.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$3,000","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320067-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320067-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320068-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320068-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320068-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320068-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320068-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","73.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$3,000","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320068-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320068-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320069-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320069-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320069-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320069-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.81%","0","Yes","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320069-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","73.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$3,000","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0320069-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0320047-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350062","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS012","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350062-00","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350062","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS012","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350062-01","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350062","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS012","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350062-02","Blue Advantage Bronze PPO? 105","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350062","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS012","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350062-03","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350029","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS022","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350029-00","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350029","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS022","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350029-01","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350029","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS022","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350029-02","Blue Advantage Bronze PPO? 105","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350029","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS022","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350029-03","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350042","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS032","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350042-00","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350042","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS032","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350042-01","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350042","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS032","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350042-02","Blue Advantage Bronze PPO? 105","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350042","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS032","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350042-03","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350043","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS042","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350043-00","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350043","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS042","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350043-01","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350043","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS042","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350043-02","Blue Advantage Bronze PPO? 105","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350043","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS042","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350043-03","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350044","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS052","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350044-00","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350044","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS052","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350044-01","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350044","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS052","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350044-02","Blue Advantage Bronze PPO? 105","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350044","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS052","OKF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350044-03","Blue Advantage Bronze PPO? 105 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.58%","0","Yes","Yes","Yes","60%","40%","$6,800","$20","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14300 per group","20.00%","$6,800","$6800 per person","$14300 per group","20.00%","$20,400","$20400 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350029-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350064","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS012","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350064-00","Blue Advantage Silver PPO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350064","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS012","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350064-01","Blue Advantage Silver PPO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350064","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS012","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350064-02","Blue Advantage Silver PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350064","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS012","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350064-05","Blue Advantage Silver PPO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$700","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350064","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS012","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350064-06","Blue Advantage Silver PPO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350052","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS042","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350052-04","Blue Advantage Silver PPO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350052","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS042","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350052-05","Blue Advantage Silver PPO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$700","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170098","CommunityCare Bronze 1 Select","98905OK017","7003819233","OKN001","OKS001","OKF011","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170098-00","CommunityCare Bronze 1 Select","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$7,300","$50","$0","$200","$700","$1,600","$200","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170098-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170098-00"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350046","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS022","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350046-00","Blue Advantage Silver PPO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350046","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS022","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350046-01","Blue Advantage Silver PPO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350046","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS022","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350046-02","Blue Advantage Silver PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350046","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS022","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350046-03","Blue Advantage Silver PPO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350046","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS022","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350046-04","Blue Advantage Silver PPO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350046","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS022","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350046-05","Blue Advantage Silver PPO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$700","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350046","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS022","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350046-06","Blue Advantage Silver PPO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350051","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS032","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350051-00","Blue Advantage Silver PPO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350051","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS032","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350051-01","Blue Advantage Silver PPO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350051","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS032","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350051-02","Blue Advantage Silver PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350051","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS032","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350051-03","Blue Advantage Silver PPO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350051","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS032","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350051-04","Blue Advantage Silver PPO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350051","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS032","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350051-05","Blue Advantage Silver PPO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$700","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350051","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS032","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350051-06","Blue Advantage Silver PPO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350052","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS042","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350052-00","Blue Advantage Silver PPO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350052","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS042","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350052-01","Blue Advantage Silver PPO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350052","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS042","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350052-02","Blue Advantage Silver PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350052","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS042","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350052-03","Blue Advantage Silver PPO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350052","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS042","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350052-06","Blue Advantage Silver PPO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350053","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS052","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350053-00","Blue Advantage Silver PPO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-00.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350053","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS052","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350053-01","Blue Advantage Silver PPO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350053","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS052","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350053-02","Blue Advantage Silver PPO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350053","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS052","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350053-03","Blue Advantage Silver PPO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350053","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS052","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350053-04","Blue Advantage Silver PPO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350053","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS052","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350053-05","Blue Advantage Silver PPO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$700","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","87571OK0350053","Blue Advantage Silver PPO? 104","87571OK035",,"OKN002","OKS052","OKF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0350053-06","Blue Advantage Silver PPO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0350046-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090004","CommunityCare PPO Platinum A Select","87698OK009","7912900140","OKN001","OKS001","OKF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090004-00","CommunityCare PPO Platinum A Select","Standard Platinum Off Exchange Plan",,"0.881174087524414","Yes","Yes","No","100%",,"$1,000","$30","$1,200","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090004-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090004-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090004","CommunityCare PPO Platinum A Select","87698OK009","7912900140","OKN001","OKS001","OKF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090004-01","CommunityCare PPO Platinum A Select","Standard Platinum On Exchange Plan",,"0.881174087524414","Yes","Yes","No","100%",,"$1,000","$30","$1,200","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090004-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090004-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090008","CommunityCare PPO Gold A Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090008-00","CommunityCare PPO Gold A Select","Standard Gold Off Exchange Plan",,"0.816132187843323","Yes","Yes","No","100%",,"$1,900","$30","$1,600","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090008-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090008-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090008","CommunityCare PPO Gold A Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090008-01","CommunityCare PPO Gold A Select","Standard Gold On Exchange Plan",,"0.816132187843323","Yes","Yes","No","100%",,"$1,900","$30","$1,600","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090008-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090008-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090007","CommunityCare PPO Gold B Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090007-00","CommunityCare PPO Gold B Select","Standard Gold Off Exchange Plan",,"0.806976437568665","Yes","Yes","No","100%",,"$2,400","$30","$1,400","$200","$0","$800","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090007-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090007-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090007","CommunityCare PPO Gold B Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090007-01","CommunityCare PPO Gold B Select","Standard Gold On Exchange Plan",,"0.806976437568665","Yes","Yes","No","100%",,"$2,400","$30","$1,400","$200","$0","$800","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090007-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090007-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090006","CommunityCare PPO Gold C Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090006-01","CommunityCare PPO Gold C Select","Standard Gold On Exchange Plan",,"0.788877904415131","Yes","Yes","No","100%",,"$2,900","$30","$1,300","$200","$0","$800","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090006-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090006-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090005","CommunityCare PPO Gold D Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090005-00","CommunityCare PPO Gold D Select","Standard Gold Off Exchange Plan",,"0.800007700920105","Yes","Yes","No","100%",,"$3,400","$30","$700","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090005-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090005-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090005","CommunityCare PPO Gold D Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090005-01","CommunityCare PPO Gold D Select","Standard Gold On Exchange Plan",,"0.800007700920105","Yes","Yes","No","100%",,"$3,400","$30","$700","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090005-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090005-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090012","CommunityCare PPO Silver A Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090012-00","CommunityCare PPO Silver A Select","Standard Silver Off Exchange Plan",,"0.719489574432373","Yes","Yes","No","100%",,"$4,400","$30","$900","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090012-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090012-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090012","CommunityCare PPO Silver A Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090012-01","CommunityCare PPO Silver A Select","Standard Silver On Exchange Plan",,"0.719489574432373","Yes","Yes","No","100%",,"$4,400","$30","$900","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090012-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090012-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090011","CommunityCare PPO Silver B Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090011-00","CommunityCare PPO Silver B Select","Standard Silver Off Exchange Plan",,"0.719319641590118","Yes","Yes","No","100%",,"$4,900","$30","$700","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090011-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090011-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090011","CommunityCare PPO Silver B Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090011-01","CommunityCare PPO Silver B Select","Standard Silver On Exchange Plan",,"0.719319641590118","Yes","Yes","No","100%",,"$4,900","$30","$700","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090011-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090011-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090010","CommunityCare PPO Silver C Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090010-00","CommunityCare PPO Silver C Select","Standard Silver Off Exchange Plan",,"0.71528571844101","Yes","Yes","No","100%",,"$5,900","$30","$500","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090010-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090010-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090010","CommunityCare PPO Silver C Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090010-01","CommunityCare PPO Silver C Select","Standard Silver On Exchange Plan",,"0.71528571844101","Yes","Yes","No","100%",,"$5,900","$30","$500","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090010-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090010-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090013","CommunityCare PPO Silver D Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090013-00","CommunityCare PPO Silver D Select","Standard Silver Off Exchange Plan",,"0.718204319477081","Yes","Yes","No","100%",,"$6,600","$30","$100","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090013-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090013-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090013","CommunityCare PPO Silver D Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090013-01","CommunityCare PPO Silver D Select","Standard Silver On Exchange Plan",,"0.718204319477081","Yes","Yes","No","100%",,"$6,600","$30","$100","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201787698OK0090013-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090013-01"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090014","CommunityCare PPO Bronze A Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090014-00","CommunityCare PPO Bronze A Select","Standard Bronze Off Exchange Plan",,"0.619269788265228","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,800","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201787698OK0090014-00&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090014-00"
"2017","OK","87698","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1580741","87698OK0090014","CommunityCare PPO Bronze A Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9966",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","87698OK0090014-01","CommunityCare PPO Bronze A Select","Standard Bronze On Exchange Plan",,"0.619269788265228","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,800","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201787698OK0090014-01&type=sbc","http://marketplace.ccok.com?plan=201787698OK0090014-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170098","CommunityCare Bronze 1 Select","98905OK017","7003819233","OKN001","OKS001","OKF011","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170098-01","CommunityCare Bronze 1 Select","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$7,300","$50","$0","$200","$700","$1,600","$200","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170098-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170098-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170099","CommunityCare Bronze 1 Classic","98905OK017","7003819233","OKN002","OKS002","OKF011","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170099-00","CommunityCare Bronze 1 Classic","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$7,300","$50","$0","$200","$700","$1,600","$200","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170099-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170099-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170099","CommunityCare Bronze 1 Classic","98905OK017","7003819233","OKN002","OKS002","OKF011","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170099-01","CommunityCare Bronze 1 Classic","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$7,300","$50","$0","$200","$700","$1,600","$200","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170099-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170099-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170094","CommunityCare Silver 6 Select","98905OK017","7003819233","OKN001","OKS001","OKF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170094-00","CommunityCare Silver 6 Select","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$20","$600","$200","$100","$700","$90","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170094-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170094-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170094","CommunityCare Silver 6 Select","98905OK017","7003819233","OKN001","OKS001","OKF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170094-01","CommunityCare Silver 6 Select","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$20","$600","$200","$100","$700","$90","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170094-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170094-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170095","CommunityCare Silver 6 Classic","98905OK017","7003819233","OKN002","OKS002","OKF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170095-00","CommunityCare Silver 6 Classic","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$60","$600","$200","$100","$700","$90","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170095-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170095-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170095","CommunityCare Silver 6 Classic","98905OK017","7003819233","OKN002","OKS002","OKF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170095-01","CommunityCare Silver 6 Classic","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$60","$600","$200","$100","$700","$90","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170095-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170095-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170084","CommunityCare Gold 4 Select","98905OK017","7003819233","OKN001","OKS001","OKF003","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170084-00","CommunityCare Gold 4 Select","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$2,200","$20","$1,000","$200","$500","$600","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170084-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170084-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170084","CommunityCare Gold 4 Select","98905OK017","7003819233","OKN001","OKS001","OKF003","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170084-01","CommunityCare Gold 4 Select","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$2,200","$20","$1,000","$200","$500","$600","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170084-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170084-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170085","CommunityCare Gold 4 Classic","98905OK017","7003819233","OKN002","OKS002","OKF003","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170085-00","CommunityCare Gold 4 Classic","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$2,200","$20","$1,000","$200","$500","$600","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170085-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170085-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170085","CommunityCare Gold 4 Classic","98905OK017","7003819233","OKN002","OKS002","OKF003","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170085-01","CommunityCare Gold 4 Classic","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$2,200","$20","$1,000","$200","$500","$600","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170085-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170085-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170027","CommunityCare Platinum Premier Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170027-00","CommunityCare Platinum Premier Select","Standard Platinum Off Exchange Plan",,"0.917617678642273","Yes","Yes","No","100%",,"$0","$30","$700","$200","$0","$800","$50","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170027-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170027-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170027","CommunityCare Platinum Premier Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170027-01","CommunityCare Platinum Premier Select","Standard Platinum On Exchange Plan",,"0.917617678642273","Yes","Yes","No","100%",,"$0","$30","$700","$200","$0","$800","$50","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170027-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170027-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170047","CommunityCare Platinum Premier Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170047-00","CommunityCare Platinum Premier Classic","Standard Platinum Off Exchange Plan",,"0.917617678642273","Yes","Yes","No","100%",,"$0","$30","$700","$200","$0","$800","$50","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170047-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170047-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170047","CommunityCare Platinum Premier Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170047-01","CommunityCare Platinum Premier Classic","Standard Platinum On Exchange Plan",,"0.917617678642273","Yes","Yes","No","100%",,"$0","$30","$700","$200","$0","$800","$50","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170047-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170047-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170025","CommunityCare Platinum 1 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170025-00","CommunityCare Platinum 1 Select","Standard Platinum Off Exchange Plan",,"0.904553771018982","Yes","Yes","No","100%",,"$500","$300","$100","$200","$0","$800","$20","$40","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170025-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170025-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170025","CommunityCare Platinum 1 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170025-01","CommunityCare Platinum 1 Select","Standard Platinum On Exchange Plan",,"0.904553771018982","Yes","Yes","No","100%",,"$500","$300","$100","$200","$0","$800","$20","$40","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170025-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170025-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170045","CommunityCare Platinum 1 Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170045-00","CommunityCare Platinum 1 Classic","Standard Platinum Off Exchange Plan",,"0.904553771018982","Yes","Yes","No","100%",,"$500","$300","$100","$200","$0","$800","$20","$40","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170045-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170045-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170045","CommunityCare Platinum 1 Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170045-01","CommunityCare Platinum 1 Classic","Standard Platinum On Exchange Plan",,"0.904553771018982","Yes","Yes","No","100%",,"$500","$300","$100","$200","$0","$800","$20","$40","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170045-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170045-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170066","CommunityCare Platinum 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170066-00","CommunityCare Platinum 2 Select","Standard Platinum Off Exchange Plan",,"0.880932867527008","Yes","Yes","No","100%",,"$1,000","$0","$1,100","$200","$0","$800","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170066-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170066-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170066","CommunityCare Platinum 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170066-01","CommunityCare Platinum 2 Select","Standard Platinum On Exchange Plan",,"0.880932867527008","Yes","Yes","No","100%",,"$1,000","$0","$1,100","$200","$0","$800","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170066-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170066-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170076","CommunityCare Platinum 2 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170076-00","CommunityCare Platinum 2 Classic","Standard Platinum Off Exchange Plan",,"0.880932867527008","Yes","Yes","No","100%",,"$1,000","$0","$1,100","$200","$0","$800","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170076-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170076-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170076","CommunityCare Platinum 2 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170076-01","CommunityCare Platinum 2 Classic","Standard Platinum On Exchange Plan",,"0.880932867527008","Yes","Yes","No","100%",,"$1,000","$0","$1,100","$200","$0","$800","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170076-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170076-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170026","CommunityCare Platinum 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170026-00","CommunityCare Platinum 3 Select","Standard Platinum Off Exchange Plan",,"0.89600944519043","Yes","Yes","No","100%",,"$1,500","$600","$100","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170026-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170026-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170026","CommunityCare Platinum 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170026-01","CommunityCare Platinum 3 Select","Standard Platinum On Exchange Plan",,"0.89600944519043","Yes","Yes","No","100%",,"$1,500","$600","$100","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170026-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170026-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170046","CommunityCare Platinum 3 Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170046-00","CommunityCare Platinum 3 Classic","Standard Platinum Off Exchange Plan",,"0.89600944519043","Yes","Yes","No","100%",,"$1,500","$600","$100","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170046-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170046-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170046","CommunityCare Platinum 3 Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170046-01","CommunityCare Platinum 3 Classic","Standard Platinum On Exchange Plan",,"0.89600944519043","Yes","Yes","No","100%",,"$1,500","$600","$100","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170046-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170046-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170033","CommunityCare Gold 1 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170033-00","CommunityCare Gold 1 Select","Standard Gold Off Exchange Plan",,"0.818180322647095","Yes","Yes","No","100%",,"$1,500","$30","$1,700","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170033-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170033-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170033","CommunityCare Gold 1 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170033-01","CommunityCare Gold 1 Select","Standard Gold On Exchange Plan",,"0.818180322647095","Yes","Yes","No","100%",,"$1,500","$30","$1,700","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170033-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170033-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170053","CommunityCare Gold 1 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170053-00","CommunityCare Gold 1 Classic","Standard Gold Off Exchange Plan",,"0.818180322647095","Yes","Yes","No","100%",,"$1,500","$30","$1,700","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170053-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170053-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170053","CommunityCare Gold 1 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170053-01","CommunityCare Gold 1 Classic","Standard Gold On Exchange Plan",,"0.818180322647095","Yes","Yes","No","100%",,"$1,500","$30","$1,700","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170053-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170053-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170034","CommunityCare Gold 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170034-00","CommunityCare Gold 2 Select","Standard Gold Off Exchange Plan",,"0.818652451038361","Yes","Yes","No","100%",,"$1,900","$30","$1,600","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170034-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170034-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170034","CommunityCare Gold 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170034-01","CommunityCare Gold 2 Select","Standard Gold On Exchange Plan",,"0.818652451038361","Yes","Yes","No","100%",,"$1,900","$30","$1,600","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170034-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170034-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170054","CommunityCare Gold 2 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170054-00","CommunityCare Gold 2 Classic","Standard Gold Off Exchange Plan",,"0.818652451038361","Yes","Yes","No","100%",,"$1,900","$30","$1,600","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170054-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170054-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170054","CommunityCare Gold 2 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170054-01","CommunityCare Gold 2 Classic","Standard Gold On Exchange Plan",,"0.818652451038361","Yes","Yes","No","100%",,"$1,900","$30","$1,600","$200","$0","$900","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170054-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170054-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170032","CommunityCare Gold 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170032-00","CommunityCare Gold 3 Select","Standard Gold Off Exchange Plan",,"0.814120829105377","Yes","Yes","No","100%",,"$1,900","$30","$1,000","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170032-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170032-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170032","CommunityCare Gold 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170032-01","CommunityCare Gold 3 Select","Standard Gold On Exchange Plan",,"0.814120829105377","Yes","Yes","No","100%",,"$1,900","$30","$1,000","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170032-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170032-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170052","CommunityCare Gold 3 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170052-00","CommunityCare Gold 3 Classic","Standard Gold Off Exchange Plan",,"0.814120829105377","Yes","Yes","No","100%",,"$1,900","$30","$1,000","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170052-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170052-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170052","CommunityCare Gold 3 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170052-01","CommunityCare Gold 3 Classic","Standard Gold On Exchange Plan",,"0.814120829105377","Yes","Yes","No","100%",,"$1,900","$30","$1,000","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170052-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170052-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170030","CommunityCare Gold 6 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170030-00","CommunityCare Gold 6 Select","Standard Gold Off Exchange Plan",,"0.802264094352722","Yes","Yes","No","100%",,"$2,400","$30","$1,000","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170030-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170030-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170030","CommunityCare Gold 6 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170030-01","CommunityCare Gold 6 Select","Standard Gold On Exchange Plan",,"0.802264094352722","Yes","Yes","No","100%",,"$2,400","$30","$1,000","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170030-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170030-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170050","CommunityCare Gold 6 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170050-00","CommunityCare Gold 6 Classic","Standard Gold Off Exchange Plan",,"0.802264094352722","Yes","Yes","No","100%",,"$2,400","$30","$1,000","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170050-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170050-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170050","CommunityCare Gold 6 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170050-01","CommunityCare Gold 6 Classic","Standard Gold On Exchange Plan",,"0.802264094352722","Yes","Yes","No","100%",,"$2,400","$30","$1,000","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170050-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170050-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170035","CommunityCare Gold 7 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170035-00","CommunityCare Gold 7 Select","Standard Gold Off Exchange Plan",,"0.819843530654907","Yes","Yes","No","100%",,"$2,900","$800","$100","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170035-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170035-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170035","CommunityCare Gold 7 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170035-01","CommunityCare Gold 7 Select","Standard Gold On Exchange Plan",,"0.819843530654907","Yes","Yes","No","100%",,"$2,900","$800","$100","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170035-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170035-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170055","CommunityCare Gold 7 Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170055-00","CommunityCare Gold 7 Classic","Standard Gold Off Exchange Plan",,"0.819843530654907","Yes","Yes","No","100%",,"$2,900","$800","$100","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170055-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170055-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170055","CommunityCare Gold 7 Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170055-01","CommunityCare Gold 7 Classic","Standard Gold On Exchange Plan",,"0.819843530654907","Yes","Yes","No","100%",,"$2,900","$800","$100","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170055-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170055-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170028","CommunityCare Gold 8 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170028-00","CommunityCare Gold 8 Select","Standard Gold Off Exchange Plan",,"0.796728610992432","Yes","Yes","No","100%",,"$2,900","$30","$900","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170028-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170028-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170028","CommunityCare Gold 8 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170028-01","CommunityCare Gold 8 Select","Standard Gold On Exchange Plan",,"0.796728610992432","Yes","Yes","No","100%",,"$2,900","$30","$900","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170028-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170028-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170048","CommunityCare Gold 8 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170048-00","CommunityCare Gold 8 Classic","Standard Gold Off Exchange Plan",,"0.796728610992432","Yes","Yes","No","100%",,"$2,900","$30","$900","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170048-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170048-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170048","CommunityCare Gold 8 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170048-01","CommunityCare Gold 8 Classic","Standard Gold On Exchange Plan",,"0.796728610992432","Yes","Yes","No","100%",,"$2,900","$30","$900","$200","$0","$800","$100","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170048-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170048-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170067","CommunityCare Gold 9 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170067-00","CommunityCare Gold 9 Select","Standard Gold Off Exchange Plan",,"0.815308749675751","Yes","Yes","No","100%",,"$3,400","$500","$0","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170067-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170067-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170067","CommunityCare Gold 9 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170067-01","CommunityCare Gold 9 Select","Standard Gold On Exchange Plan",,"0.815308749675751","Yes","Yes","No","100%",,"$3,400","$500","$0","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170067-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170067-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170077","CommunityCare Gold 9 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170077-00","CommunityCare Gold 9 Classic","Standard Gold Off Exchange Plan",,"0.815308749675751","Yes","Yes","No","100%",,"$3,400","$500","$0","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170077-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170077-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170077","CommunityCare Gold 9 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170077-01","CommunityCare Gold 9 Classic","Standard Gold On Exchange Plan",,"0.815308749675751","Yes","Yes","No","100%",,"$3,400","$500","$0","$200","$0","$900","$100","$40","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170077-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170077-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170037","CommunityCare Silver 1 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170037-00","CommunityCare Silver 1 Select","Standard Silver Off Exchange Plan",,"0.706801056861877","No","Yes","No","100%",,"$2,900","$40","$1,300","$200","$0","$1,200","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170037-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170037-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170037","CommunityCare Silver 1 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170037-01","CommunityCare Silver 1 Select","Standard Silver On Exchange Plan",,"0.706801056861877","No","Yes","No","100%",,"$2,900","$40","$1,300","$200","$0","$1,200","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170037-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170037-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170057","CommunityCare Silver 1 Classic","98905OK017","7003819233","OKN002","OKS002","OKF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170057-00","CommunityCare Silver 1 Classic","Standard Silver Off Exchange Plan",,"0.706801056861877","No","Yes","No","100%",,"$2,900","$40","$1,300","$200","$0","$1,200","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170057-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170057-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170057","CommunityCare Silver 1 Classic","98905OK017","7003819233","OKN002","OKS002","OKF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170057-01","CommunityCare Silver 1 Classic","Standard Silver On Exchange Plan",,"0.706801056861877","No","Yes","No","100%",,"$2,900","$40","$1,300","$200","$0","$1,200","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170057-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170057-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170069","CommunityCare Silver 5 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170069-00","CommunityCare Silver 5 Select","Standard Silver Off Exchange Plan",,"0.717679619789124","No","Yes","No","100%",,"$3,900","$1,000","$100","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170069-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170069-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170069","CommunityCare Silver 5 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170069-01","CommunityCare Silver 5 Select","Standard Silver On Exchange Plan",,"0.717679619789124","No","Yes","No","100%",,"$3,900","$1,000","$100","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170069-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170069-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170079","CommunityCare Silver 5 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170079-00","CommunityCare Silver 5 Classic","Standard Silver Off Exchange Plan",,"0.717679619789124","No","Yes","No","100%",,"$3,900","$1,000","$100","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170079-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170079-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170079","CommunityCare Silver 5 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170079-01","CommunityCare Silver 5 Classic","Standard Silver On Exchange Plan",,"0.717679619789124","No","Yes","No","100%",,"$3,900","$1,000","$100","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170079-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170079-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170038","CommunityCare Silver 7 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170038-00","CommunityCare Silver 7 Select","Standard Silver Off Exchange Plan",,"0.717358767986298","Yes","Yes","No","100%",,"$5,400","$30","$0","$200","$100","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170038-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170038-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170038","CommunityCare Silver 7 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170038-01","CommunityCare Silver 7 Select","Standard Silver On Exchange Plan",,"0.717358767986298","Yes","Yes","No","100%",,"$5,400","$30","$0","$200","$100","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170038-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170038-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170058","CommunityCare Silver 7 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170058-00","CommunityCare Silver 7 Classic","Standard Silver Off Exchange Plan",,"0.717358767986298","Yes","Yes","No","100%",,"$5,400","$30","$0","$200","$100","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170058-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170058-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170058","CommunityCare Silver 7 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170058-01","CommunityCare Silver 7 Classic","Standard Silver On Exchange Plan",,"0.717358767986298","Yes","Yes","No","100%",,"$5,400","$30","$0","$200","$100","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170058-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170058-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170070","CommunityCare Silver 9 Select","98905OK017","7003819233","OKN001","OKS001","OKF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170070-00","CommunityCare Silver 9 Select","Standard Silver Off Exchange Plan",,"0.719859421253204","Yes","Yes","No","100%",,"$5,900","$400","$100","$200","$0","$1,000","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170070-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170070-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170070","CommunityCare Silver 9 Select","98905OK017","7003819233","OKN001","OKS001","OKF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170070-01","CommunityCare Silver 9 Select","Standard Silver On Exchange Plan",,"0.719859421253204","Yes","Yes","No","100%",,"$5,900","$400","$100","$200","$0","$1,000","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170070-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170070-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170080","CommunityCare Silver 9 Classic","98905OK017","7003819233","OKN002","OKS002","OKF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170080-00","CommunityCare Silver 9 Classic","Standard Silver Off Exchange Plan",,"0.719859421253204","Yes","Yes","No","100%",,"$5,900","$400","$100","$200","$0","$1,000","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170080-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170080-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170080","CommunityCare Silver 9 Classic","98905OK017","7003819233","OKN002","OKS002","OKF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170080-01","CommunityCare Silver 9 Classic","Standard Silver On Exchange Plan",,"0.719859421253204","Yes","Yes","No","100%",,"$5,900","$400","$100","$200","$0","$1,000","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170080-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170080-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170071","CommunityCare Silver 10 Select","98905OK017","7003819233","OKN001","OKS001","OKF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170071-00","CommunityCare Silver 10 Select","Standard Silver Off Exchange Plan",,"0.68366402387619","Yes","Yes","No","100%",,"$6,400","$30","$400","$200","$0","$1,000","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170071-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170071-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170071","CommunityCare Silver 10 Select","98905OK017","7003819233","OKN001","OKS001","OKF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170071-01","CommunityCare Silver 10 Select","Standard Silver On Exchange Plan",,"0.68366402387619","Yes","Yes","No","100%",,"$6,400","$30","$400","$200","$0","$1,000","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170071-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170071-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170081","CommunityCare Silver 10 Classic","98905OK017","7003819233","OKN002","OKS002","OKF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170081-00","CommunityCare Silver 10 Classic","Standard Silver Off Exchange Plan",,"0.68366402387619","Yes","Yes","No","100%",,"$6,400","$30","$400","$200","$0","$1,000","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170081-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170081-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170081","CommunityCare Silver 10 Classic","98905OK017","7003819233","OKN002","OKS002","OKF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170081-01","CommunityCare Silver 10 Classic","Standard Silver On Exchange Plan",,"0.68366402387619","Yes","Yes","No","100%",,"$6,400","$30","$400","$200","$0","$1,000","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170081-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170081-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170036","CommunityCare Silver 11 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170036-00","CommunityCare Silver 11 Select","Standard Silver Off Exchange Plan",,"0.707668542861938","Yes","Yes","No","100%",,"$6,900","$30","$0","$200","$100","$800","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170036-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170036-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170036","CommunityCare Silver 11 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170036-01","CommunityCare Silver 11 Select","Standard Silver On Exchange Plan",,"0.707668542861938","Yes","Yes","No","100%",,"$6,900","$30","$0","$200","$100","$800","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170036-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170036-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170056","CommunityCare Silver 11 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170056-00","CommunityCare Silver 11 Classic","Standard Silver Off Exchange Plan",,"0.707668542861938","Yes","Yes","No","100%",,"$6,900","$30","$0","$200","$100","$800","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170056-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170056-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170056","CommunityCare Silver 11 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170056-01","CommunityCare Silver 11 Classic","Standard Silver On Exchange Plan",,"0.707668542861938","Yes","Yes","No","100%",,"$6,900","$30","$0","$200","$100","$800","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170056-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170056-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170042","CommunityCare Bronze 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170042-00","CommunityCare Bronze 2 Select","Standard Bronze Off Exchange Plan",,"0.619269788265228","Yes","Yes","No","100%",,"$6,900","$300","$0","$200","$4,800","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201798905OK0170042-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170042-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170042","CommunityCare Bronze 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170042-01","CommunityCare Bronze 2 Select","Standard Bronze On Exchange Plan",,"0.619269788265228","Yes","Yes","No","100%",,"$6,900","$300","$0","$200","$4,800","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201798905OK0170042-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170042-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170062","CommunityCare Bronze 2 Classic","98905OK017","7003819233","OKN002","OKS002","OKF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170062-00","CommunityCare Bronze 2 Classic","Standard Bronze Off Exchange Plan",,"0.619269788265228","Yes","Yes","No","100%",,"$6,900","$300","$0","$200","$4,800","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201798905OK0170062-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170062-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170062","CommunityCare Bronze 2 Classic","98905OK017","7003819233","OKN002","OKS002","OKF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170062-01","CommunityCare Bronze 2 Classic","Standard Bronze On Exchange Plan",,"0.619269788265228","Yes","Yes","No","100%",,"$6,900","$300","$0","$200","$4,800","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201798905OK0170062-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170062-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170086","CommunityCare Gold 5 Select","98905OK017","7003819233","OKN001","OKS001","OKF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170086-00","CommunityCare Gold 5 Select","Standard Gold Off Exchange Plan",,"0.7907475233078","Yes","Yes","No","100%",,"$2,200","$30","$1,000","$200","$1,300","$700","$60","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170086-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170086-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170086","CommunityCare Gold 5 Select","98905OK017","7003819233","OKN001","OKS001","OKF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170086-01","CommunityCare Gold 5 Select","Standard Gold On Exchange Plan",,"0.7907475233078","Yes","Yes","No","100%",,"$2,200","$30","$1,000","$200","$1,300","$700","$60","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170086-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170086-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170087","CommunityCare Gold 5 Classic","98905OK017","7003819233","OKN002","OKS002","OKF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170087-00","CommunityCare Gold 5 Classic","Standard Gold Off Exchange Plan",,"0.7907475233078","Yes","Yes","No","100%",,"$2,200","$30","$1,000","$200","$1,300","$700","$60","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170087-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170087-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170087","CommunityCare Gold 5 Classic","98905OK017","7003819233","OKN002","OKS002","OKF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170087-01","CommunityCare Gold 5 Classic","Standard Gold On Exchange Plan",,"0.7907475233078","Yes","Yes","No","100%",,"$2,200","$30","$1,000","$200","$1,300","$700","$60","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201798905OK0170087-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170087-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170088","CommunityCare Silver 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170088-00","CommunityCare Silver 2 Select","Standard Silver Off Exchange Plan",,"0.694549918174744","No","Yes","No","100%",,"$2,900","$30","$1,800","$200","$100","$900","$200","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170088-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170088-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170088","CommunityCare Silver 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170088-01","CommunityCare Silver 2 Select","Standard Silver On Exchange Plan",,"0.694549918174744","No","Yes","No","100%",,"$2,900","$30","$1,800","$200","$100","$900","$200","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170088-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170088-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170089","CommunityCare Silver 2 Classic","98905OK017","7003819233","OKN002","OKS002","OKF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170089-00","CommunityCare Silver 2 Classic","Standard Silver Off Exchange Plan",,"0.694549918174744","No","Yes","No","100%",,"$2,900","$30","$1,800","$200","$100","$900","$200","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170089-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170089-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170089","CommunityCare Silver 2 Classic","98905OK017","7003819233","OKN002","OKS002","OKF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170089-01","CommunityCare Silver 2 Classic","Standard Silver On Exchange Plan",,"0.694549918174744","No","Yes","No","100%",,"$2,900","$30","$1,800","$200","$100","$900","$200","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170089-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170089-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170090","CommunityCare Silver 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170090-00","CommunityCare Silver 3 Select","Standard Silver Off Exchange Plan",,"0.681871592998505","No","Yes","No","100%",,"$3,400","$30","$1,200","$200","$700","$700","$100","$40","$0","$0","$0","$0",,"0","0","8",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170090-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170090-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170090","CommunityCare Silver 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170090-01","CommunityCare Silver 3 Select","Standard Silver On Exchange Plan",,"0.681871592998505","No","Yes","No","100%",,"$3,400","$30","$1,200","$200","$700","$700","$100","$40","$0","$0","$0","$0",,"0","0","8",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170090-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170090-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170091","CommunityCare Silver 3 Classic","98905OK017","7003819233","OKN002","OKS002","OKF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170091-00","CommunityCare Silver 3 Classic","Standard Silver Off Exchange Plan",,"0.681871592998505","No","Yes","No","100%",,"$3,400","$30","$1,200","$200","$700","$700","$100","$40","$0","$0","$0","$0",,"0","0","8",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170091-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170091-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170091","CommunityCare Silver 3 Classic","98905OK017","7003819233","OKN002","OKS002","OKF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170091-01","CommunityCare Silver 3 Classic","Standard Silver On Exchange Plan",,"0.681871592998505","No","Yes","No","100%",,"$3,400","$30","$1,200","$200","$700","$700","$100","$40","$0","$0","$0","$0",,"0","0","8",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170091-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170091-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170092","CommunityCare Silver 4 Select","98905OK017","7003819233","OKN001","OKS001","OKF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170092-00","CommunityCare Silver 4 Select","Standard Silver Off Exchange Plan",,"0.698740780353546","Yes","Yes","No","100%",,"$3,900","$30","$700","$200","$3,000","$300","$30","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201798905OK0170092-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170092-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170092","CommunityCare Silver 4 Select","98905OK017","7003819233","OKN001","OKS001","OKF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170092-01","CommunityCare Silver 4 Select","Standard Silver On Exchange Plan",,"0.698740780353546","Yes","Yes","No","100%",,"$3,900","$30","$700","$200","$3,000","$300","$30","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201798905OK0170092-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170092-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170093","CommunityCare Silver 4 Classic","98905OK017","7003819233","OKN002","OKS002","OKF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170093-00","CommunityCare Silver 4 Classic","Standard Silver Off Exchange Plan",,"0.698740780353546","Yes","Yes","No","100%",,"$3,900","$30","$700","$200","$3,000","$300","$30","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201798905OK0170093-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170093-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170093","CommunityCare Silver 4 Classic","98905OK017","7003819233","OKN002","OKS002","OKF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170093-01","CommunityCare Silver 4 Classic","Standard Silver On Exchange Plan",,"0.698740780353546","Yes","Yes","No","100%",,"$3,900","$30","$700","$200","$3,000","$300","$30","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201798905OK0170093-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170093-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170096","CommunityCare Silver 8 Select","98905OK017","7003819233","OKN001","OKS001","OKF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170096-00","CommunityCare Silver 8 Select","Standard Silver Off Exchange Plan",,"0.680594027042389","No","Yes","No","100%",,"$5,900","$300","$0","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","8",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170096-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170096-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170096","CommunityCare Silver 8 Select","98905OK017","7003819233","OKN001","OKS001","OKF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170096-01","CommunityCare Silver 8 Select","Standard Silver On Exchange Plan",,"0.680594027042389","No","Yes","No","100%",,"$5,900","$300","$0","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","8",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170096-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170096-01"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170097","CommunityCare Silver 8 Classic","98905OK017","7003819233","OKN002","OKS002","OKF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170097-00","CommunityCare Silver 8 Classic","Standard Silver Off Exchange Plan",,"0.680594027042389","No","Yes","No","100%",,"$5,900","$300","$0","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","8",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170097-00&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170097-00"
"2017","OK","98905","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","No","73-1433979","98905OK0170097","CommunityCare Silver 8 Classic","98905OK017","7003819233","OKN002","OKS002","OKF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2017","98905OK0170097-01","CommunityCare Silver 8 Classic","Standard Silver On Exchange Plan",,"0.680594027042389","No","Yes","No","100%",,"$5,900","$300","$0","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","8",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201798905OK0170097-01&type=sbc","http://marketplace.ccok.com?plan=201798905OK0170097-01"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","57-0287419","26065SC0360001","Business BlueEssentials PPO Gold 1","26065SC036",,"SCN002","SCS001","SCF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.997",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0360001-00","Business BlueEssentials PPO Gold 1","Standard Gold Off Exchange Plan",,"0.790516555309296","Yes","Yes","No","100%",,"$1,400","$20","$1,170","$150","$1,150","$480","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.southcarolinablues.com/links/metallic/2017/business/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2017/business/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380001-00","BlueEssentials Gold 1","Standard Gold Off Exchange Plan",,"0.805589199066162","No","Yes","No","100%",,"$1,200","$20","$1,210","$150","$1,150","$480","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380001-01","BlueEssentials Gold 1","Standard Gold On Exchange Plan",,"0.805589199066162","No","Yes","No","100%",,"$1,200","$20","$1,210","$150","$1,150","$480","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","57-0287419","26065SC0360001","Business BlueEssentials PPO Gold 1","26065SC036",,"SCN002","SCS001","SCF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.997",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0360001-01","Business BlueEssentials PPO Gold 1","Standard Gold On Exchange Plan",,"0.790516555309296","Yes","Yes","No","100%",,"$1,400","$20","$1,170","$150","$1,150","$480","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.southcarolinablues.com/links/metallic/2017/business/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2017/business/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","57-0287419","26065SC0360002","Business BlueEssentials PPO Silver 1","26065SC036",,"SCN002","SCS001","SCF008","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9965",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0360002-00","Business BlueEssentials PPO Silver 1","Standard Silver Off Exchange Plan",,"0.715135753154755","Yes","Yes","No","100%",,"$2,600","$20","$1,160","$150","$1,150","$600","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.southcarolinablues.com/links/metallic/2017/business/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2017/business/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-00","BlueEssentials Silver 2","Standard Silver Off Exchange Plan",,"0.703717350959778","Yes","Yes","No","100%",,"$2,000","$20","$2,100","$150","$1,150","$400","$510","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver2","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380001-02","BlueEssentials Gold 1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-02","BlueEssentials Silver 4","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver4_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","84939","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","84939SC0190001","Guardian Essentials for Families and Individuals","84939SC019",,"SCN002","SCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","84939SC0190001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","SC","84939","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","84939SC0190002","Guardian Essentials for Families and Individuals","84939SC019",,"SCN002","SCS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","84939SC0190002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","SC","84939","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","84939SC0160004","Guardian Family Essentials","84939SC016",,"SCN001","SCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","84939SC0160004-01","Guardian Family Essentials","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","SC","84939","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","84939SC0170001","Guardian Select for Families and Individuals","84939SC017",,"SCN002","SCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","84939SC0170001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","SC","84939","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","84939SC0170002","Guardian Select for Families and Individuals","84939SC017",,"SCN002","SCS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","84939SC0170002-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","SC","84939","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","84939SC0180001","Guardian Basics for Families and Individuals","84939SC018",,"SCN002","SCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","84939SC0180001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","SC","84939","HIOS","2016-05-16 23:14:35","Individual","Yes","13-5123390","84939SC0180002","Guardian Basics for Families and Individuals","84939SC018",,"SCN002","SCS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","84939SC0180002-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","SC","84966","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5581829","84966SC0120001","EHB Basic Dental Plan (Low)","84966SC012",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","84966SC0120001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380001-03","BlueEssentials Gold 1","Limited Cost Sharing Plan Variation",,"0.805589199066162","No","Yes","No","100%",,"$1,200","$20","$1,210","$150","$1,150","$480","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","57-0287419","26065SC0360002","Business BlueEssentials PPO Silver 1","26065SC036",,"SCN002","SCS001","SCF008","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9965",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0360002-01","Business BlueEssentials PPO Silver 1","Standard Silver On Exchange Plan",,"0.715135753154755","Yes","Yes","No","100%",,"$2,600","$20","$1,160","$150","$1,150","$600","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.southcarolinablues.com/links/metallic/2017/business/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2017/business/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380007-00","BlueEssentials Gold 2","Standard Gold Off Exchange Plan",,"0.808250069618225","No","Yes","No","100%",,"$800","$10","$1,940","$150","$800","$420","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold2","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380007-01","BlueEssentials Gold 2","Standard Gold On Exchange Plan",,"0.808250069618225","No","Yes","No","100%",,"$800","$10","$1,940","$150","$800","$420","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold2","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380007-02","BlueEssentials Gold 2","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380007-03","BlueEssentials Gold 2","Limited Cost Sharing Plan Variation",,"0.808250069618225","No","Yes","No","100%",,"$800","$10","$1,940","$150","$800","$420","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-00","BlueEssentials Silver 1","Standard Silver Off Exchange Plan",,"0.706279635429382","Yes","Yes","No","100%",,"$260","$20","$3,500","$150","$260","$1,500","$590","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$260","$260 per person","$520 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-01","BlueEssentials Silver 1","Standard Silver On Exchange Plan",,"0.706279635429382","Yes","Yes","No","100%",,"$260","$20","$3,500","$150","$260","$1,500","$590","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$260","$260 per person","$520 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-02","BlueEssentials Silver 1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-03","BlueEssentials Silver 1","Limited Cost Sharing Plan Variation",,"0.706279635429382","Yes","Yes","No","100%",,"$260","$20","$3,500","$150","$260","$1,500","$590","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$260","$260 per person","$520 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-04","BlueEssentials Silver 1","73% AV Level Silver Plan",,"0.739974975585938","Yes","Yes","No","100%",,"$260","$20","$3,500","$150","$260","$1,200","$660","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$260","$260 per person","$520 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver1_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-05","BlueEssentials Silver 1","87% AV Level Silver Plan",,"0.879032969474792","Yes","Yes","No","100%",,"$0","$20","$1,090","$150","$0","$1,200","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver1_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-06","BlueEssentials Silver 1","94% AV Level Silver Plan",,"0.940925419330597","Yes","Yes","No","100%",,"$0","$20","$360","$150","$0","$400","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver1_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-01","BlueEssentials Silver 2","Standard Silver On Exchange Plan",,"0.703717350959778","Yes","Yes","No","100%",,"$2,000","$20","$2,100","$150","$1,150","$400","$510","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver2","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-02","BlueEssentials Silver 2","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-03","BlueEssentials Silver 2","Limited Cost Sharing Plan Variation",,"0.703717350959778","Yes","Yes","No","100%",,"$2,000","$20","$2,100","$150","$1,150","$400","$510","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-04","BlueEssentials Silver 2","73% AV Level Silver Plan",,"0.7358318567276","Yes","Yes","No","100%",,"$1,300","$20","$2,380","$150","$1,150","$400","$510","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver2_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-05","BlueEssentials Silver 2","87% AV Level Silver Plan",,"0.877670288085938","Yes","Yes","No","100%",,"$200","$20","$1,410","$150","$200","$580","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver2_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-06","BlueEssentials Silver 2","94% AV Level Silver Plan",,"0.941527307033539","Yes","Yes","No","100%",,"$0","$20","$360","$150","$0","$600","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver2_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-00","BlueEssentials Silver 3","Standard Silver Off Exchange Plan",,"0.718974411487579","Yes","Yes","No","100%",,"$2,790","$20","$1,120","$150","$1,150","$480","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver3","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-01","BlueEssentials Silver 3","Standard Silver On Exchange Plan",,"0.718974411487579","Yes","Yes","No","100%",,"$2,790","$20","$1,120","$150","$1,150","$480","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver3","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-02","BlueEssentials Silver 3","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-03","BlueEssentials Silver 3","Limited Cost Sharing Plan Variation",,"0.718974411487579","Yes","Yes","No","100%",,"$2,790","$20","$1,120","$150","$1,150","$480","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-04","BlueEssentials Silver 3","73% AV Level Silver Plan",,"0.739352524280548","Yes","Yes","No","100%",,"$2,600","$20","$1,160","$150","$1,150","$400","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver3_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-05","BlueEssentials Silver 3","87% AV Level Silver Plan",,"0.879817306995392","Yes","Yes","No","100%",,"$100","$20","$1,430","$150","$100","$550","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver3_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-06","BlueEssentials Silver 3","94% AV Level Silver Plan",,"0.946206033229828","Yes","Yes","No","100%",,"$0","$0","$360","$150","$0","$0","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver3_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-00","BlueEssentials Silver 4","Standard Silver Off Exchange Plan",,"0.717340171337128","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$1,150","$480","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver4","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-01","BlueEssentials Silver 4","Standard Silver On Exchange Plan",,"0.717340171337128","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$1,150","$480","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver4","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-03","BlueEssentials Silver 4","Limited Cost Sharing Plan Variation",,"0.717340171337128","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$1,150","$480","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver4_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-04","BlueEssentials Silver 4","73% AV Level Silver Plan",,"0.739104688167572","No","Yes","No","100%",,"$2,400","$20","$1,460","$150","$1,150","$480","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver4_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-05","BlueEssentials Silver 4","87% AV Level Silver Plan",,"0.873042464256287","No","Yes","No","100%",,"$150","$20","$1,780","$150","$150","$730","$330","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver4_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-06","BlueEssentials Silver 4","94% AV Level Silver Plan",,"0.935498595237732","No","Yes","No","100%",,"$0","$0","$360","$150","$0","$0","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver4_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-00","BlueEssentials Silver 7","Standard Silver Off Exchange Plan",,"0.680203974246979","Yes","Yes","No","100%",,"$2,790","$10","$1,120","$150","$1,150","$280","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver7","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-01","BlueEssentials Silver 7","Standard Silver On Exchange Plan",,"0.680203974246979","Yes","Yes","No","100%",,"$2,790","$10","$1,120","$150","$1,150","$280","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver7","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-02","BlueEssentials Silver 7","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver7_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-03","BlueEssentials Silver 7","Limited Cost Sharing Plan Variation",,"0.680203974246979","Yes","Yes","No","100%",,"$2,790","$10","$1,120","$150","$1,150","$280","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver7_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-04","BlueEssentials Silver 7","73% AV Level Silver Plan",,"0.739095628261566","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver7_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-05","BlueEssentials Silver 7","87% AV Level Silver Plan",,"0.869120001792908","Yes","Yes","No","100%",,"$1,000","$0","$630","$150","$1,000","$0","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver7_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-06","BlueEssentials Silver 7","94% AV Level Silver Plan",,"0.943470060825348","Yes","Yes","No","100%",,"$200","$0","$500","$150","$200","$0","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver7_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-00","BlueEssentials Silver 11","Standard Silver Off Exchange Plan",,"0.686633467674255","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver11","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-01","BlueEssentials Silver 11","Standard Silver On Exchange Plan",,"0.686633467674255","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver11","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-02","BlueEssentials Silver 11","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver11_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-03","BlueEssentials Silver 11","Limited Cost Sharing Plan Variation",,"0.686633467674255","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver11_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-04","BlueEssentials Silver 11","73% AV Level Silver Plan",,"0.731312930583954","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver11_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-05","BlueEssentials Silver 11","87% AV Level Silver Plan",,"0.870501458644867","Yes","Yes","No","100%",,"$1,000","$0","$630","$150","$1,000","$0","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver11_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-06","BlueEssentials Silver 11","94% AV Level Silver Plan",,"0.933425605297089","Yes","Yes","No","100%",,"$0","$0","$730","$150","$0","$0","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver11_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-00","BlueEssentials Silver 12","Standard Silver Off Exchange Plan",,"0.686674773693085","Yes","Yes","No","100%",,"$2,790","$0","$1,340","$150","$1,150","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver12","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-01","BlueEssentials Silver 12","Standard Silver On Exchange Plan",,"0.686674773693085","Yes","Yes","No","100%",,"$2,790","$0","$1,340","$150","$1,150","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver12","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-02","BlueEssentials Silver 12","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver12_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-03","BlueEssentials Silver 12","Limited Cost Sharing Plan Variation",,"0.686674773693085","Yes","Yes","No","100%",,"$2,790","$0","$1,340","$150","$1,150","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver12_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-04","BlueEssentials Silver 12","73% AV Level Silver Plan",,"0.738627314567566","Yes","Yes","No","100%",,"$2,790","$0","$1,340","$150","$1,150","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver12_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-05","BlueEssentials Silver 12","87% AV Level Silver Plan",,"0.868143677711487","Yes","Yes","No","100%",,"$600","$0","$1,330","$150","$600","$0","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver12_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-06","BlueEssentials Silver 12","94% AV Level Silver Plan",,"0.934402942657471","Yes","Yes","No","100%",,"$150","$0","$360","$150","$150","$0","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver12_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-00","BlueEssentials Silver 14","Standard Silver Off Exchange Plan",,"0.681036829948425","Yes","Yes","No","100%",,"$6,650","$20","$90","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver14","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-01","BlueEssentials Silver 14","Standard Silver On Exchange Plan",,"0.681036829948425","Yes","Yes","No","100%",,"$6,650","$20","$90","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver14","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-02","BlueEssentials Silver 14","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver14_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-03","BlueEssentials Silver 14","Limited Cost Sharing Plan Variation",,"0.681036829948425","Yes","Yes","No","100%",,"$6,650","$20","$90","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver14_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-04","BlueEssentials Silver 14","73% AV Level Silver Plan",,"0.726906836032867","Yes","Yes","No","100%",,"$2,790","$20","$670","$150","$1,150","$400","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver14_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-05","BlueEssentials Silver 14","87% AV Level Silver Plan",,"0.878135800361633","Yes","Yes","No","100%",,"$800","$0","$970","$150","$800","$0","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver14_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-06","BlueEssentials Silver 14","94% AV Level Silver Plan",,"0.939066588878632","Yes","Yes","No","100%",,"$250","$0","$450","$150","$250","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver14_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380008-00","BlueEssentials HD Gold 3","Standard Gold Off Exchange Plan",,"0.801271975040436","Yes","Yes","No","100%",,"$2,200","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$4400 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDGold3","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380008-01","BlueEssentials HD Gold 3","Standard Gold On Exchange Plan",,"0.801271975040436","Yes","Yes","No","100%",,"$2,200","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$4400 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDGold3","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380008-02","BlueEssentials HD Gold 3","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDGold3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380008-03","BlueEssentials HD Gold 3","Limited Cost Sharing Plan Variation",,"0.801271975040436","Yes","Yes","No","100%",,"$2,200","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$4400 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDGold3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-00","BlueEssentials HD Silver 5","Standard Silver Off Exchange Plan",,"0.702220737934113","Yes","Yes","No","100%",,"$2,600","$0","$940","$150","$1,150","$0","$820","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver5","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-01","BlueEssentials HD Silver 5","Standard Silver On Exchange Plan",,"0.702220737934113","Yes","Yes","No","100%",,"$2,600","$0","$940","$150","$1,150","$0","$820","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver5","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-02","BlueEssentials HD Silver 5","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver5_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-03","BlueEssentials HD Silver 5","Limited Cost Sharing Plan Variation",,"0.702220737934113","Yes","Yes","No","100%",,"$2,600","$0","$940","$150","$1,150","$0","$820","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver5_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-04","BlueEssentials HD Silver 5","73% AV Level Silver Plan",,"0.739263355731964","Yes","Yes","No","100%",,"$1,750","$0","$1,110","$150","$1,150","$0","$820","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver5_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-05","BlueEssentials HD Silver 5","87% AV Level Silver Plan",,"0.87397700548172","Yes","Yes","No","100%",,"$250","$0","$1,410","$150","$250","$0","$1,000","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver5_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-06","BlueEssentials HD Silver 5","94% AV Level Silver Plan",,"0.936961114406586","Yes","Yes","No","100%",,"$200","$0","$350","$150","$200","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver5_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380011-00","BlueEssentials HD Silver 6","Standard Silver Off Exchange Plan",,"0.708173513412476","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver6","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380011-01","BlueEssentials HD Silver 6","Standard Silver On Exchange Plan",,"0.708173513412476","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver6","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380011-02","BlueEssentials HD Silver 6","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver6_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380011-03","BlueEssentials HD Silver 6","Limited Cost Sharing Plan Variation",,"0.708173513412476","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver6_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380011-04","BlueEssentials HD Silver 6","73% AV Level Silver Plan",,"0.738653838634491","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver6_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380011-05","BlueEssentials HD Silver 6","87% AV Level Silver Plan",,"0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver6_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380011-06","BlueEssentials HD Silver 6","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver6_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380022-00","BlueEssentials HD Silver 13","Standard Silver Off Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver13","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380022-01","BlueEssentials HD Silver 13","Standard Silver On Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver13","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380022-02","BlueEssentials HD Silver 13","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver13_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380022-03","BlueEssentials HD Silver 13","Limited Cost Sharing Plan Variation",,"0.680664837360382","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver13_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380022-04","BlueEssentials HD Silver 13","73% AV Level Silver Plan",,"0.738653838634491","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver13_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380022-05","BlueEssentials HD Silver 13","87% AV Level Silver Plan",,"0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver13_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380022-06","BlueEssentials HD Silver 13","94% AV Level Silver Plan",,"0.948019683361053","Yes","Yes","No","100%",,"$450","$0","$0","$150","$450","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDSilver13_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380006-00","BlueEssentials HD Bronze 2","Standard Bronze Off Exchange Plan",,"0.61224490404129","Yes","Yes","No","100%",,"$2,790","$0","$2,250","$150","$1,150","$0","$2,060","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze2","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380006-01","BlueEssentials HD Bronze 2","Standard Bronze On Exchange Plan",,"0.61224490404129","Yes","Yes","No","100%",,"$2,790","$0","$2,250","$150","$1,150","$0","$2,060","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze2","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380006-02","BlueEssentials HD Bronze 2","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380006-03","BlueEssentials HD Bronze 2","Limited Cost Sharing Plan Variation",,"0.61224490404129","Yes","Yes","No","100%",,"$2,790","$0","$2,250","$150","$1,150","$0","$2,060","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF044","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380012-00","BlueEssentials HD Bronze 3","Standard Bronze Off Exchange Plan",,"0.618163466453552","Yes","Yes","No","100%",,"$2,790","$0","$1,350","$150","$1,150","$0","$1,240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze3","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF044","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380012-01","BlueEssentials HD Bronze 3","Standard Bronze On Exchange Plan",,"0.618163466453552","Yes","Yes","No","100%",,"$2,790","$0","$1,350","$150","$1,150","$0","$1,240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze3","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF044","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380012-02","BlueEssentials HD Bronze 3","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF044","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380012-03","BlueEssentials HD Bronze 3","Limited Cost Sharing Plan Variation",,"0.618163466453552","Yes","Yes","No","100%",,"$2,790","$0","$1,350","$150","$1,150","$0","$1,240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380013","BlueEssentials HD Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380013-00","BlueEssentials HD Bronze 4","Standard Bronze Off Exchange Plan",,"0.614280521869659","Yes","Yes","No","100%",,"$2,790","$0","$1,800","$150","$1,150","$0","$1,650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze4","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380013","BlueEssentials HD Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380013-01","BlueEssentials HD Bronze 4","Standard Bronze On Exchange Plan",,"0.614280521869659","Yes","Yes","No","100%",,"$2,790","$0","$1,800","$150","$1,150","$0","$1,650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze4","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380013","BlueEssentials HD Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380013-02","BlueEssentials HD Bronze 4","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze4_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380013","BlueEssentials HD Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380013-03","BlueEssentials HD Bronze 4","Limited Cost Sharing Plan Variation",,"0.614280521869659","Yes","Yes","No","100%",,"$2,790","$0","$1,800","$150","$1,150","$0","$1,650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze4_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380014-00","BlueEssentials HD Bronze 5","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze5","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380014-01","BlueEssentials HD Bronze 5","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze5","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380014-02","BlueEssentials HD Bronze 5","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze5_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380014-03","BlueEssentials HD Bronze 5","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/HDBronze5_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380021","BlueEssentials Gold 4","26065SC038",,"SCN001","SCS001","SCF045","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380021-00","BlueEssentials Gold 4","Standard Gold Off Exchange Plan",,"0.7808758020401","No","Yes","Yes","80%","20%","$2,200","$0","$510","$150","$1,150","$0","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","10.00%","$2,200","$2200 per person","$4400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold4","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380021","BlueEssentials Gold 4","26065SC038",,"SCN001","SCS001","SCF045","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380021-01","BlueEssentials Gold 4","Standard Gold On Exchange Plan",,"0.7808758020401","No","Yes","Yes","80%","20%","$2,200","$0","$510","$150","$1,150","$0","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","10.00%","$2,200","$2200 per person","$4400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold4","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380021","BlueEssentials Gold 4","26065SC038",,"SCN001","SCS001","SCF045","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380021-02","BlueEssentials Gold 4","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","80%","20%","$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold4_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380021","BlueEssentials Gold 4","26065SC038",,"SCN001","SCS001","SCF045","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380021-03","BlueEssentials Gold 4","Limited Cost Sharing Plan Variation",,"0.7808758020401","No","Yes","Yes","80%","20%","$2,200","$0","$510","$150","$1,150","$0","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","10.00%","$2,200","$2200 per person","$4400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Gold4_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-00","BlueEssentials Silver 8","Standard Silver Off Exchange Plan",,"0.685981154441834","No","Yes","Yes","80%","20%","$2,790","$0","$670","$150","$1,150","$0","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","15.00%","$5,250","$5250 per person","$10500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver8","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-01","BlueEssentials Silver 8","Standard Silver On Exchange Plan",,"0.685981154441834","No","Yes","Yes","80%","20%","$2,790","$0","$670","$150","$1,150","$0","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","15.00%","$5,250","$5250 per person","$10500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver8","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-02","BlueEssentials Silver 8","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","80%","20%","$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver8_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-03","BlueEssentials Silver 8","Limited Cost Sharing Plan Variation",,"0.685981154441834","No","Yes","Yes","80%","20%","$2,790","$0","$670","$150","$1,150","$0","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","15.00%","$5,250","$5250 per person","$10500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver8_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-04","BlueEssentials Silver 8","73% AV Level Silver Plan",,"0.734599888324738","No","Yes","Yes","80%","20%","$2,790","$0","$450","$150","$1,150","$0","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,700","$3700 per person","$7400 per group","10.00%","$3,700","$3700 per person","$7400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver8_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-05","BlueEssentials Silver 8","87% AV Level Silver Plan",,"0.86913675069809","No","Yes","Yes","80%","20%","$850","$0","$640","$150","$850","$80","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver8_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-06","BlueEssentials Silver 8","94% AV Level Silver Plan",,"0.940310537815094","No","Yes","Yes","80%","20%","$0","$0","$0","$150","$0","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%","$0","$0 per person","$0 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver8_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-00","BlueEssentials Silver 9","Standard Silver Off Exchange Plan",,"0.680230617523193","No","Yes","No","100%",,"$2,790","$10","$2,240","$150","$1,150","$200","$640","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver9","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-01","BlueEssentials Silver 9","Standard Silver On Exchange Plan",,"0.680230617523193","No","Yes","No","100%",,"$2,790","$10","$2,240","$150","$1,150","$200","$640","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver9","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-02","BlueEssentials Silver 9","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver9_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-03","BlueEssentials Silver 9","Limited Cost Sharing Plan Variation",,"0.680230617523193","No","Yes","No","100%",,"$2,790","$10","$2,240","$150","$1,150","$200","$640","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver9_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-04","BlueEssentials Silver 9","73% AV Level Silver Plan",,"0.72250509262085","No","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$0","$640","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver9_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-05","BlueEssentials Silver 9","87% AV Level Silver Plan",,"0.879244565963745","No","Yes","No","100%",,"$1,000","$0","$1,250","$150","$1,000","$0","$250","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver9_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-06","BlueEssentials Silver 9","94% AV Level Silver Plan",,"0.9392249584198","No","Yes","No","100%",,"$300","$0","$350","$150","$300","$0","$70","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver9_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-00","BlueEssentials Silver 10","Standard Silver Off Exchange Plan",,"0.683254659175873","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver10","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-01","BlueEssentials Silver 10","Standard Silver On Exchange Plan",,"0.683254659175873","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver10","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-02","BlueEssentials Silver 10","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver10_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-03","BlueEssentials Silver 10","Limited Cost Sharing Plan Variation",,"0.683254659175873","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver10_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-04","BlueEssentials Silver 10","73% AV Level Silver Plan",,"0.7330282330513","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver10_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-05","BlueEssentials Silver 10","87% AV Level Silver Plan",,"0.87061870098114","Yes","Yes","No","100%",,"$1,700","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver10_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9948",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-06","BlueEssentials Silver 10","94% AV Level Silver Plan",,"0.948948264122009","Yes","Yes","No","100%",,"$250","$0","$0","$150","$250","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Silver10_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380005-00","BlueEssentials Bronze 1","Standard Bronze Off Exchange Plan",,"0.617136061191559","Yes","Yes","No","100%",,"$2,790","$20","$2,240","$150","$1,150","$1,200","$640","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Bronze1","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380005-01","BlueEssentials Bronze 1","Standard Bronze On Exchange Plan",,"0.617136061191559","Yes","Yes","No","100%",,"$2,790","$20","$2,240","$150","$1,150","$1,200","$640","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Bronze1","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380005-02","BlueEssentials Bronze 1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Bronze1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380005-03","BlueEssentials Bronze 1","Limited Cost Sharing Plan Variation",,"0.617136061191559","Yes","Yes","No","100%",,"$2,790","$20","$2,240","$150","$1,150","$1,200","$640","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Bronze1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0390001","BlueEssentials Catastrophic 1","26065SC039",,"SCN001","SCS001","SCF006","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0390001-00","BlueEssentials Catastrophic 1","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Catastrophic1","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","26065","HIOS","2017-01-20 09:19:19","Individual","No","57-0287419","26065SC0390001","BlueEssentials Catastrophic 1","26065SC039",,"SCN001","SCS001","SCF006","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0390001-01","BlueEssentials Catastrophic 1","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2017/individual/Catastrophic1","https://www.SouthCarolinaBlues.com/links/metallic/2017/individual/brochure"
"2017","SC","47973","HIOS","2016-08-18 02:41:03","Individual","Yes","57-0523959","47973SC0040001","Group Pediatric EHB Rider","47973SC004",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","47973SC0040001-00","Group Pediatric EHB Rider","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","47973","HIOS","2016-08-18 02:41:03","SHOP (Small Group)","Yes","57-0523959","47973SC0050001","Group Dental Policy","47973SC005",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","47973SC0050001-00","Group Dental Policy","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","47973","HIOS","2016-08-18 02:41:03","Individual","Yes","57-0523959","47973SC0040002","Group Pediatric EHB Rider","47973SC004",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","47973SC0040002-00","Group Pediatric EHB Rider","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","47973","HIOS","2016-08-18 02:41:03","SHOP (Small Group)","Yes","57-0523959","47973SC0030001","Group Child Only EHB Policy","47973SC003",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","47973SC0030001-00","Group Child Only EHB Policy","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010012","BESTDental Value","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Value_Plan.pdf"
"2017","SC","92498","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","92498SC0010007","Dentegra Dental PPO Pediatric Basic Plan","92498SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010007-17"
"2017","SC","92498","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","92498SC0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","92498SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0020007-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0020007-17"
"2017","SC","92498","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","92498SC0020012","Dentegra Dental PPO for Small Businesses Family Preferred Plan","92498SC002",,"SCN001","SCS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0020012-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0020012-17"
"2017","SC","92498","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","92498SC0010012","Dentegra Dental PPO Family Preferred Plan","92498SC001",,"SCN001","SCS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010012-17"
"2017","SC","92498","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","92498SC0010011","Dentegra Dental PPO Family Basic Plan","92498SC001",,"SCN001","SCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010011-17"
"2017","SC","92498","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","92498SC0020011","Dentegra Dental PPO for Small Businesses Family Basic Plan","92498SC002",,"SCN001","SCS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0020011-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0020011-17"
"2017","SC","97325","HIOS","2016-07-12 07:07:21","Individual","Yes","47-0397286","97325SC0020001","Renaissance Individual Dental PPO, EHB Certified","97325SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","97325","HIOS","2016-07-12 07:07:21","SHOP (Small Group)","Yes","47-0397286","97325SC0030001","Renaissance Group Dental PPO, EHB Certified","97325SC003",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0030001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","97325","HIOS","2016-07-12 07:07:21","SHOP (Small Group)","Yes","47-0397286","97325SC0030002","Renaissance Group Dental PPO, EHB Certified","97325SC003",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0030002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","97325","HIOS","2016-07-12 07:07:21","Individual","Yes","47-0397286","97325SC0020002","Renaissance Individual Dental PPO, EHB Certified","97325SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","97325","HIOS","2016-07-12 07:07:21","Individual","Yes","47-0397286","97325SC0060001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","97325SC006",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0060001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_High_2017","http://www.renaissancedental.com/SC_EHB_High_2017"
"2017","SC","54362","HIOS","2016-06-26 07:33:26","Individual","Yes","59-1031071","54362SC0030001","Cigna Dental Pediatric","54362SC003","7730182962","SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","54362SC0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","SC","84939","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","13-5123390","84939SC0140004","Guardian Family Advantage","84939SC014",,"SCN001","SCS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","84939SC0140004-01","Guardian Family Advantage","Standard High On Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010007","BESTDental Premium","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Premium_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","89281SC0020003","BESTOne Advantage Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/2017/SC_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","89281SC0020003","BESTOne Advantage Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/2017/SC_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010007","BESTDental Premium","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Premium_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010008","BESTDental Standard - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Standard-H_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","89281SC0020004","BESTOne Plus Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/2017/SC_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","89281SC0020004","BESTOne Plus Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/2017/SC_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010008","BESTDental Standard - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Standard-H_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010010","BESTDental Choice - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Choice-H_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010010","BESTDental Choice - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Choice-H_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010009","BESTDental Standard - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/sc/2017/SC_BESTDental_Standard-L_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","89281SC0020005","BESTOne Plus Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/2017/SC_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","89281SC0020005","BESTOne Plus Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/2017/SC_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010009","BESTDental Standard - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/sc/2017/SC_BESTDental_Standard-L_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010011","BESTDental Choice - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Choice-L_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","89281SC0020006","BESTOne Basic Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/2017/SC_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","89281SC0020006","BESTOne Basic Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/2017/SC_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010011","BESTDental Choice - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Choice-L_Plan.pdf"
"2017","SC","89281","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","89281SC0010012","BESTDental Value","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2017/SC_BESTDental_Value_Plan.pdf"
"2017","SC","97325","HIOS","2016-07-12 07:07:21","SHOP (Small Group)","Yes","47-0397286","97325SC0080001","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0080001-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_Group_High_2017","http://www.renaissancedental.com/SC_EHB_Group_High_2017"
"2017","SC","97325","HIOS","2016-07-12 07:07:21","SHOP (Small Group)","Yes","47-0397286","97325SC0080002","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0080002-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_Group_Low_2017","http://www.renaissancedental.com/SC_EHB_Group_Low_2017"
"2017","SC","97325","HIOS","2016-07-12 07:07:21","Individual","Yes","47-0397286","97325SC0060002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","97325SC006",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0060002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_Low_2017","http://www.renaissancedental.com/SC_EHB_Low_2017"
"2017","SC","97325","HIOS","2016-07-12 07:07:21","SHOP (Small Group)","Yes","47-0397286","97325SC0080003","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0080003-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_50_50_High_2017","http://www.renaissancedental.com/SC_50_50_High_2017"
"2017","SC","97325","HIOS","2016-07-12 07:07:21","SHOP (Small Group)","Yes","47-0397286","97325SC0080004","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0080004-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_50_50_Low_2017","http://www.renaissancedental.com/SC_50_50_Low_2017"
"2017","SC","97325","HIOS","2016-07-12 07:07:21","Individual","Yes","47-0397286","97325SC0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified","97325SC005",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0050001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","97325","HIOS","2016-07-12 07:07:21","Individual","Yes","47-0397286","97325SC0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified","97325SC005",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0050002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SC","97325","HIOS","2016-07-12 07:07:21","Individual","Yes","47-0397286","97325SC0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","97325SC007",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0070001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_Ped_High_2017","http://www.renaissancedental.com/SC_Ped_High_2017"
"2017","SC","97325","HIOS","2016-07-12 07:07:21","Individual","Yes","47-0397286","97325SC0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","97325SC007",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0070002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_Ped_Low_2017","http://www.renaissancedental.com/SC_Ped_Low_2017"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190074","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS001","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190074-00","BlueCross SG Silver 44S","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190074","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS001","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190074-01","BlueCross SG Silver 44S","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190075","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS002","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190075-00","BlueCross SG Silver 44S","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190075","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS002","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190075-01","BlueCross SG Silver 44S","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190076","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS003","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190076-00","BlueCross SG Silver 44S","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190076","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS003","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190076-01","BlueCross SG Silver 44S","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190077","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS004","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190077-00","BlueCross SG Silver 44S","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190077","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS004","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190077-01","BlueCross SG Silver 44S","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190078","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS005","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190078-00","BlueCross SG Silver 44S","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190078","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS005","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190078-01","BlueCross SG Silver 44S","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190079","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS006","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190079-00","BlueCross SG Silver 44S","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190079","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS006","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190079-01","BlueCross SG Silver 44S","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190080","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS007","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190080-00","BlueCross SG Silver 44S","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190080","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS007","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190080-01","BlueCross SG Silver 44S","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190081","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS008","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190081-00","BlueCross SG Silver 44S","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190081","BlueCross SG Silver 44S","14002TN019",,"TNN002","TNS008","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190081-01","BlueCross SG Silver 44S","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190082","BlueCross SG Silver 44P","14002TN019",,"TNN001","TNS009","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190082-00","BlueCross SG Silver 44P","Standard Silver Off Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190082","BlueCross SG Silver 44P","14002TN019",,"TNN001","TNS009","TNF017","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190082-01","BlueCross SG Silver 44P","Standard Silver On Exchange Plan",,"0.715739548206329","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-44P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190065","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS001","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190065-00","BlueCross SG Silver 25S","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190065","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS001","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190065-01","BlueCross SG Silver 25S","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190066","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS002","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190066-00","BlueCross SG Silver 25S","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190066","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS002","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190066-01","BlueCross SG Silver 25S","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190067","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS003","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190067-00","BlueCross SG Silver 25S","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190067","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS003","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190067-01","BlueCross SG Silver 25S","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190068","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS004","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190068-00","BlueCross SG Silver 25S","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190068","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS004","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190068-01","BlueCross SG Silver 25S","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190069","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS005","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190069-00","BlueCross SG Silver 25S","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190069","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS005","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190069-01","BlueCross SG Silver 25S","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190070","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS006","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190070-00","BlueCross SG Silver 25S","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190070","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS006","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190070-01","BlueCross SG Silver 25S","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190071","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS007","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190071-00","BlueCross SG Silver 25S","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190071","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS007","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190071-01","BlueCross SG Silver 25S","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190072","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS008","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190072-00","BlueCross SG Silver 25S","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190072","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS008","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190072-01","BlueCross SG Silver 25S","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190073","BlueCross SG Silver 25P","14002TN019",,"TNN001","TNS009","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190073-00","BlueCross SG Silver 25P","Standard Silver Off Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190073","BlueCross SG Silver 25P","14002TN019",,"TNN001","TNS009","TNF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190073-01","BlueCross SG Silver 25P","Standard Silver On Exchange Plan","70.52%","0.698885798454285","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2017/Grp-Silver-25P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190092","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS001","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190092-00","BlueCross SG Gold 36S","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190092","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS001","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190092-01","BlueCross SG Gold 36S","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190093","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS002","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190093-00","BlueCross SG Gold 36S","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190093","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS002","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190093-01","BlueCross SG Gold 36S","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190094","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS003","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190094-00","BlueCross SG Gold 36S","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190094","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS003","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190094-01","BlueCross SG Gold 36S","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190095","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS004","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190095-00","BlueCross SG Gold 36S","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190095","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS004","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190095-01","BlueCross SG Gold 36S","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190096","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS005","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190096-00","BlueCross SG Gold 36S","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190096","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS005","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190096-01","BlueCross SG Gold 36S","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190097","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS006","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190097-00","BlueCross SG Gold 36S","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190097","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS006","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190097-01","BlueCross SG Gold 36S","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190098","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS007","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190098-00","BlueCross SG Gold 36S","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190098","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS007","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190098-01","BlueCross SG Gold 36S","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190099","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS008","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190099-00","BlueCross SG Gold 36S","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190099","BlueCross SG Gold 36S","14002TN019",,"TNN002","TNS008","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190099-01","BlueCross SG Gold 36S","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190100","BlueCross SG Gold 36P","14002TN019",,"TNN001","TNS009","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190100-00","BlueCross SG Gold 36P","Standard Gold Off Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190100","BlueCross SG Gold 36P","14002TN019",,"TNN001","TNS009","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190100-01","BlueCross SG Gold 36P","Standard Gold On Exchange Plan",,"0.809156119823456","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-36P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190083","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS001","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190083-00","BlueCross SG Gold 31S","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190083","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS001","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190083-01","BlueCross SG Gold 31S","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190084","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS002","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190084-00","BlueCross SG Gold 31S","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190084","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS002","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190084-01","BlueCross SG Gold 31S","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190085","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS003","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190085-00","BlueCross SG Gold 31S","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190085","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS003","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190085-01","BlueCross SG Gold 31S","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190086","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS004","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190086-00","BlueCross SG Gold 31S","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190086","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS004","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190086-01","BlueCross SG Gold 31S","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190087","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS005","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190087-00","BlueCross SG Gold 31S","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190087","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS005","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190087-01","BlueCross SG Gold 31S","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190088","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS006","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190088-00","BlueCross SG Gold 31S","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190088","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS006","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190088-01","BlueCross SG Gold 31S","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190089","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS007","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190089-00","BlueCross SG Gold 31S","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190089","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS007","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190089-01","BlueCross SG Gold 31S","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190090","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS008","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190090-00","BlueCross SG Gold 31S","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190090","BlueCross SG Gold 31S","14002TN019",,"TNN002","TNS008","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190090-01","BlueCross SG Gold 31S","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330172","Bronze B07S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330172-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/129800/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190091","BlueCross SG Gold 31P","14002TN019",,"TNN001","TNS009","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190091-00","BlueCross SG Gold 31P","Standard Gold Off Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190091","BlueCross SG Gold 31P","14002TN019",,"TNN001","TNS009","TNF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190091-01","BlueCross SG Gold 31P","Standard Gold On Exchange Plan",,"0.818233072757721","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20.00%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Gold-31P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330172","Bronze B07S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330172-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/127600/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330172","Bronze B07S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330172-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330172","Bronze B07S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330172-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330174","Bronze B07S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330174-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/129800/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330174","Bronze B07S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330174-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/127600/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330174","Bronze B07S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330174-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330174","Bronze B07S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330174-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330175","Bronze B07S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330175-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/129800/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330175","Bronze B07S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330175-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/127600/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330175","Bronze B07S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330175-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330175","Bronze B07S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330175-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330177","Bronze B07S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330177-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/129800/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330177","Bronze B07S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330177-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/127600/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330177","Bronze B07S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330177-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330177","Bronze B07S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330177-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330178","Bronze B07S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330178-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/129800/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330178","Bronze B07S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330178-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2017/127600/B07S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330178","Bronze B07S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330178-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330178","Bronze B07S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330178-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.618796169757843","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50.00%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/B07S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190101","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS001","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190101-00","BlueCross SG Platinum 08S","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190101","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS001","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190101-01","BlueCross SG Platinum 08S","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190102","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS002","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190102-00","BlueCross SG Platinum 08S","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190102","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS002","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190102-01","BlueCross SG Platinum 08S","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190103","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS003","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190103-00","BlueCross SG Platinum 08S","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190103","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS003","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190103-01","BlueCross SG Platinum 08S","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190104","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS004","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190104-00","BlueCross SG Platinum 08S","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190104","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS004","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190104-01","BlueCross SG Platinum 08S","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190105","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS005","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190105-00","BlueCross SG Platinum 08S","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190105","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS005","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190105-01","BlueCross SG Platinum 08S","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190106","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS006","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190106-00","BlueCross SG Platinum 08S","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190106","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS006","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190106-01","BlueCross SG Platinum 08S","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190107","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS007","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190107-00","BlueCross SG Platinum 08S","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190107","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS007","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190107-01","BlueCross SG Platinum 08S","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190108","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS008","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190108-00","BlueCross SG Platinum 08S","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190108","BlueCross SG Platinum 08S","14002TN019",,"TNN002","TNS008","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190108-01","BlueCross SG Platinum 08S","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08S","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190109","BlueCross SG Platinum 08P","14002TN019",,"TNN001","TNS009","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190109-00","BlueCross SG Platinum 08P","Standard Platinum Off Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","SHOP (Small Group)","No","62-0427913","14002TN0190109","BlueCross SG Platinum 08P","14002TN019",,"TNN001","TNS009","TNF017","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0190109-01","BlueCross SG Platinum 08P","Standard Platinum On Exchange Plan","91.65%","0","No","Yes","No","100%",,"$200","$600","$0","$30","$0","$1,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2017/Grp-Platinum-08P","http://www.bcbst.com/SHOPbrochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330208-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330208-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330208-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330208-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330208-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.738381147384644","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330208-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.861926198005676","Yes","Yes","No","100%",,"$0","$0","$1,700","$30","$0","$0","$1,700","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330208-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930375933647156","Yes","Yes","No","100%",,"$0","$0","$675","$30","$0","$0","$675","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330210-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330210-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330210-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330210-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330210-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.738381147384644","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330210-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.861926198005676","Yes","Yes","No","100%",,"$0","$0","$1,700","$30","$0","$0","$1,700","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330210-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930375933647156","Yes","Yes","No","100%",,"$0","$0","$675","$30","$0","$0","$675","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330211-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330211-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330211-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330211-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330211-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.738381147384644","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330211-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.861926198005676","Yes","Yes","No","100%",,"$0","$0","$1,700","$30","$0","$0","$1,700","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330211-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930375933647156","Yes","Yes","No","100%",,"$0","$0","$675","$30","$0","$0","$675","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330213-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330213-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330213-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330213-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330213-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.738381147384644","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330213-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.861926198005676","Yes","Yes","No","100%",,"$0","$0","$1,700","$30","$0","$0","$1,700","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330213-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930375933647156","Yes","Yes","No","100%",,"$0","$0","$675","$30","$0","$0","$675","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330214-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330214-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330214-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330214-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.711644649505615","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330214-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.738381147384644","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330214-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.861926198005676","Yes","Yes","No","100%",,"$0","$0","$1,700","$30","$0","$0","$1,700","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330214-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930375933647156","Yes","Yes","No","100%",,"$0","$0","$675","$30","$0","$0","$675","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S01S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330240-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330240-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330240-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330240-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330240-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.720043480396271","Yes","Yes","No","100%",,"$1,350","$0","$2,850","$30","$1,350","$0","$1,900","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330240-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861378073692322","Yes","Yes","No","100%",,"$175","$0","$1,400","$30","$175","$0","$1,400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330240-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930008590221405","Yes","Yes","No","100%",,"$20","$0","$655","$30","$20","$0","$655","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330242-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330242-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330242-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330242-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330242-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.720043480396271","Yes","Yes","No","100%",,"$1,350","$0","$2,850","$30","$1,350","$0","$1,900","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330242-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861378073692322","Yes","Yes","No","100%",,"$175","$0","$1,400","$30","$175","$0","$1,400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330242-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930008590221405","Yes","Yes","No","100%",,"$20","$0","$655","$30","$20","$0","$655","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330243-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330243-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330243-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330243-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330243-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.720043480396271","Yes","Yes","No","100%",,"$1,350","$0","$2,850","$30","$1,350","$0","$1,900","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330243-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861378073692322","Yes","Yes","No","100%",,"$175","$0","$1,400","$30","$175","$0","$1,400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330243-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930008590221405","Yes","Yes","No","100%",,"$20","$0","$655","$30","$20","$0","$655","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330245-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330245-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330245-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330245-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330245-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.720043480396271","Yes","Yes","No","100%",,"$1,350","$0","$2,850","$30","$1,350","$0","$1,900","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330245-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861378073692322","Yes","Yes","No","100%",,"$175","$0","$1,400","$30","$175","$0","$1,400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330245-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930008590221405","Yes","Yes","No","100%",,"$20","$0","$655","$30","$20","$0","$655","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330246-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/129800/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330246-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330246-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330246-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.680237233638763","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$30","$2,000","$0","$1,500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330246-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.720043480396271","Yes","Yes","No","100%",,"$1,350","$0","$2,850","$30","$1,350","$0","$1,900","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-A_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330246-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861378073692322","Yes","Yes","No","100%",,"$175","$0","$1,400","$30","$175","$0","$1,400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-B_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330246-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930008590221405","Yes","Yes","No","100%",,"$20","$0","$655","$30","$20","$0","$655","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2017/127600/S04S-C_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330336","Gold G06S, Network S","14002TN033",,"TNN002","TNS001","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330336-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/129800/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330336","Gold G06S, Network S","14002TN033",,"TNN002","TNS001","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330336-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330336","Gold G06S, Network S","14002TN033",,"TNN002","TNS001","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330336-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330336","Gold G06S, Network S","14002TN033",,"TNN002","TNS001","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330336-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330338","Gold G06S, Network S","14002TN033",,"TNN002","TNS003","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330338-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/129800/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330338","Gold G06S, Network S","14002TN033",,"TNN002","TNS003","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330338-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330338","Gold G06S, Network S","14002TN033",,"TNN002","TNS003","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330338-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330338","Gold G06S, Network S","14002TN033",,"TNN002","TNS003","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330338-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330339","Gold G06S, Network S","14002TN033",,"TNN002","TNS005","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330339-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/129800/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330339","Gold G06S, Network S","14002TN033",,"TNN002","TNS005","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330339-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330339","Gold G06S, Network S","14002TN033",,"TNN002","TNS005","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330339-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330339","Gold G06S, Network S","14002TN033",,"TNN002","TNS005","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330339-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330341","Gold G06S, Network S","14002TN033",,"TNN002","TNS007","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330341-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/129800/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330341","Gold G06S, Network S","14002TN033",,"TNN002","TNS007","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330341-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330341","Gold G06S, Network S","14002TN033",,"TNN002","TNS007","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330341-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330341","Gold G06S, Network S","14002TN033",,"TNN002","TNS007","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330341-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330342","Gold G06S, Network S","14002TN033",,"TNN002","TNS008","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330342-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/129800/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330342","Gold G06S, Network S","14002TN033",,"TNN002","TNS008","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330342-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330342","Gold G06S, Network S","14002TN033",,"TNN002","TNS008","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330342-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI1_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","14002","HIOS","2017-01-20 09:19:19","Individual","No","62-0427913","14002TN0330342","Gold G06S, Network S","14002TN033",,"TNN002","TNS008","TNF023","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2017/index.page?","14002TN0330342-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.809777438640594","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2017/127600/G06S-AI2_SBC.pdf","http://www.bcbst.com/brochures"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010012","BESTDental Value","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Value_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010012","BESTDental Value","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Value_Plan.pdf"
"2017","TN","28398","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","28398TN0030001","TruAssure Dental Small Group Basic Plan","28398TN003",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","28398TN0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","28398","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","28398TN0010001","TruAssure Basic Adult or Child Dental Plan","28398TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN"
"2017","TN","28398","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","28398TN0010001","TruAssure Basic Adult or Child Dental Plan","28398TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN"
"2017","TN","28398","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","28398TN0040001","TruAssure Dental Small Group Preferred Plan","28398TN004",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","28398TN0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","28398","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","28398TN0020001","TruAssure Preferred Adult or Child Dental Plan","28398TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN"
"2017","TN","28398","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","28398TN0020001","TruAssure Preferred Adult or Child Dental Plan","28398TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","38886TN0070001","DentaTrust - PPO Pediatric High Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070001-00","DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","38886TN0080003","DentaSpan Family High Option","38886TN008","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0080003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbTN.dentalcareplus.com","https://hixsgsbTN.dentalcareplus.com"
"2017","TN","79913","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","79913TN0010011","Dentegra Dental PPO Family Basic Plan","79913TN001",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010011-17"
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","Yes","39-1263473","82120TN0630001","Humana Dental Smart Choice","82120TN063",,"TNN005","TNS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9883","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","82120TN0630001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857140"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060017","Cigna Connect HSA 5000","99248TN006","7730182962","TNN004","TNS001","TNF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060017-01","Cigna Connect HSA 5000","Standard Bronze On Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060001","Cigna Connect HSA 5000","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060001-03","Cigna Connect HSA 5000-1","Limited Cost Sharing Plan Variation",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-1-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-1-nashville-tn"
"2017","TN","21535","HIOS","2016-06-24 02:40:05","SHOP (Small Group)","Yes","13-5581829","21535TN0120001","EHB Basic Dental Plan (Low)","21535TN012",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","21535TN0120001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","22384","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","47-0397286","22384TN0040001","Delta Dental Small Group Product","22384TN004",,"TNN001","TNS001",,"Existing","POS","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","","22384TN0040001-00","Delta Dental Small Group Product","Standard Low Off Exchange Plan","70.00%",,,,"Yes","60%","40%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","22384","HIOS","2016-07-01 08:12:23","Individual","Yes","62-0812197","22384TN0010001","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384","","22384TN0010001-01","Delta Dental FFM Individual Product","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan","http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan"
"2017","TN","22384","HIOS","2016-07-01 08:12:23","Individual","Yes","62-0812197","22384TN0010002","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384","","22384TN0010002-01","Delta Dental FFM Individual Product","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan","http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan"
"2017","TN","22384","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","47-0397286","22384TN0040002","Delta Dental Small Group Product","22384TN004",,"TNN001","TNS001",,"Existing","POS","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","","22384TN0040002-00","Delta Dental Small Group Product","Standard High Off Exchange Plan","85.00%",,,,"Yes","60%","40%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","22384","HIOS","2016-07-01 08:12:23","Individual","Yes","62-0812197","22384TN0030001","Delta Dental Individual Plan","22384TN003",,"TNN002","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"","22384TN0030001-00","Delta Dental Individual Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","22384","HIOS","2016-07-01 08:12:23","Individual","Yes","62-0812197","22384TN0030002","Delta Dental Individual Plan","22384TN003",,"TNN002","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"","22384TN0030002-00","Delta Dental Individual Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","22384","HIOS","2016-07-01 08:12:23","Individual","Yes","62-0812197","22384TN0010003","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384","","22384TN0010003-01","Delta Dental FFM Individual Product","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaltn.com/ACAMarketplace/IndividualFamilyPlan","http://www.deltadentaltn.com/ACAMarketplace/IndividualFamilyPlan"
"2017","TN","22384","HIOS","2016-07-01 08:12:23","Individual","Yes","62-0812197","22384TN0010004","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384","","22384TN0010004-01","Delta Dental FFM Individual Product","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaltn.com/ACAMarketplace/IndividualFamilyPlan","http://www.deltadentaltn.com/ACAMarketplace/IndividualFamilyPlan"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","24601TN0020003","BESTOne Advantage Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/TN/2017/TN_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010007","BESTDental Premium","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Premium_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010007","BESTDental Premium","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Premium_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","24601TN0020003","BESTOne Advantage Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/TN/2017/TN_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","24601TN0020004","BESTOne Plus Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/TN/2017/TN_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010008","BESTDental Standard - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Standard-H_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010008","BESTDental Standard - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Standard-H_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","24601TN0020004","BESTOne Plus Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/TN/2017/TN_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010010","BESTDental Choice - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Choice-H_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010010","BESTDental Choice - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Choice-H_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010009","BESTDental Standard - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Standard-L_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","24601TN0020005","BESTOne Plus Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tn/2017/TN_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","24601TN0020005","BESTOne Plus Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tn/2017/TN_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010009","BESTDental Standard - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Standard-L_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010011","BESTDental Choice - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Choice-L_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","24601TN0020006","BESTOne Basic Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tn/2017/TN_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","24601TN0020006","BESTOne Basic Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tn/2017/TN_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","TN","24601","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","24601TN0010011","BESTDental Choice - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2017/TN_BESTDental_Choice-L_Plan.pdf"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","38886TN0080003","DentaSpan Family High Option","38886TN008","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0080003-01","DentaSpan Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbTN.dentalcareplus.com","https://hixsgsbTN.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","38886TN0070001","DentaTrust - PPO Pediatric High Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070001-01","DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","38886TN0070002","DentaTrust - PPO Pediatric Low Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070002-00","DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","38886TN0080004","DentaSpan Family Low Option","38886TN008","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0080004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbTN.dentalcareplus.com","https://hixsgsbTN.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","38886TN0080004","DentaSpan Family Low Option","38886TN008","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0080004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbTN.dentalcareplus.com","https://hixsgsbTN.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","38886TN0070002","DentaTrust - PPO Pediatric Low Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070002-01","DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","38886TN0090003","DentaSpan Family High Option- Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0090003-00","DentaSpan Family High Option- Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbTN.dentalcareplus.com","https://hixsgsbTN.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","38886TN0090004","DentaSpan Family Low Option- Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0090004-00","DentaSpan Family Low Option- Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbTN.dentalcareplus.com","https://hixsgsbTN.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","38886TN0090001","DentaSpan Pediatric High Option- Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0090001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbTN.dentalcareplus.com","https://hixsgsbTN.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","38886TN0070003","DentaTrust-PPO Family High Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","38886TN0070003","DentaTrust-PPO Family High Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","31-1185262","38886TN0090002","DentaSpan Pediatric Low Option- Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0090002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbTN.dentalcareplus.com","https://hixsgsbTN.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","38886TN0070004","DentaTrust-PPO Family Low Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,".Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com"
"2017","TN","38886","HIOS","2016-07-01 08:12:23","Individual","Yes","31-1185262","38886TN0070004","DentaTrust-PPO Family Low Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,".Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","20-2970185","43878TN0020003","DentaQuest EPO Family High","43878TN002",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0020003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","Individual","Yes","20-2970185","43878TN0010001","DentaQuest EPO  Pediatric High","43878TN001",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010001-00","DentaQuest EPO  Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","Individual","Yes","20-2970185","43878TN0010001","DentaQuest EPO  Pediatric High","43878TN001",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010001-01","DentaQuest EPO  Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","20-2970185","43878TN0020003","DentaQuest EPO Family High","43878TN002",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0020003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","20-2970185","43878TN0020004","DentaQuest EPO Family Low","43878TN002",,"TNN001","TNS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0020004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","SHOP (Small Group)","Yes","20-2970185","43878TN0020004","DentaQuest EPO Family Low","43878TN002",,"TNN001","TNS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0020004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","Individual","Yes","20-2970185","43878TN0010003","DentaQuest EPO Family High","43878TN001",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","Individual","Yes","20-2970185","43878TN0010003","DentaQuest EPO Family High","43878TN001",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","Individual","Yes","20-2970185","43878TN0010004","DentaQuest EPO Family Low","43878TN001",,"TNN001","TNS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","43878","HIOS","2016-06-29 04:36:58","Individual","Yes","20-2970185","43878TN0010004","DentaQuest EPO Family Low","43878TN001",,"TNN001","TNS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2017","TN","78859","HIOS","2016-08-10 02:51:42","SHOP (Small Group)","Yes","57-0523959","78859TN0020001","Group Dental Policy","78859TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditioanl with inside maximum","Yes","traditional with inside maximum","Yes",,"","78859TN0020001-00","Group Dental Policy","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","79913","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","79913TN0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","79913TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0020007-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0020007-17"
"2017","TN","79913","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","79913TN0010007","Dentegra Dental PPO Pediatric Basic Plan","79913TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010007-17"
"2017","TN","79913","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","79913TN0010012","Dentegra Dental PPO Family Preferred Plan","79913TN001",,"TNN001","TNS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010012-17"
"2017","TN","79913","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","79913TN0020012","Dentegra Dental PPO for Small Businesses Family Preferred Plan","79913TN002",,"TNN001","TNS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0020012-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn00200012-17"
"2017","TN","79913","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","79913TN0020011","Dentegra Dental PPO for Small Businesses Family Basic Plan","79913TN002",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0020011-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn00200011-17"
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600011","Humana Basic 7150/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600011-00","Humana Basic 7150/Knoxville PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850484",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600011","Humana Basic 7150/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600011-01","Humana Basic 7150/Knoxville PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850484",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","Yes","39-1263473","82120TN0630001","Humana Dental Smart Choice","82120TN063",,"TNN005","TNS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9883","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","82120TN0630001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857140"
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600021","Humana Basic 7150/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600021-00","Humana Basic 7150/Memphis PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850510",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600021","Humana Basic 7150/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600021-01","Humana Basic 7150/Memphis PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850510",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600031","Humana Basic 7150/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600031-00","Humana Basic 7150/Nashville PPOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850536",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600023","Humana Silver 3550/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600023-01","Humana Silver 3550/Memphis PPOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850861",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600023","Humana Silver 3550/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600023-02","Humana Silver 3550/Memphis PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850874",
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060017","Cigna Connect HSA 5000","99248TN006","7730182962","TNN004","TNS001","TNF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060017-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-0-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060017","Cigna Connect HSA 5000","99248TN006","7730182962","TNN004","TNS001","TNF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060017-03","Cigna Connect HSA 5000-1","Limited Cost Sharing Plan Variation",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-1-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-1-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060001","Cigna Connect HSA 5000","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060001-00","Cigna Connect HSA 5000","Standard Bronze Off Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060001","Cigna Connect HSA 5000","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060001-01","Cigna Connect HSA 5000","Standard Bronze On Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060001","Cigna Connect HSA 5000","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060001-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-nashville-tn"
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600031","Humana Basic 7150/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600031-01","Humana Basic 7150/Nashville PPOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850536",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600012","Humana Bronze 4800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600012-00","Humana Bronze 4800/Knoxville PPOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2850549",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600012","Humana Bronze 4800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600012-01","Humana Bronze 4800/Knoxville PPOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2850549",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600012","Humana Bronze 4800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600012-02","Humana Bronze 4800/Knoxville PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850562",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600012","Humana Bronze 4800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600012-03","Humana Bronze 4800/Knoxville PPOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850575",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600022","Humana Bronze 4800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600022-00","Humana Bronze 4800/Memphis PPOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2850601",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600022","Humana Bronze 4800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600022-01","Humana Bronze 4800/Memphis PPOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2850601",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600022","Humana Bronze 4800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600022-02","Humana Bronze 4800/Memphis PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850614",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600022","Humana Bronze 4800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600022-03","Humana Bronze 4800/Memphis PPOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850627",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600032","Humana Bronze 4800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600032-00","Humana Bronze 4800/Nashville PPOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2850653",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600032","Humana Bronze 4800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600032-01","Humana Bronze 4800/Nashville PPOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2850653",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600032","Humana Bronze 4800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600032-02","Humana Bronze 4800/Nashville PPOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850666",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600032","Humana Bronze 4800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","82120TN0600032-03","Humana Bronze 4800/Nashville PPOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850679",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600013","Humana Silver 3550/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600013-00","Humana Silver 3550/Knoxville PPOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850809",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600013","Humana Silver 3550/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600013-01","Humana Silver 3550/Knoxville PPOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850809",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600013","Humana Silver 3550/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600013-02","Humana Silver 3550/Knoxville PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850822",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600013","Humana Silver 3550/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600013-03","Humana Silver 3550/Knoxville PPOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850835",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600013","Humana Silver 3550/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600013-04","Humana Silver 3000/Knoxville PPOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850770",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600013","Humana Silver 3550/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600013-05","Humana Silver 900/Knoxville PPOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850952",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600013","Humana Silver 3550/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600013-06","Humana Silver 250/Knoxville PPOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850731",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600023","Humana Silver 3550/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600023-00","Humana Silver 3550/Memphis PPOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850861",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600023","Humana Silver 3550/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600023-03","Humana Silver 3550/Memphis PPOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850887",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600023","Humana Silver 3550/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600023-04","Humana Silver 3000/Memphis PPOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850783",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600023","Humana Silver 3550/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600023-05","Humana Silver 900/Memphis PPOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850965",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600023","Humana Silver 3550/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600023-06","Humana Silver 250/Memphis PPOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850744",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600033","Humana Silver 3550/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600033-00","Humana Silver 3550/Nashville PPOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850913",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600033","Humana Silver 3550/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600033-01","Humana Silver 3550/Nashville PPOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850913",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600033","Humana Silver 3550/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600033-02","Humana Silver 3550/Nashville PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850926",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600033","Humana Silver 3550/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600033-03","Humana Silver 3550/Nashville PPOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850939",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600033","Humana Silver 3550/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600033-04","Humana Silver 3000/Nashville PPOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850796",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600033","Humana Silver 3550/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600033-05","Humana Silver 900/Nashville PPOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850978",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600033","Humana Silver 3550/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600033-06","Humana Silver 250/Nashville PPOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$7,100","$7100 per person","$14200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850757",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600034","Humana Gold 1250/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF004","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600034-00","Humana Gold 1250/Nashville PPOx","Standard Gold Off Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850692",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600034","Humana Gold 1250/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF004","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600034-01","Humana Gold 1250/Nashville PPOx","Standard Gold On Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850692",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600034","Humana Gold 1250/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF004","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600034-02","Humana Gold 1250/Nashville PPOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850705",
"2017","TN","82120","HIOS","2016-08-20 07:40:33","Individual","No","39-1263473","82120TN0600034","Humana Gold 1250/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF004","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","82120TN0600034-03","Humana Gold 1250/Nashville PPOx","Limited Cost Sharing Plan Variation",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850718",
"2017","TN","90303","HIOS","2016-06-01 23:04:04","SHOP (Small Group)","Yes","47-0397286","90303TN0030001","Renaissance Group Dental PPO, EHB Certified","90303TN003",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","90303TN0030001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","90303","HIOS","2016-06-01 23:04:04","SHOP (Small Group)","Yes","47-0397286","90303TN0030002","Renaissance Group Dental PPO, EHB Certified","90303TN003",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","90303TN0030002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TN","90402","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","90402TN0090001","Guardian Essentials for Families and Individuals","90402TN009",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","90402TN0090001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","TN","90402","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","90402TN0090001","Guardian Essentials for Families and Individuals","90402TN009",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","90402TN0090001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","TN","90402","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","90402TN0070001","Guardian Select for Families and Individuals","90402TN007",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","90402TN0070001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","TN","90402","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","90402TN0070001","Guardian Select for Families and Individuals","90402TN007",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","90402TN0070001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","TN","90402","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","90402TN0080001","Guardian Basics for Families and Individuals","90402TN008",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","90402TN0080001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","TN","90402","HIOS","2016-06-23 03:05:53","Individual","Yes","13-5123390","90402TN0080001","Guardian Basics for Families and Individuals","90402TN008",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","90402TN0080001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","Yes","59-1031071","99248TN0030001","Cigna Dental Pediatric","99248TN003","7730182962","TNN003","TNS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","Yes","59-1031071","99248TN0030001","Cigna Dental Pediatric","99248TN003","7730182962","TNN003","TNS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030001-01","Cigna Dental Pediatric","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","Yes","59-1031071","99248TN0030002","Cigna Dental Family + Pediatric","99248TN003","7730182962","TNN003","TNS003",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030002-01","Cigna Dental Family + Pediatric","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-family-pediatric-fedvip"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060017","Cigna Connect HSA 5000","99248TN006","7730182962","TNN004","TNS001","TNF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060017-00","Cigna Connect HSA 5000","Standard Bronze Off Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060009","Cigna Connect HSA 5000","99248TN006","7730182962","TNN002","TNS004","TNF002","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060009-00","Cigna Connect HSA 5000","Standard Bronze Off Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060009","Cigna Connect HSA 5000","99248TN006","7730182962","TNN002","TNS004","TNF002","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060009-01","Cigna Connect HSA 5000","Standard Bronze On Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060009","Cigna Connect HSA 5000","99248TN006","7730182962","TNN002","TNS004","TNF002","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060009-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060009","Cigna Connect HSA 5000","99248TN006","7730182962","TNN002","TNS004","TNF002","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060009-03","Cigna Connect HSA 5000-1","Limited Cost Sharing Plan Variation",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-1-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-1-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060018","Cigna Connect 6400","99248TN006","7730182962","TNN004","TNS001","TNF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060018-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060018","Cigna Connect 6400","99248TN006","7730182962","TNN004","TNS001","TNF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060018-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060018","Cigna Connect 6400","99248TN006","7730182962","TNN004","TNS001","TNF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060018-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-0-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060018","Cigna Connect 6400","99248TN006","7730182962","TNN004","TNS001","TNF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060018-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-1-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-1-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060002","Cigna Connect 6400","99248TN006","7730182962","TNN002","TNS002","TNF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060002-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060002","Cigna Connect 6400","99248TN006","7730182962","TNN002","TNS002","TNF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060002-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060002","Cigna Connect 6400","99248TN006","7730182962","TNN002","TNS002","TNF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060002","Cigna Connect 6400","99248TN006","7730182962","TNN002","TNS002","TNF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060002-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-1-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-1-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060010","Cigna Connect 6400","99248TN006","7730182962","TNN002","TNS004","TNF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060010-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060010","Cigna Connect 6400","99248TN006","7730182962","TNN002","TNS004","TNF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060010-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060010","Cigna Connect 6400","99248TN006","7730182962","TNN002","TNS004","TNF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060010-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060010","Cigna Connect 6400","99248TN006","7730182962","TNN002","TNS004","TNF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060010-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","59.70%","0.611947357654572","Yes","Yes","No","100%",,"$5,570","$1,580","$0","$30","$140","$990","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-1-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-6400-1-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060020","Cigna Connect 2500","99248TN006","7730182962","TNN004","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060020-00","Cigna Connect 2500","Standard Silver Off Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060020","Cigna Connect 2500","99248TN006","7730182962","TNN004","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060020-01","Cigna Connect 2500","Standard Silver On Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060020","Cigna Connect 2500","99248TN006","7730182962","TNN004","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060020-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-0-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060020","Cigna Connect 2500","99248TN006","7730182962","TNN004","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060020-03","Cigna Connect 2500-1","Limited Cost Sharing Plan Variation","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-1-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-1-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060020","Cigna Connect 2500","99248TN006","7730182962","TNN004","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060020-04","Cigna Connect 2100-2","73% AV Level Silver Plan","72.00%","0.72014844417572","Yes","Yes","No","100%",,"$2,100","$0","$1,060","$30","$2,100","$0","$590","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2100-2-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-2100-2-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060020","Cigna Connect 2500","99248TN006","7730182962","TNN004","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060020-05","Cigna Connect 500-3","87% AV Level Silver Plan","86.81%","0.868251085281372","Yes","Yes","No","100%",,"$500","$0","$1,300","$30","$500","$0","$910","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-500-3-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-500-3-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060020","Cigna Connect 2500","99248TN006","7730182962","TNN004","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060020-06","Cigna Connect 100-4A","94% AV Level Silver Plan","93.29%","0.932940661907196","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4a-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-100-4a-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060003","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS002","TNF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-00","Cigna Connect 2500","Standard Silver Off Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060003","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS002","TNF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-01","Cigna Connect 2500","Standard Silver On Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060003","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS002","TNF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060003","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS002","TNF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-03","Cigna Connect 2500-1","Limited Cost Sharing Plan Variation","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-1-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-1-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060003","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS002","TNF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-04","Cigna Connect 2100-2","73% AV Level Silver Plan","72.00%","0.72014844417572","Yes","Yes","No","100%",,"$2,100","$0","$1,060","$30","$2,100","$0","$590","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2100-2-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-2100-2-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060003","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS002","TNF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-05","Cigna Connect 500-3","87% AV Level Silver Plan","86.81%","0.868251085281372","Yes","Yes","No","100%",,"$500","$0","$1,300","$30","$500","$0","$910","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-500-3-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-500-3-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060003","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS002","TNF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-06","Cigna Connect 100-4A","94% AV Level Silver Plan","93.29%","0.932940661907196","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4a-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-100-4a-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060012","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS004","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060012-00","Cigna Connect 2500","Standard Silver Off Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060012","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS004","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060012-01","Cigna Connect 2500","Standard Silver On Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060012","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS004","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060012-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060012","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS004","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060012-03","Cigna Connect 2500-1","Limited Cost Sharing Plan Variation","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-1-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-2500-1-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060012","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS004","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060012-04","Cigna Connect 2100-2","73% AV Level Silver Plan","72.00%","0.72014844417572","Yes","Yes","No","100%",,"$2,100","$0","$1,060","$30","$2,100","$0","$590","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2100-2-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-2100-2-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060012","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS004","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060012-05","Cigna Connect 500-3","87% AV Level Silver Plan","86.81%","0.868251085281372","Yes","Yes","No","100%",,"$500","$0","$1,300","$30","$500","$0","$910","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-500-3-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-500-3-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060012","Cigna Connect 2500","99248TN006","7730182962","TNN002","TNS004","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060012-06","Cigna Connect 100-4A","94% AV Level Silver Plan","93.29%","0.932940661907196","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4a-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-100-4a-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4000","99248TN006","7730182962","TNN004","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-00","Cigna Connect 4000","Standard Silver Off Exchange Plan","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4000","99248TN006","7730182962","TNN004","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-01","Cigna Connect 4000","Standard Silver On Exchange Plan","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4000","99248TN006","7730182962","TNN004","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-0-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4000","99248TN006","7730182962","TNN004","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-03","Cigna Connect 4000-1","Limited Cost Sharing Plan Variation","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-1-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-1-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4000","99248TN006","7730182962","TNN004","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-04","Cigna Connect 2800-2","73% AV Level Silver Plan","72.97%","0.734843075275421","Yes","Yes","No","100%",,"$2,800","$80","$890","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2800-2-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-2800-2-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4000","99248TN006","7730182962","TNN004","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-05","Cigna Connect 300-3","87% AV Level Silver Plan","86.80%","0.871096849441528","Yes","Yes","No","100%",,"$300","$70","$1,390","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-300-3-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-300-3-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4000","99248TN006","7730182962","TNN004","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-06","Cigna Connect 100-4B","94% AV Level Silver Plan","93.06%","0.932581007480621","Yes","Yes","No","100%",,"$100","$40","$710","$30","$100","$430","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4b-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-100-4b-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-00","Cigna Connect 4000","Standard Silver Off Exchange Plan","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-01","Cigna Connect 4000","Standard Silver On Exchange Plan","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-03","Cigna Connect 4000-1","Limited Cost Sharing Plan Variation","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-1-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-1-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-04","Cigna Connect 2800-2","73% AV Level Silver Plan","72.97%","0.734843075275421","Yes","Yes","No","100%",,"$2,800","$80","$890","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2800-2-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-2800-2-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-05","Cigna Connect 300-3","87% AV Level Silver Plan","86.80%","0.871096849441528","Yes","Yes","No","100%",,"$300","$70","$1,390","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-300-3-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-300-3-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-06","Cigna Connect 100-4B","94% AV Level Silver Plan","93.06%","0.932581007480621","Yes","Yes","No","100%",,"$100","$40","$710","$30","$100","$430","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4b-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-100-4b-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS004","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-00","Cigna Connect 4000","Standard Silver Off Exchange Plan","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS004","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-01","Cigna Connect 4000","Standard Silver On Exchange Plan","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS004","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS004","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-03","Cigna Connect 4000-1","Limited Cost Sharing Plan Variation","68.67%","0.692040860652924","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4000-1-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-4000-1-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS004","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-04","Cigna Connect 2800-2","73% AV Level Silver Plan","72.97%","0.734843075275421","Yes","Yes","No","100%",,"$2,800","$80","$890","$30","$140","$830","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2800-2-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-2800-2-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS004","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-05","Cigna Connect 300-3","87% AV Level Silver Plan","86.80%","0.871096849441528","Yes","Yes","No","100%",,"$300","$70","$1,390","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-300-3-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-300-3-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4000","99248TN006","7730182962","TNN002","TNS004","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-06","Cigna Connect 100-4B","94% AV Level Silver Plan","93.06%","0.932581007480621","Yes","Yes","No","100%",,"$100","$40","$710","$30","$100","$430","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4b-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-100-4b-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060004","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS002","TNF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-00","Cigna Connect 3000","Standard Silver Off Exchange Plan","69.47%","0.701637625694275","Yes","Yes","No","100%",,"$3,000","$60","$1,270","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-3000-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060004","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS002","TNF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-01","Cigna Connect 3000","Standard Silver On Exchange Plan","69.47%","0.701637625694275","Yes","Yes","No","100%",,"$3,000","$60","$1,270","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-3000-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060004","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS002","TNF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060004","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS002","TNF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-03","Cigna Connect 3000-1","Limited Cost Sharing Plan Variation","69.47%","0.701637625694275","Yes","Yes","No","100%",,"$3,000","$60","$1,270","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-1-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-3000-1-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060004","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS002","TNF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-04","Cigna Connect 1900-2","73% AV Level Silver Plan","73.68%","0.743382811546326","Yes","Yes","No","100%",,"$1,900","$60","$1,600","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1900-2-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-1900-2-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060004","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS002","TNF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-05","Cigna Connect 200-3","87% AV Level Silver Plan","87.48%","0.877537369728088","Yes","Yes","No","100%",,"$200","$40","$1,560","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-200-3-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-200-3-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060004","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS002","TNF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-06","Cigna Connect 0-4","94% AV Level Silver Plan","93.74%","0.940966129302979","Yes","Yes","No","100%",,"$0","$30","$360","$30","$0","$360","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-4-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-4-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060013","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS004","TNF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060013-00","Cigna Connect 3000","Standard Silver Off Exchange Plan","69.47%","0.701637625694275","Yes","Yes","No","100%",,"$3,000","$60","$1,270","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-3000-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060013","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS004","TNF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060013-01","Cigna Connect 3000","Standard Silver On Exchange Plan","69.47%","0.701637625694275","Yes","Yes","No","100%",,"$3,000","$60","$1,270","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-3000-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060013","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS004","TNF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060013-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060013","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS004","TNF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060013-03","Cigna Connect 3000-1","Limited Cost Sharing Plan Variation","69.47%","0.701637625694275","Yes","Yes","No","100%",,"$3,000","$60","$1,270","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3000-1-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-3000-1-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060013","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS004","TNF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060013-04","Cigna Connect 1900-2","73% AV Level Silver Plan","73.68%","0.743382811546326","Yes","Yes","No","100%",,"$1,900","$60","$1,600","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1900-2-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-1900-2-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060013","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS004","TNF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060013-05","Cigna Connect 200-3","87% AV Level Silver Plan","87.48%","0.877537369728088","Yes","Yes","No","100%",,"$200","$40","$1,560","$30","$140","$640","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-200-3-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-200-3-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060013","Cigna Connect 3000","99248TN006","7730182962","TNN002","TNS004","TNF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060013-06","Cigna Connect 0-4","94% AV Level Silver Plan","93.74%","0.940966129302979","Yes","Yes","No","100%",,"$0","$30","$360","$30","$0","$360","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-4-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-4-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060023","Cigna Connect 1500","99248TN006","7730182962","TNN004","TNS001","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060023-00","Cigna Connect 1500","Standard Gold Off Exchange Plan","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060023","Cigna Connect 1500","99248TN006","7730182962","TNN004","TNS001","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060023-01","Cigna Connect 1500","Standard Gold On Exchange Plan","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060023","Cigna Connect 1500","99248TN006","7730182962","TNN004","TNS001","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060023-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-0-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060023","Cigna Connect 1500","99248TN006","7730182962","TNN004","TNS001","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060023-03","Cigna Connect 1500-1","Limited Cost Sharing Plan Variation","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-1-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-1-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060006","Cigna Connect 1500","99248TN006","7730182962","TNN002","TNS002","TNF006","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-00","Cigna Connect 1500","Standard Gold Off Exchange Plan","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060006","Cigna Connect 1500","99248TN006","7730182962","TNN002","TNS002","TNF006","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-01","Cigna Connect 1500","Standard Gold On Exchange Plan","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060006","Cigna Connect 1500","99248TN006","7730182962","TNN002","TNS002","TNF006","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060006","Cigna Connect 1500","99248TN006","7730182962","TNN002","TNS002","TNF006","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-03","Cigna Connect 1500-1","Limited Cost Sharing Plan Variation","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-1-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-1-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060016","Cigna Connect 1500","99248TN006","7730182962","TNN002","TNS004","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060016-00","Cigna Connect 1500","Standard Gold Off Exchange Plan","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060016","Cigna Connect 1500","99248TN006","7730182962","TNN002","TNS004","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060016-01","Cigna Connect 1500","Standard Gold On Exchange Plan","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060016","Cigna Connect 1500","99248TN006","7730182962","TNN002","TNS004","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060016-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060016","Cigna Connect 1500","99248TN006","7730182962","TNN002","TNS004","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060016-03","Cigna Connect 1500-1","Limited Cost Sharing Plan Variation","78.06%","0.784005761146545","Yes","Yes","No","100%",,"$1,500","$70","$860","$30","$140","$720","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1500-1-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-1500-1-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060019","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN004","TNS001","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060019-00","Cigna US-TN Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060019","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN004","TNS001","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060019-01","Cigna US-TN Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060019","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN004","TNS001","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060019-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-0-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060019","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN004","TNS001","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060019-03","Cigna US-TN Connect 6650-1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-1-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-1-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060007","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN002","TNS002","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060007-00","Cigna US-TN Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060007","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN002","TNS002","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060007-01","Cigna US-TN Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060007","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN002","TNS002","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060007-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060007","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN002","TNS002","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060007-03","Cigna US-TN Connect 6650-1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-1-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-1-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060011","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN002","TNS004","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060011-00","Cigna US-TN Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060011","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN002","TNS004","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060011-01","Cigna US-TN Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060011","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN002","TNS004","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060011-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060011","Cigna US-TN Connect 6650","99248TN006","7730182962","TNN002","TNS004","TNF008","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060011-03","Cigna US-TN Connect 6650-1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-6650-1-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-6650-1-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060022","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN004","TNS001","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060022-00","Cigna US-TN Connect 3500","Standard Silver Off Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060022","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN004","TNS001","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060022-01","Cigna US-TN Connect 3500","Standard Silver On Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060022","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN004","TNS001","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060022-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2017/sob/cigna-connect-0-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060022","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN004","TNS001","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060022-03","Cigna US-TN Connect 3500-1","Limited Cost Sharing Plan Variation","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-1-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-1-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060022","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN004","TNS001","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060022-04","Cigna US-TN Connect 3000-2","73% AV Level Silver Plan","73.61%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3000-2-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3000-2-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060022","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN004","TNS001","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060022-05","Cigna US-TN Connect 700-3","87% AV Level Silver Plan","87.50%","0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-700-3-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-700-3-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060022","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN004","TNS001","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060022-06","Cigna US-TN Connect 250-4","94% AV Level Silver Plan","94.31%","0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$350","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-250-4-mem-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-250-4-mem-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060008","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS002","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060008-00","Cigna US-TN Connect 3500","Standard Silver Off Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060008","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS002","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060008-01","Cigna US-TN Connect 3500","Standard Silver On Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060008","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS002","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060008-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-nashville-tn","http://www.cigna.com/2017/sob/cigna-connect-0-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060008","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS002","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060008-03","Cigna US-TN Connect 3500-1","Limited Cost Sharing Plan Variation","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-1-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-1-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060008","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS002","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060008-04","Cigna US-TN Connect 3000-2","73% AV Level Silver Plan","73.61%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3000-2-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3000-2-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060008","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS002","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060008-05","Cigna US-TN Connect 700-3","87% AV Level Silver Plan","87.50%","0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-700-3-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-700-3-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060008","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS002","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060008-06","Cigna US-TN Connect 250-4","94% AV Level Silver Plan","94.31%","0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$350","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-250-4-nashville-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-250-4-nashville-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060015","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS004","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060015-00","Cigna US-TN Connect 3500","Standard Silver Off Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060015","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS004","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060015-01","Cigna US-TN Connect 3500","Standard Silver On Exchange Plan","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060015","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS004","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060015-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-tricities-tn","http://www.cigna.com/2017/sob/cigna-connect-0-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060015","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS004","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060015-03","Cigna US-TN Connect 3500-1","Limited Cost Sharing Plan Variation","70.79%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3500-1-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3500-1-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060015","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS004","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060015-04","Cigna US-TN Connect 3000-2","73% AV Level Silver Plan","73.61%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-3000-2-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-3000-2-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060015","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS004","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060015-05","Cigna US-TN Connect 700-3","87% AV Level Silver Plan","87.50%","0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-700-3-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-700-3-tricities-tn"
"2017","TN","99248","HIOS","2016-08-15 07:42:31","Individual","No","59-1031071","99248TN0060015","Cigna US-TN Connect 3500","99248TN006","7730182962","TNN002","TNS004","TNF009","New","EPO","Silver","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060015-06","Cigna US-TN Connect 250-4","94% AV Level Silver Plan","94.31%","0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$350","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-tn-connect-250-4-tricities-tn","http://www.cigna.com/2017/sob/cigna-us-tn-connect-250-4-tricities-tn"
"2017","TX","12846","HIOS","2016-07-20 03:02:32","SHOP (Small Group)","Yes","13-5123390","12846TX0200002","Guardian Pediatric Advantage","12846TX020",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","12846TX0200002-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","12846","HIOS","2016-07-20 03:02:32","SHOP (Small Group)","Yes","13-5123390","12846TX0210002","Guardian Pediatric Essentials","12846TX021",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","12846TX0210002-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","12846","HIOS","2016-07-20 03:02:32","SHOP (Small Group)","Yes","13-5123390","12846TX0230002","Guardian Family Advantage","12846TX023",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","12846TX0230002-00","Guardian Family Advantage","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","12846","HIOS","2016-07-20 03:02:32","SHOP (Small Group)","Yes","13-5123390","12846TX0230002","Guardian Family Advantage","12846TX023",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","12846TX0230002-01","Guardian Family Advantage","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","12846","HIOS","2016-07-20 03:02:32","SHOP (Small Group)","Yes","13-5123390","12846TX0250002","Guardian Family Essentials","12846TX025",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","12846TX0250002-00","Guardian Family Essentials","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","12846","HIOS","2016-07-20 03:02:32","SHOP (Small Group)","Yes","13-5123390","12846TX0250002","Guardian Family Essentials","12846TX025",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","12846TX0250002-01","Guardian Family Essentials","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","19312","HIOS","2016-08-04 02:29:22","Individual","Yes","91-1857813","19312TX0010010","Premier Choice","19312TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","http://www.premierlife.com/payment","","19312TX0010010-00","Premier Choice","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/prospective-members/hbex","https://www.premierlife.com/prospective-members/hbex"
"2017","TX","19312","HIOS","2016-08-04 02:29:22","Individual","Yes","91-1857813","19312TX0010010","Premier Choice","19312TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","http://www.premierlife.com/payment","","19312TX0010010-01","Premier Choice","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/prospective-members/hbex","https://www.premierlife.com/prospective-members/hbex"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0010001","Simple Secure","20069TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9991",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0010001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF007","20069TX0010001-00","Simple Secure - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$0","$0","$80","$0","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0010001-00","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0010001-00"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0010001","Simple Secure","20069TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9991",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0010001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF007","20069TX0010001-01","Simple Secure - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$0","$0","$80","$0","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0010001-01","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0010001-01"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0100001","Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards","20069TX010",,"TXN001","TXS001","TXF008","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0100001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF008","20069TX0100001-00","Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards","Standard Bronze Off Exchange Plan","61.65%",,"Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$4,000","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0100001-00","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0100001-00"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0100001","Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards","20069TX010",,"TXN001","TXS001","TXF008","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0100001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF008","20069TX0100001-01","Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards","Standard Bronze On Exchange Plan","61.65%",,"Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$4,000","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0100001-01","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0100001-01"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0100001","Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards","20069TX010",,"TXN001","TXS001","TXF008","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0100001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF008","20069TX0100001-02","Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0100001-02","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0100001-02"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0100001","Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards","20069TX010",,"TXN001","TXS001","TXF008","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0100001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF008","20069TX0100001-03","Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards","Limited Cost Sharing Plan Variation","61.65%",,"Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$4,000","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0100001-03","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0100001-03"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0110001","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX011",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF009","20069TX0110001-00","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","Standard Silver Off Exchange Plan","70.02%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$0","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0110001-00","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0110001-00"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0110001","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX011",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF009","20069TX0110001-01","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","Standard Silver On Exchange Plan","70.02%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$0","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0110001-01","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0110001-01"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0110001","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX011",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF009","20069TX0110001-02","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0110001-02","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0110001-02"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0110001","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX011",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF009","20069TX0110001-03","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","Limited Cost Sharing Plan Variation","70.02%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$0","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0110001-03","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0110001-03"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0110001","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX011",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF009","20069TX0110001-04","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","73% AV Level Silver Plan","73.97%",,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$0","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0110001-04","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0110001-04"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0110001","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX011",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF009","20069TX0110001-05","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","87% AV Level Silver Plan","86.98%",,"Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$0","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0110001-05","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0110001-05"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0110001","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX011",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF009","20069TX0110001-06","Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","94% AV Level Silver Plan","94.82%",,"Yes","Yes","No","100%",,"$600","$0","$0","$200","$0","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0110001-06","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0110001-06"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0120001","Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX012",,"TXN001","TXS001","TXF010","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9993",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0120001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF010","20069TX0120001-00","Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","Standard Gold Off Exchange Plan","81.61%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$0","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0120001-00","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0120001-00"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0120001","Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX012",,"TXN001","TXS001","TXF010","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9993",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0120001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF010","20069TX0120001-01","Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","Standard Gold On Exchange Plan","81.61%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$0","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0120001-01","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0120001-01"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0120001","Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX012",,"TXN001","TXS001","TXF010","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9993",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0120001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF010","20069TX0120001-02","Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0120001-02","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0120001-02"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0120001","Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","20069TX012",,"TXN001","TXS001","TXF010","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9993",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0120001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF010","20069TX0120001-03","Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits","Limited Cost Sharing Plan Variation","81.61%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$0","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0120001-03","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0120001-03"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0310001","Market Bronze","20069TX031",,"TXN001","TXS001","TXF001","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0310001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF001","20069TX0310001-00","Market Bronze - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Standard Bronze Off Exchange Plan","61.88%",,"Yes","Yes","No","100%",,"$6,300","$20","$0","$200","$4,000","$900","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0310001-00","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0310001-00"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0310001","Market Bronze","20069TX031",,"TXN001","TXS001","TXF001","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0310001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF001","20069TX0310001-01","Market Bronze - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Standard Bronze On Exchange Plan","61.88%",,"Yes","Yes","No","100%",,"$6,300","$20","$0","$200","$4,000","$900","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0310001-01","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0310001-01"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0310001","Market Bronze","20069TX031",,"TXN001","TXS001","TXF001","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0310001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF001","20069TX0310001-02","Market Bronze - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0310001-02","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0310001-02"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0310001","Market Bronze","20069TX031",,"TXN001","TXS001","TXF001","New","EPO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0310001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF001","20069TX0310001-03","Market Bronze - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Limited Cost Sharing Plan Variation","61.88%",,"Yes","Yes","No","100%",,"$6,300","$20","$0","$200","$4,000","$900","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0310001-03","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0310001-03"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0320001","Market Silver","20069TX032",,"TXN001","TXS001","TXF002","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF002","20069TX0320001-00","Market Silver - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Standard Silver Off Exchange Plan","70.63%",,"Yes","Yes","No","100%",,"$3,500","$20","$600","$200","$100","$2,100","$0","$80",,,,,,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0320001-00","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0320001-00"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0320001","Market Silver","20069TX032",,"TXN001","TXS001","TXF002","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF002","20069TX0320001-01","Market Silver - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Standard Silver On Exchange Plan","70.63%",,"Yes","Yes","No","100%",,"$3,500","$20","$600","$200","$100","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0320001-01","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0320001-01"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0320001","Market Silver","20069TX032",,"TXN001","TXS001","TXF002","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF002","20069TX0320001-02","Market Silver - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0320001-02","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0320001-02"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0320001","Market Silver","20069TX032",,"TXN001","TXS001","TXF002","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF002","20069TX0320001-03","Market Silver - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Limited Cost Sharing Plan Variation","70.63%",,"Yes","Yes","No","100%",,"$3,500","$20","$600","$200","$100","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0320001-03","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0320001-03"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0320001","Market Silver","20069TX032",,"TXN001","TXS001","TXF002","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF002","20069TX0320001-04","Market Silver (CSR 250) - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","73% AV Level Silver Plan","73.55%",,"Yes","Yes","No","100%",,"$3,000","$20","$700","$200","$100","$2,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0320001-04","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0320001-04"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0320001","Market Silver","20069TX032",,"TXN001","TXS001","TXF002","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF002","20069TX0320001-05","Market Silver (CSR 200)  - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","87% AV Level Silver Plan","87.47%",,"Yes","Yes","No","100%",,"$700","$10","$900","$200","$100","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0320001-05","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0320001-05"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0320001","Market Silver","20069TX032",,"TXN001","TXS001","TXF002","New","EPO","Silver","Design 2","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9981",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF002","20069TX0320001-06","Market Silver (CSR 150) - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","94% AV Level Silver Plan","94.30%",,"Yes","Yes","No","100%",,"$300","$10","$300","$200","$100","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0320001-06","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0320001-06"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0330001","Market Gold","20069TX033",,"TXN001","TXS001","TXF003","New","EPO","Gold","Design 3","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9993",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0330001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF003","20069TX0330001-00","Market Gold - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Standard Gold Off Exchange Plan","79.98%",,"Yes","Yes","No","100%",,"$1,300","$20","$900","$200","$100","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0330001-00","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0330001-00"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0330001","Market Gold","20069TX033",,"TXN001","TXS001","TXF003","New","EPO","Gold","Design 3","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9993",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0330001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF003","20069TX0330001-01","Market Gold - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Standard Gold On Exchange Plan","79.98%",,"Yes","Yes","No","100%",,"$1,300","$20","$900","$200","$100","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0330001-01","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0330001-01"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0330001","Market Gold","20069TX033",,"TXN001","TXS001","TXF003","New","EPO","Gold","Design 3","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9993",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0330001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF003","20069TX0330001-02","Market Gold - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0330001-02","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0330001-02"
"2017","TX","20069","HIOS","2017-03-18 05:10:20","Individual","No","47-3185443","20069TX0330001","Market Gold","20069TX033",,"TXN001","TXS001","TXF003","New","EPO","Gold","Design 3","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9993",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2017&hios=20069TX0330001","https://www.hioscar.com/search/TX/drugs?year=2017&formulary=TXF003","20069TX0330001-03","Market Gold - Free Telemedicine, Free Preventive Care, Step Tracking Rewards","Limited Cost Sharing Plan Variation","79.98%",,"Yes","Yes","No","100%",,"$1,300","$20","$900","$200","$100","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2017&hios=20069TX0330001-03","https://www.hioscar.com/hx/brochure/?state=tx&year=2017&hios=20069TX0330001-03"
"2017","TX","23749","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","23749TX0010001","Dentegra DPO Pediatric Basic Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010001-00","Dentegra DPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010001-17"
"2017","TX","23749","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","23749TX0020001","Dentegra DPO for Small Businesses Pediatric Basic Plan","23749TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0020001-00","Dentegra DPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0020001-17"
"2017","TX","23749","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","23749TX0020004","Dentegra DPO for Small Businesses Family Preferred Plan","23749TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0020004-01","Dentegra DPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0020004-17"
"2017","TX","23749","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","23749TX0010004","Dentegra DPO Family Preferred Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010004-01","Dentegra DPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010004-17"
"2017","TX","23749","HIOS","2016-08-24 02:30:21","Individual","Yes","75-1233841","23749TX0010006","Dentegra DPO Family Basic Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010006-01","Dentegra DPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010006-17"
"2017","TX","23749","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","75-1233841","23749TX0020006","Dentegra DPO for Small Businesses Family Basic Plan","23749TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0020006-01","Dentegra DPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0020006-17"
"2017","TX","23891","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","74-2447512","23891TX0020002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0020002-00","DeltaCare USA Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0020002-17"
"2017","TX","23891","HIOS","2016-08-19 02:25:56","Individual","Yes","74-2447512","23891TX0010002","DeltaCare USA Pediatric Preferred Plan","23891TX001",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0010002-00","DeltaCare USA Pediatric Preferred Plan","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010002-17"
"2017","TX","23891","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","74-2447512","23891TX0020001","DeltaCare USA Pediatric Basic Plan for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0020001-00","DeltaCare USA Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0020001-17"
"2017","TX","23891","HIOS","2016-08-19 02:25:56","Individual","Yes","74-2447512","23891TX0010001","DeltaCare USA Pediatric Basic Plan","23891TX001",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0010001-00","DeltaCare USA Pediatric Basic Plan","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010001-17"
"2017","TX","23891","HIOS","2016-08-19 02:25:56","Individual","Yes","74-2447512","23891TX0010006","DeltaCare USA Basic Plan for Families","23891TX001",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0010006-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010006-17"
"2017","TX","23891","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","74-2447512","23891TX0020006","DeltaCare USA Basic Plan for Families for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0020006-01","DeltaCare USA Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0020006-17"
"2017","TX","23891","HIOS","2016-08-19 02:25:56","SHOP (Small Group)","Yes","74-2447512","23891TX0020004","DeltaCare USA Preferred Plan for Families for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0020004-01","DeltaCare USA Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0020004-17"
"2017","TX","23891","HIOS","2016-08-19 02:25:56","Individual","Yes","74-2447512","23891TX0010004","DeltaCare USA Preferred Plan for Families","23891TX001",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0010004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010004-17"
"2017","TX","24349","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","24349TX0020001","DPO Pediatric Basic Plan for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020001-00","DPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020001-17"
"2017","TX","24349","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","24349TX0010001","Delta Dental Individual DPO Pediatric Basic Plan","24349TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010001-00","Delta Dental Individual DPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010001-17"
"2017","TX","24349","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","24349TX0010002","Delta Dental Individual DPO Pediatric Preferred Plan","24349TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010002-00","Delta Dental Individual DPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010002-17"
"2017","TX","24349","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","24349TX0020002","DPO Pediatric Preferred Plan for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020002-00","DPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020002-17"
"2017","TX","24349","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","24349TX0020004","DPO Preferred Plan for Families for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020004-01","DPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020004-17"
"2017","TX","24349","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","24349TX0010004","Delta Dental Individual and Family DPO Preferred Plan for Families","24349TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010004-01","Delta Dental Individual and Family DPO Preferred Plan for Families","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010004-17"
"2017","TX","24349","HIOS","2016-08-24 02:30:21","Individual","Yes","94-2761537","24349TX0010006","Delta Dental Individual and Family DPO Basic Plan for Families","24349TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010006-01","Delta Dental Individual and Family DPO Basic Plan for Families","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010006-17"
"2017","TX","24349","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","94-2761537","24349TX0020006","DPO Basic Plan for Families for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020006-01","DPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020006-17"
"2017","TX","26250","HIOS","2016-07-01 08:12:23","Individual","Yes","75-2698702","26250TX0070001","Managed DentalGuard TX Essentials 2","26250TX007",,"TXN002","TXS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.993","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/payments","","26250TX0070001-00","Managed DentalGuard TX Essentials 2","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","TX","26250","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-2698702","26250TX0030003","Managed DentalGuard TX 10 Family Plan","26250TX003",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","26250TX0030003-01","Managed DentalGuard TX 10 Family Plan","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","26250","HIOS","2016-07-01 08:12:23","Individual","Yes","75-2698702","26250TX0070001","Managed DentalGuard TX Essentials 2","26250TX007",,"TXN002","TXS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.993","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/payments","","26250TX0070001-01","Managed DentalGuard TX Essentials 2","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","TX","26250","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-2698702","26250TX0040004","Managed DentalGuard TX 30 Family Plan","26250TX004",,"TXN001","TXS002",,"New","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.991","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","26250TX0040004-00","Managed DentalGuard TX 30 Family Plan","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","26250","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-2698702","26250TX0050004","Managed DentalGuard TX 40 Family Plan","26250TX005",,"TXN001","TXS002",,"New","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.991","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","26250TX0050004-00","Managed DentalGuard TX 40 Family Plan","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","26250","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-2698702","26250TX0030004","Managed DentalGuard TX 10 Family Plan","26250TX003",,"TXN001","TXS002",,"New","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","26250TX0030004-00","Managed DentalGuard TX 10 Family Plan","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140001","Gold Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-00","Gold Coinsurance","Standard Gold Off Exchange Plan",,"0.79472404718399","No","Yes","No","100%",,"$1,200","$50","$900","$200","$0","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_GoldCoins_SBC_26539TX0140001.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_GoldCoins_SOC_26539TX0140001.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140001","Gold Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-01","Gold Coinsurance","Standard Gold On Exchange Plan",,"0.79472404718399","No","Yes","No","100%",,"$1,200","$50","$900","$200","$0","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_GoldCoins_SBC_26539TX0140001.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_GoldCoins_SOC_26539TX0140001.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140001","Gold Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-02","Gold Coinsurance","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_GoldCoins_SBC_26539TX0140001-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_GoldCoins_SOC_26539TX0140001-02.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140001","Gold Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-03","Gold Coinsurance","Limited Cost Sharing Plan Variation",,"0.79472404718399","No","Yes","No","100%",,"$1,200","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_GoldCoins_SBC_26539TX0140001-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_GoldCoins_SOC_26539TX0140001-03.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-00","Silver Coinsurance","Standard Silver Off Exchange Plan",,"0.719033658504486","No","Yes","No","100%",,"$3,100","$20","$700","$200","$0","$1,500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SBC_26539TX0140003.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SOC_26539TX0140003.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-01","Silver Coinsurance","Standard Silver On Exchange Plan",,"0.719033658504486","No","Yes","No","100%",,"$3,100","$20","$700","$200","$0","$1,500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SBC_26539TX0140003.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SOC_26539TX0140003.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-02","Silver Coinsurance","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SBC_26539TX0140003-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SOC_26539TX0140003-02.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-03","Silver Coinsurance","Limited Cost Sharing Plan Variation",,"0.719033658504486","No","Yes","No","100%",,"$3,100","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SBC_26539TX0140003-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SOC_26539TX0140003-03.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-04","Silver Coinsurance 73% AV","73% AV Level Silver Plan",,"0.739777386188507","No","Yes","No","100%",,"$2,900","$20","$800","$200","$0","$1,500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,850","$2850 per person","$5700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SBC_26539TX0140003-04.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SOC_26539TX0140003-04.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-05","Silver Coinsurance 87% AV","87% AV Level Silver Plan",,"0.878561437129974","No","Yes","No","100%",,"$500","$30","$900","$200","$0","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SBC_26539TX0140003-05.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SOC_26539TX0140003-05.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-06","Silver Coinsurance 94%AV","94% AV Level Silver Plan",,"0.932416081428528","No","Yes","No","100%",,"$0","$20","$900","$200","$0","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SBC_26539TX0140003-06.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverCoins_SOC_26539TX0140003-06.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140008","Silver HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-00","Silver HSA(100%)","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SBC_26539TX0140008.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SOC_26539TX0140008.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140008","Silver HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-01","Silver HSA(100%)","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SBC_26539TX0140008.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SOC_26539TX0140008.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140008","Silver HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-02","Silver HSA(100%)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SBC_26539TX0140008-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SOC_26539TX0140008-02.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140008","Silver HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-03","Silver HSA(100%)","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SBC_26539TX0140008-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SOC_26539TX0140008-03.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140008","Silver HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-04","Silver HSA(100%)  73%AV","73% AV Level Silver Plan",,"0.730675756931305","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$3,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SBC_26539TX0140008-04.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SOC_26539TX0140008-04.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140008","Silver HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-05","Silver 100%  87%AV","87% AV Level Silver Plan",,"0.868040502071381","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SBC_26539TX0140008-05.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SOC_26539TX0140008-05.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140008","Silver HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-06","Silver  100%  94%AV","94% AV Level Silver Plan",,"0.932620525360107","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SBC_26539TX0140008-06.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_SilverHSA_SOC_26539TX0140008-06.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140006","Bronze HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-00","Bronze HSA(100%)","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeHSA_SBC_26539TX0140006.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeHSA_SOC_26539TX0140006.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140006","Bronze HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-01","Bronze HSA(100%)","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeHSA_SBC_26539TX0140006.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeHSA_SOC_26539TX0140006.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140006","Bronze HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-02","Bronze HSA(100%)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeHSA_SBC_26539TX0140006-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeHSA_SOC_26539TX0140006-02.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140006","Bronze HSA(100%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-03","Bronze HSA(100%)","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeHSA_SBC_26539TX0140006-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeHSA_SOC_26539TX0140006-03.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140009","Standard Bronze Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency Services only","No","Emergency Services only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140009-00","Standard Bronze Coinsurance","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,600","$20","$0","$200","$0","$1,900","$500","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeStandard_SBC_26539TX0140009.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeStandard_SOC_26539TX0140009.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140009","Standard Bronze Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency Services only","No","Emergency Services only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140009-01","Standard Bronze Coinsurance","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,600","$20","$0","$200","$0","$1,900","$500","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeStandard_SBC_26539TX0140009.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeStandard_SOC_26539TX0140009.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140009","Standard Bronze Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency Services only","No","Emergency Services only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140009-02","Standard Bronze Coinsurance","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeStandard_SBC_26539TX0140009-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeStandard_SOC_26539TX0140009-02.pdf"
"2017","TX","26539","HIOS","2017-01-20 09:19:19","Individual","No","75-2569094","26539TX0140009","Standard Bronze Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9973",,,"2017-01-01",,"No","Emergency Services only","No","Emergency Services only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2017_MarketPlace_Firstcare_Formulary.pdf","26539TX0140009-03","Standard Bronze Coinsurance","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeStandard_SBC_26539TX0140009-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2017_FC_BronzeStandard_SOC_26539TX0140009-03.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN001","TXS001","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010001-00","Community Health Choice HMO Gold 001","Standard Gold Off Exchange Plan","81.90%",,"No","Yes","No","100%",,"$0","$890","$0","$150","$0","$1,380","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010001-00_Gold_Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN001","TXS001","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010001-01","Community Health Choice HMO Gold 001","Standard Gold On Exchange Plan","81.90%",,"No","Yes","No","100%",,"$0","$890","$0","$150","$0","$1,380","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010001-01_Gold_Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN001","TXS001","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010001-02","Community Health Choice HMO Gold 001","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010001-02_Gold_Copay_NAI_ZERO_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN001","TXS001","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010001-03","Community Health Choice HMO Gold 001","Limited Cost Sharing Plan Variation","81.90%",,"No","Yes","No","100%",,"$0","$890","$0","$150","$0","$1,380","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010001-03_Gold_Copay_NAI_LIMITED_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010002-00","Community Health Choice HMO Silver 002","Standard Silver Off Exchange Plan","70.80%",,"No","Yes","No","100%",,"$0","$1,150","$0","$150","$0","$2,260","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010002-00_Silver_Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010002-01","Community Health Choice HMO Silver 002","Standard Silver On Exchange Plan","70.80%",,"No","Yes","No","100%",,"$0","$1,150","$0","$150","$0","$2,260","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010002-01_Silver_Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010002-02","Community Health Choice HMO Silver 002","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010002-02_Silver_Copay_NAI_ZERO_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010002-03","Community Health Choice HMO Silver 002","Limited Cost Sharing Plan Variation","70.80%",,"No","Yes","No","100%",,"$0","$1,150","$0","$150","$0","$2,260","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010002-03_Silver_Copay_NAI_LIMITED_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010002-04","Community Health Choice HMO Silver 002","73% AV Level Silver Plan","73.20%",,"No","Yes","No","100%",,"$0","$1,150","$0","$150","$0","$1,860","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010002-04_Silver73Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010002-05","Community Health Choice HMO Silver 002","87% AV Level Silver Plan","86.90%",,"No","Yes","No","100%",,"$0","$630","$0","$150","$0","$1,030","$190","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010002-05_Silver87Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010002-06","Community Health Choice HMO Silver 002","94% AV Level Silver Plan","94.40%",,"No","Yes","No","100%",,"$0","$430","$0","$150","$0","$500","$130","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010002-06_Silver94Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010006","KelseyCare powered by Community Health Choice HMO 006","27248TX001","7932102164","TXN002","TXS002","TXF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010006-00","KelseyCare powered by Community Health Choice HMO 006","Standard Gold Off Exchange Plan","81.90%",,"No","Yes","No","100%",,"$0","$890","$0","$150","$0","$1,380","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010006-00_Gold_Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010006","KelseyCare powered by Community Health Choice HMO 006","27248TX001","7932102164","TXN002","TXS002","TXF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010006-01","KelseyCare powered by Community Health Choice HMO 006","Standard Gold On Exchange Plan","81.90%",,"No","Yes","No","100%",,"$0","$890","$0","$150","$0","$1,380","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010006-01_Gold_Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010006","KelseyCare powered by Community Health Choice HMO 006","27248TX001","7932102164","TXN002","TXS002","TXF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010006-02","KelseyCare powered by Community Health Choice HMO 006","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010006-02_Gold_Copay_NAI_ZERO_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010006","KelseyCare powered by Community Health Choice HMO 006","27248TX001","7932102164","TXN002","TXS002","TXF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010006-03","Kelse Care powered by Community Health Choice HMO 006","Limited Cost Sharing Plan Variation","81.90%",,"No","Yes","No","100%",,"$0","$890","$0","$150","$0","$1,380","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010006-03_Gold_Copay_NAI_LIMITED_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010007","KelseyCare powered by Community Health Choice HMO 007","27248TX001","7932102164","TXN002","TXS002","TXF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010007-00","KelseyCare powered by Community Health Choice HMO 007","Standard Silver Off Exchange Plan","70.80%",,"No","Yes","No","100%",,"$0","$1,150","$0","$150","$0","$2,260","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010007-00_Silver_Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010007","KelseyCare powered by Community Health Choice HMO 007","27248TX001","7932102164","TXN002","TXS002","TXF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010007-01","KelseyCare powered by Community Health Choice HMO 007","Standard Silver On Exchange Plan","70.80%",,"No","Yes","No","100%",,"$0","$1,150","$0","$150","$0","$2,260","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010007-01_Silver_Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010007","KelseyCare powered by Community Health Choice HMO 007","27248TX001","7932102164","TXN002","TXS002","TXF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010007-02","KelseyCare powered by Community Health Choice HMO 007","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010007-02_Silver_Copay_NAI_ZERO_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010007","KelseyCare powered by Community Health Choice HMO 007","27248TX001","7932102164","TXN002","TXS002","TXF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010007-03","KelseyCare powered by Community Health Choice HMO 007","Limited Cost Sharing Plan Variation","70.80%",,"No","Yes","No","100%",,"$0","$1,150","$0","$150","$0","$2,260","$380","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010007-03_Silver_Copay_NAI_LIMITED_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010007","KelseyCare powered by Community Health Choice HMO 007","27248TX001","7932102164","TXN002","TXS002","TXF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010007-04","KelseyCare powered by Community Health Choice HMO 007","73% AV Level Silver Plan","73.20%",,"No","Yes","No","100%",,"$0","$1,150","$0","$150","$0","$1,860","$250","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010007-04_Silver73Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010007","KelseyCare powered by Community Health Choice HMO 007","27248TX001","7932102164","TXN002","TXS002","TXF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010007-05","KelseyCare powered by Community Health Choice HMO 007","87% AV Level Silver Plan","86.90%",,"No","Yes","No","100%",,"$0","$630","$0","$150","$0","$1,030","$190","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010007-05_Silver87Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010007","KelseyCare powered by Community Health Choice HMO 007","27248TX001","7932102164","TXN002","TXS002","TXF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010007-06","KelseyCare powered by Community Health Choice HMO 007","94% AV Level Silver Plan","94.40%",,"No","Yes","No","100%",,"$0","$430","$0","$150","$0","$500","$130","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010007-06_Silver94Copay_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2017/HMO_Copay_EOC_2016.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010003-00","Community Health Choice HMO Bronze 003","Standard Bronze Off Exchange Plan","60.86%","0","No","Yes","No","100%",,"$5,000","$500","$0","$150","$5,000","$390","$0","$80","$0","$0","$0","$0",,"5","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$200","$200 per person","$400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010003-00_Bronze_Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010003-01","Community Health Choice HMO Bronze 003","Standard Bronze On Exchange Plan","60.86%","0","No","Yes","No","100%",,"$5,000","$500","$0","$150","$5,000","$390","$0","$80","$0","$0","$0","$0",,"5","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$200","$200 per person","$400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010003-01_Bronze_Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010003-02","Community Health Choice HMO Bronze 003","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010003-02_Bronze_Deductible_NAI_ZERO_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010003-03","Community Health Choice HMO Bronze 003","Limited Cost Sharing Plan Variation","60.86%","0","No","Yes","No","100%",,"$5,000","$500","$0","$150","$5,000","$390","$0","$80","$0","$0","$0","$0",,"5","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$200","$200 per person","$400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010003-03_Bronze_Deductible_NAI_LIMITED_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010004-00","Community Health Choice HMO Silver 004","Standard Silver Off Exchange Plan","70.16%",,"No","Yes","No","100%",,"$1,500","$890","$0","$150","$1,500","$600","$180","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010004-00_Silver_Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010004-01","Community Health Choice HMO Silver 004","Standard Silver On Exchange Plan","70.16%",,"No","Yes","No","100%",,"$1,500","$890","$0","$150","$1,500","$600","$180","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010004-01_Silver_Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010004-02","Community Health Choice HMO Silver 004","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010004-02_Silver_Deductible_NAI_ZERO_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010004-03","Community Health Choice HMO Silver 004","Limited Cost Sharing Plan Variation","70.16%",,"No","Yes","No","100%",,"$1,500","$890","$0","$150","$1,500","$600","$180","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010004-03_Silver_Deductible_NAI_LIMITED_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010004-04","Community Health Choice HMO Silver 004","73% AV Level Silver Plan","72.84%",,"No","Yes","No","100%",,"$1,250","$890","$0","$150","$1,250","$640","$160","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010004-04_Silver73Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010004-05","Community Health Choice HMO Silver 004","87% AV Level Silver Plan","86.94%",,"No","Yes","No","100%",,"$0","$630","$0","$150","$0","$1,030","$190","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010004-05_Silver87Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2017)","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140008-01","Ambetter Balanced Care 3 (2017)","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140008-01.pdf","https://api.centene.com/Brochures/2017/29418TX0140008-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2017)","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140008-02","Ambetter Balanced Care 3 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140008-02.pdf","https://api.centene.com/Brochures/2017/29418TX0140008-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2017)","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140008-03","Ambetter Balanced Care 3 (2017)","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140008-03.pdf","https://api.centene.com/Brochures/2017/29418TX0140008-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2017)","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140008-04","Ambetter Balanced Care 3 (2017)","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140008-04.pdf","https://api.centene.com/Brochures/2017/29418TX0140008-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2017)","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140008-05","Ambetter Balanced Care 3 (2017)","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140008-05.pdf","https://api.centene.com/Brochures/2017/29418TX0140008-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2017)","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140008-06","Ambetter Balanced Care 3 (2017)","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140008-06.pdf","https://api.centene.com/Brochures/2017/29418TX0140008-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2017)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140009-00","Ambetter Balanced Care 4 (2017)","Standard Silver Off Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140009-00.pdf","https://api.centene.com/Brochures/2017/29418TX0140009-00.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010004-06","Community Health Choice HMO Silver 004","94% AV Level Silver Plan","94.37%",,"No","Yes","No","100%",,"$0","$430","$0","$150","$0","$500","$130","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010004-06_Silver94Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010005-00","Community Health Choice HMO Gold 005","Standard Gold Off Exchange Plan","79.40%",,"No","Yes","No","100%",,"$500","$710","$0","$150","$500","$810","$310","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010005-00_Gold_Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010005-01","Community Health Choice HMO Gold 005","Standard Gold On Exchange Plan","79.40%",,"No","Yes","No","100%",,"$500","$710","$0","$150","$500","$810","$310","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010005-01_Gold_Deductible_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010005-02","Community Health Choice HMO Gold 005","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010005-02_Gold_Deductible_NAI_ZERO_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","27248","HIOS","2017-01-25 02:20:17","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/Community-Health-Choice-Formulary-2017.pdf","27248TX0010005-03","Community Health Choice HMO Gold 005","Limited Cost Sharing Plan Variation","79.40%",,"No","Yes","No","100%",,"$500","$710","$0","$150","$500","$810","$310","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/27248TX0010005-03_Gold_Deductible_NAI_LIMITED_2017.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2017/HMO_Deductible_EOC_2017.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140001-00","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/29418TX0140001-00.pdf","https://api.centene.com/Brochures/2017/29418TX0140001-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140001-01","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/29418TX0140001-01.pdf","https://api.centene.com/Brochures/2017/29418TX0140001-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140001-02","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/29418TX0140001-02.pdf","https://api.centene.com/Brochures/2017/29418TX0140001-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140001-03","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/29418TX0140001-03.pdf","https://api.centene.com/Brochures/2017/29418TX0140001-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-00","Ambetter Balanced Care 1 (2017)","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140002-00.pdf","https://api.centene.com/Brochures/2017/29418TX0140002-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-01","Ambetter Balanced Care 1 (2017)","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140002-01.pdf","https://api.centene.com/Brochures/2017/29418TX0140002-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-02","Ambetter Balanced Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140002-02.pdf","https://api.centene.com/Brochures/2017/29418TX0140002-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-03","Ambetter Balanced Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140002-03.pdf","https://api.centene.com/Brochures/2017/29418TX0140002-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-04","Ambetter Balanced Care 1 (2017)","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140002-04.pdf","https://api.centene.com/Brochures/2017/29418TX0140002-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-05","Ambetter Balanced Care 1 (2017)","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140002-05.pdf","https://api.centene.com/Brochures/2017/29418TX0140002-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-06","Ambetter Balanced Care 1 (2017)","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140002-06.pdf","https://api.centene.com/Brochures/2017/29418TX0140002-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2017)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-00","Ambetter Balanced Care 2 (2017)","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140003-00.pdf","https://api.centene.com/Brochures/2017/29418TX0140003-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2017)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-01","Ambetter Balanced Care 2 (2017)","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140003-01.pdf","https://api.centene.com/Brochures/2017/29418TX0140003-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2017)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-02","Ambetter Balanced Care 2 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140003-02.pdf","https://api.centene.com/Brochures/2017/29418TX0140003-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2017)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-03","Ambetter Balanced Care 2 (2017)","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140003-03.pdf","https://api.centene.com/Brochures/2017/29418TX0140003-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2017)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-04","Ambetter Balanced Care 2 (2017)","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140003-04.pdf","https://api.centene.com/Brochures/2017/29418TX0140003-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2017)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-05","Ambetter Balanced Care 2 (2017)","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140003-05.pdf","https://api.centene.com/Brochures/2017/29418TX0140003-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2017)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-06","Ambetter Balanced Care 2 (2017)","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140003-06.pdf","https://api.centene.com/Brochures/2017/29418TX0140003-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-00","Ambetter Balanced Care 10 (2017)","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140005-00.pdf","https://api.centene.com/Brochures/2017/29418TX0140005-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-01","Ambetter Balanced Care 10 (2017)","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140005-01.pdf","https://api.centene.com/Brochures/2017/29418TX0140005-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-02","Ambetter Balanced Care 10 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140005-02.pdf","https://api.centene.com/Brochures/2017/29418TX0140005-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-03","Ambetter Balanced Care 10 (2017)","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140005-03.pdf","https://api.centene.com/Brochures/2017/29418TX0140005-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-04","Ambetter Balanced Care 10 (2017)","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140005-04.pdf","https://api.centene.com/Brochures/2017/29418TX0140005-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-05","Ambetter Balanced Care 10 (2017)","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140005-05.pdf","https://api.centene.com/Brochures/2017/29418TX0140005-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2017)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-06","Ambetter Balanced Care 10 (2017)","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140005-06.pdf","https://api.centene.com/Brochures/2017/29418TX0140005-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2017)","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140008-00","Ambetter Balanced Care 3 (2017)","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140008-00.pdf","https://api.centene.com/Brochures/2017/29418TX0140008-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2017)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140009-01","Ambetter Balanced Care 4 (2017)","Standard Silver On Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140009-01.pdf","https://api.centene.com/Brochures/2017/29418TX0140009-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2017)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140009-02","Ambetter Balanced Care 4 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140009-02.pdf","https://api.centene.com/Brochures/2017/29418TX0140009-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2017)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140009-03","Ambetter Balanced Care 4 (2017)","Limited Cost Sharing Plan Variation",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140009-03.pdf","https://api.centene.com/Brochures/2017/29418TX0140009-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2017)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140009-04","Ambetter Balanced Care 4 (2017)","73% AV Level Silver Plan",,"0.732531428337097","Yes","Yes","No","100%",,"$5,200","$40","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140009-04.pdf","https://api.centene.com/Brochures/2017/29418TX0140009-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2017)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140009-05","Ambetter Balanced Care 4 (2017)","87% AV Level Silver Plan",,"0.865934371948242","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140009-05.pdf","https://api.centene.com/Brochures/2017/29418TX0140009-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2017)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140009-06","Ambetter Balanced Care 4 (2017)","94% AV Level Silver Plan",,"0.947982847690582","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140009-06.pdf","https://api.centene.com/Brochures/2017/29418TX0140009-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2017)","29418TX014",,"TXN001","TXS001","TXF004","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140010-00","Ambetter Balanced Care 12 (2017)","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140010-00.pdf","https://api.centene.com/Brochures/2017/29418TX0140010-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2017)","29418TX014",,"TXN001","TXS001","TXF004","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140010-01","Ambetter Balanced Care 12 (2017)","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140010-01.pdf","https://api.centene.com/Brochures/2017/29418TX0140010-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2017)","29418TX014",,"TXN001","TXS001","TXF004","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140010-02","Ambetter Balanced Care 12 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140010-02.pdf","https://api.centene.com/Brochures/2017/29418TX0140010-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2017)","29418TX014",,"TXN001","TXS001","TXF004","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140010-03","Ambetter Balanced Care 12 (2017)","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140010-03.pdf","https://api.centene.com/Brochures/2017/29418TX0140010-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2017)","29418TX014",,"TXN001","TXS001","TXF004","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140010-04","Ambetter Balanced Care 12 (2017)","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$400","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140010-04.pdf","https://api.centene.com/Brochures/2017/29418TX0140010-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2017)","29418TX014",,"TXN001","TXS001","TXF004","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140010-05","Ambetter Balanced Care 12 (2017)","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$900","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140010-05.pdf","https://api.centene.com/Brochures/2017/29418TX0140010-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2017)","29418TX014",,"TXN001","TXS001","TXF004","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140010-06","Ambetter Balanced Care 12 (2017)","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$300","$200","$250","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140010-06.pdf","https://api.centene.com/Brochures/2017/29418TX0140010-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140006-00","Ambetter Essential Care 1 (2017)","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140006-00.pdf","https://api.centene.com/Brochures/2017/29418TX0140006-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140006-01","Ambetter Essential Care 1 (2017)","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140006-01.pdf","https://api.centene.com/Brochures/2017/29418TX0140006-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140006-02","Ambetter Essential Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140006-02.pdf","https://api.centene.com/Brochures/2017/29418TX0140006-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2017)","29418TX014",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140006-03","Ambetter Essential Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0140006-03.pdf","https://api.centene.com/Brochures/2017/29418TX0140006-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9863",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-00","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150001-00.pdf","https://api.centene.com/Brochures/2017/29418TX0150001-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9863",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-01","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150001-01.pdf","https://api.centene.com/Brochures/2017/29418TX0150001-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9863",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-02","Ambetter Balanced Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150001-02.pdf","https://api.centene.com/Brochures/2017/29418TX0150001-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9863",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-03","Ambetter Balanced Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150001-03.pdf","https://api.centene.com/Brochures/2017/29418TX0150001-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9863",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-04","Ambetter Balanced Care 1 (2017) + Vision","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150001-04.pdf","https://api.centene.com/Brochures/2017/29418TX0150001-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9863",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-05","Ambetter Balanced Care 1 (2017) + Vision","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150001-05.pdf","https://api.centene.com/Brochures/2017/29418TX0150001-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9863",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-06","Ambetter Balanced Care 1 (2017) + Vision","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150001-06.pdf","https://api.centene.com/Brochures/2017/29418TX0150001-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9872",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-00","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150002-00.pdf","https://api.centene.com/Brochures/2017/29418TX0150002-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9872",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-01","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150002-01.pdf","https://api.centene.com/Brochures/2017/29418TX0150002-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9872",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-02","Ambetter Balanced Care 2 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150002-02.pdf","https://api.centene.com/Brochures/2017/29418TX0150002-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9872",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-03","Ambetter Balanced Care 2 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150002-03.pdf","https://api.centene.com/Brochures/2017/29418TX0150002-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9872",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-04","Ambetter Balanced Care 2 (2017) + Vision","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150002-04.pdf","https://api.centene.com/Brochures/2017/29418TX0150002-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9872",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-05","Ambetter Balanced Care 2 (2017) + Vision","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150002-05.pdf","https://api.centene.com/Brochures/2017/29418TX0150002-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9872",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-06","Ambetter Balanced Care 2 (2017) + Vision","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150002-06.pdf","https://api.centene.com/Brochures/2017/29418TX0150002-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9848",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-00","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150003-00.pdf","https://api.centene.com/Brochures/2017/29418TX0150003-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9848",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-01","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150003-01.pdf","https://api.centene.com/Brochures/2017/29418TX0150003-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9848",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-02","Ambetter Balanced Care 10 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150003-02.pdf","https://api.centene.com/Brochures/2017/29418TX0150003-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9848",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-03","Ambetter Balanced Care 10 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150003-03.pdf","https://api.centene.com/Brochures/2017/29418TX0150003-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9848",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-04","Ambetter Balanced Care 10 (2017) + Vision","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150003-04.pdf","https://api.centene.com/Brochures/2017/29418TX0150003-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9848",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-05","Ambetter Balanced Care 10 (2017) + Vision","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150003-05.pdf","https://api.centene.com/Brochures/2017/29418TX0150003-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9848",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-06","Ambetter Balanced Care 10 (2017) + Vision","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150003-06.pdf","https://api.centene.com/Brochures/2017/29418TX0150003-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150006-00","Ambetter Balanced Care 3 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150006-00.pdf","https://api.centene.com/Brochures/2017/29418TX0150006-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150006-01","Ambetter Balanced Care 3 (2017) + Vision","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150006-01.pdf","https://api.centene.com/Brochures/2017/29418TX0150006-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150006-02","Ambetter Balanced Care 3 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150006-02.pdf","https://api.centene.com/Brochures/2017/29418TX0150006-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150006-03","Ambetter Balanced Care 3 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150006-03.pdf","https://api.centene.com/Brochures/2017/29418TX0150006-03.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150006-04","Ambetter Balanced Care 3 (2017) + Vision","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150006-04.pdf","https://api.centene.com/Brochures/2017/29418TX0150006-04.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150006-05","Ambetter Balanced Care 3 (2017) + Vision","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150006-05.pdf","https://api.centene.com/Brochures/2017/29418TX0150006-05.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150006-06","Ambetter Balanced Care 3 (2017) + Vision","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150006-06.pdf","https://api.centene.com/Brochures/2017/29418TX0150006-06.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9856",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150004-00","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze Off Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150004-00.pdf","https://api.centene.com/Brochures/2017/29418TX0150004-00.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9856",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150004-01","Ambetter Essential Care 1 (2017) + Vision","Standard Bronze On Exchange Plan",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150004-01.pdf","https://api.centene.com/Brochures/2017/29418TX0150004-01.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9856",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150004-02","Ambetter Essential Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150004-02.pdf","https://api.centene.com/Brochures/2017/29418TX0150004-02.pdf"
"2017","TX","29418","HIOS","2016-10-18 03:04:46","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2017) + Vision","29418TX015",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9856",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150004-03","Ambetter Essential Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.615035176277161","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/29418TX0150004-03.pdf","https://api.centene.com/Brochures/2017/29418TX0150004-03.pdf"
"2017","TX","29817","HIOS","2016-08-10 02:51:42","SHOP (Small Group)","Yes","57-0523959","29817TX0020001","Group Dental Policy","29817TX002",,"TXN001","TXS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","29817TX0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690001","Humana Basic 7150/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690001-00","Humana Basic 7150/Corpus Christi HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851030",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630002","Humana Bronze 6550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0630002-02","Humana Bronze 6550/HMO Premier","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851615",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630002","Humana Bronze 6550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0630002-03","Humana Bronze 6550/HMO Premier","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851628",
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460397","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460397-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500001","BlueCare Dental? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470157","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS011","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470157-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470149","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS021","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470149-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460398","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460398-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460398","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460398-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690001","Humana Basic 7150/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690001-01","Humana Basic 7150/Corpus Christi HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851030",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690006","Humana Bronze 6550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690006-02","Humana Bronze 6550/San Antonio HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851719",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690006","Humana Bronze 6550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690006-03","Humana Bronze 6550/San Antonio HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851732",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690004","Humana Silver 3550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690004-01","Humana Silver 3550/Corpus Christi HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852252",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630004","Humana Silver 3550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630004-05","Humana Silver 3550/HMO Premier","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852668",
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470152","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS051","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470152-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470153","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS061","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470153-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460402","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460402-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690005","Humana Basic 7150/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690005-00","Humana Basic 7150/San Antonio HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851108",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690005","Humana Basic 7150/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690005-01","Humana Basic 7150/San Antonio HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851108",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690009","Humana Basic 7150/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690009-00","Humana Basic 7150/Waco HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851134",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690009","Humana Basic 7150/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690009-01","Humana Basic 7150/Waco HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851134",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630001","Humana Basic 7150/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0630001-00","Humana Basic 7150/HMO Premier","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851056",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630001","Humana Basic 7150/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0630001-01","Humana Basic 7150/HMO Premier","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851056",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690002","Humana Bronze 6550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690002-00","Humana Bronze 6550/Corpus Christi HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2851550",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690002","Humana Bronze 6550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690002-01","Humana Bronze 6550/Corpus Christi HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2851550",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690002","Humana Bronze 6550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690002-02","Humana Bronze 6550/Corpus Christi HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851563",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690002","Humana Bronze 6550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690002-03","Humana Bronze 6550/Corpus Christi HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851576",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690006","Humana Bronze 6550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690006-00","Humana Bronze 6550/San Antonio HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2851706",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690006","Humana Bronze 6550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690006-01","Humana Bronze 6550/San Antonio HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2851706",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690010","Humana Bronze 6550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690010-00","Humana Bronze 6550/Waco HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2851758",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690010","Humana Bronze 6550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690010-01","Humana Bronze 6550/Waco HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2851758",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690010","Humana Bronze 6550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690010-02","Humana Bronze 6550/Waco HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851771",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690010","Humana Bronze 6550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0690010-03","Humana Bronze 6550/Waco HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851784",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630002","Humana Bronze 6550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0630002-00","Humana Bronze 6550/HMO Premier","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2851602",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630002","Humana Bronze 6550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Complete-TX","32673TX0630002-01","Humana Bronze 6550/HMO Premier","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2851602",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690003","Humana Bronze 6150/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690003-00","Humana Bronze 6150/Corpus Christi HMOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851225",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690003","Humana Bronze 6150/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690003-01","Humana Bronze 6150/Corpus Christi HMOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851225",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690003","Humana Bronze 6150/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690003-02","Humana Bronze 6150/Corpus Christi HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851238",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690003","Humana Bronze 6150/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690003-03","Humana Bronze 6150/Corpus Christi HMOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851264",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690007","Humana Bronze 6150/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690007-00","Humana Bronze 6150/San Antonio HMOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851394",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690007","Humana Bronze 6150/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690007-01","Humana Bronze 6150/San Antonio HMOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851394",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690007","Humana Bronze 6150/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690007-02","Humana Bronze 6150/San Antonio HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851407",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690007","Humana Bronze 6150/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690007-03","Humana Bronze 6150/San Antonio HMOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851420",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690011","Humana Bronze 6150/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690011-00","Humana Bronze 6150/Waco HMOx","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851446",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690011","Humana Bronze 6150/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690011-01","Humana Bronze 6150/Waco HMOx","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851446",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690011","Humana Bronze 6150/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690011-02","Humana Bronze 6150/Waco HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851459",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690011","Humana Bronze 6150/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF002","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690011-03","Humana Bronze 6150/Waco HMOx","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851472",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630003","Humana Bronze 6150/HMO Premier","32673TX063",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630003-00","Humana Bronze 6150/HMO Premier","Standard Bronze Off Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851290",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630003","Humana Bronze 6150/HMO Premier","32673TX063",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630003-01","Humana Bronze 6150/HMO Premier","Standard Bronze On Exchange Plan",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851290",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630003","Humana Bronze 6150/HMO Premier","32673TX063",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630003-02","Humana Bronze 6150/HMO Premier","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851303",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630003","Humana Bronze 6150/HMO Premier","32673TX063",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630003-03","Humana Bronze 6150/HMO Premier","Limited Cost Sharing Plan Variation",,"0.604650497436523","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2851316",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690004","Humana Silver 3550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690004-00","Humana Silver 3550/Corpus Christi HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852252",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690004","Humana Silver 3550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690004-02","Humana Silver 3550/Corpus Christi HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852265",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690004","Humana Silver 3550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690004-03","Humana Silver 3550/Corpus Christi HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852278",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690004","Humana Silver 3550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690004-04","Humana Silver 3550/Corpus Christi HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852135",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690004","Humana Silver 3550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690004-05","Humana Silver 3550/Corpus Christi HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852655",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690004","Humana Silver 3550/Corpus Christi HMOx","32673TX069",,"TXN006","TXS003","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690004-06","Humana Silver 3550/Corpus Christi HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852057",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690008","Humana Silver 3550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690008-00","Humana Silver 3550/San Antonio HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852538",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690008","Humana Silver 3550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690008-01","Humana Silver 3550/San Antonio HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852538",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690008","Humana Silver 3550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690008-02","Humana Silver 3550/San Antonio HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852551",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690008","Humana Silver 3550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690008-03","Humana Silver 3550/San Antonio HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852564",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690008","Humana Silver 3550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690008-04","Humana Silver 3550/San Antonio HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852174",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690008","Humana Silver 3550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690008-05","Humana Silver 3550/San Antonio HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852694",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690008","Humana Silver 3550/San Antonio HMOx","32673TX069",,"TXN005","TXS007","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690008-06","Humana Silver 3550/San Antonio HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852096",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690012","Humana Silver 3550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690012-00","Humana Silver 3550/Waco HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852590",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690012","Humana Silver 3550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690012-01","Humana Silver 3550/Waco HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852590",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690012","Humana Silver 3550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690012-02","Humana Silver 3550/Waco HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852603",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690012","Humana Silver 3550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690012-03","Humana Silver 3550/Waco HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852616",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690012","Humana Silver 3550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690012-04","Humana Silver 3550/Waco HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852187",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690012","Humana Silver 3550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690012-05","Humana Silver 3550/Waco HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852707",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0690012","Humana Silver 3550/Waco HMOx","32673TX069",,"TXN004","TXS002","TXF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0690012-06","Humana Silver 3550/Waco HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852109",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630004","Humana Silver 3550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630004-00","Humana Silver 3550/HMO Premier","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852447",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630004","Humana Silver 3550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630004-01","Humana Silver 3550/HMO Premier","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852447",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630004","Humana Silver 3550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630004-02","Humana Silver 3550/HMO Premier","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852460",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630004","Humana Silver 3550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630004-03","Humana Silver 3550/HMO Premier","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852473",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630004","Humana Silver 3550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630004-04","Humana Silver 3550/HMO Premier","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852148",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630004","Humana Silver 3550/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630004-06","Humana Silver 3550/HMO Premier","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2852070",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630013","Humana Gold 0/HMO Premier","32673TX063",,"TXN001","TXS005","TXF004","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630013-00","Humana Gold 0/HMO Premier","Standard Gold Off Exchange Plan",,"0.798137724399567","Yes","Yes","Yes","97%","3%","$0","$10","$2,900","$30","$0","$600","$50","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851888",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630013","Humana Gold 0/HMO Premier","32673TX063",,"TXN001","TXS005","TXF004","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630013-01","Humana Gold 0/HMO Premier","Standard Gold On Exchange Plan",,"0.798137724399567","Yes","Yes","Yes","97%","3%","$0","$10","$2,900","$30","$0","$600","$50","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851888",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630013","Humana Gold 0/HMO Premier","32673TX063",,"TXN001","TXS005","TXF004","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630013-02","Humana Gold 0/HMO Premier","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851901",
"2017","TX","32673","HIOS","2016-08-20 07:40:33","Individual","No","61-0994632","32673TX0630013","Humana Gold 0/HMO Premier","32673TX063",,"TXN001","TXS005","TXF004","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Complete-TX","32673TX0630013-03","Humana Gold 0/HMO Premier","Limited Cost Sharing Plan Variation",,"0.798137724399567","Yes","Yes","Yes","97%","3%","$0","$10","$2,900","$30","$0","$600","$50","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2851914",
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470157","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS011","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470157-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500001","BlueCare Dental? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460397","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460397-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470149","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS021","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470149-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470150","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS031","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470150-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460399","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460399-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460399","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460399-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470150","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS031","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470150-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470151","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS041","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470151-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460400","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460400-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460400","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460400-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470151","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS041","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470151-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470152","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS051","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470152-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460401","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460401-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460401","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460401-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460402","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460402-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470153","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS061","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470153-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470154","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS071","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470154-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460403","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460403-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460403","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460403-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460408","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460408-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470159","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS121","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470159-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470166","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS191","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470166-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470154","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS071","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470154-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470155","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS081","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470155-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460404","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460404-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460404","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460404-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470155","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS081","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470155-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470156","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS091","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470156-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460405","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460405-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460405","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460405-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470156","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS091","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470156-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470006","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS101","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470006-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460406","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460406-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460406","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460406-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470006","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS101","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470006-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470158","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS111","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470158-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460407","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460407-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460407","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460407-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470158","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS111","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470158-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470159","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS121","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470159-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460408","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460408-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470160","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS131","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470160-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460409","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460409-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460409","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460409-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470160","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS131","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470160-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460410","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460410-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460410","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460410-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460411","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460411-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460411","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460411-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460412","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460412-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460412","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460412-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460413","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460413-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460413","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460413-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460414","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460414-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460414","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460414-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460415","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460415-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460415","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460415-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460416","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460416-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460416","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460416-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460417","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460417-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460417","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460417-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460242","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460242-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460242","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460242-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460393","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460393-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460393","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460393-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460394","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460394-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460394","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460394-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460395","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460395-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460395","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460395-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460396","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460396-00","Blue Advantage Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460396","Blue Advantage Security HMO? 100","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460396-01","Blue Advantage Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460242-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460372","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460372-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470161","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS141","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470161-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500003","BlueCare Dental 4 Kids? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500003","BlueCare Dental 4 Kids? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470161","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS141","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470161-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460372","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460372-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460372","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460372-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470162","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS151","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470162-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470162","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS151","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470162-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460372","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460372-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460373","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460373-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470163","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS161","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470163-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460368","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460368-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460368","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460368-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460421","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460421-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460421","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460421-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470276","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS041","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470276-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470276","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS041","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470276-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460452","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460452-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470163","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS161","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470163-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460373","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460373-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460373","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460373-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470164","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS171","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470164-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470164","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS171","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470164-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460373","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460373-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460374","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460374-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470165","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS181","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470165-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470165","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS181","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470165-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460374","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460374-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460374","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460374-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470166","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS191","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470166-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460374","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460374-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460375","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460375-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470167","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS201","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470167-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470167","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS201","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470167-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460375","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460375-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460375","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460375-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460378","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460378-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470168","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS211","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470168-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470168","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS211","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470168-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460375","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460375-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460376","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460376-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470169","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS221","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470169-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470169","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS221","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470169-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460376","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460376-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460376","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460376-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470170","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS231","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470170-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470170","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS231","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470170-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460376","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460376-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460377","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460377-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470171","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS241","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470171-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470171","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS241","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470171-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460377","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460377-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460377","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460377-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470172","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS251","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470172-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470172","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS251","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470172-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460377","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460377-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470173","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS261","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470173-00","Blue Advantage Bronze HMO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470173","Blue Advantage Bronze HMO 006","33602TX047",,"TXN011","TXS261","TXF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470173-01","Blue Advantage Bronze HMO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460378","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460378-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460383","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460383-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460390","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460390-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460390","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460390-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460390","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460390-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470278","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS061","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470278-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460378","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460378-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460378","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460378-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460379","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460379-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460379","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460379-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460379","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460379-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460379","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460379-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460380","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460380-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460380","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460380-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460380","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460380-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460380","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460380-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460381","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460381-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460381","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460381-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460381","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460381-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460381","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460381-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460382","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460382-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460382","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460382-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460382","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460382-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460382","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460382-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460383","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460383-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460383","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460383-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460383","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460383-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460384","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460384-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460384","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460384-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460384","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460384-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460384","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460384-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460385","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460385-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460385","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460385-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460385","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460385-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460385","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460385-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460386","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460386-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460386","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460386-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460386","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460386-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460386","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460386-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460387","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460387-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460387","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460387-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460387","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460387-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460387","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460387-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460388","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460388-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460388","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460388-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460388","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460388-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460388","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460388-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460389","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460389-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460389","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460389-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460389","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460389-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460389","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460389-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460390","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460390-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460391","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460391-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460391","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460391-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460391","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460391-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460391","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460391-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460392","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460392-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460392","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460392-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460392","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460392-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460392","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460392-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460241","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460241-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460241","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460241-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460241","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460241-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460241","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460241-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460368","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460368-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460368","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460368-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460369","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460369-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460369","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460369-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460369","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460369-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460369","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460369-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460370","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460370-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460370","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460370-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460370","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460370-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460370","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460370-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460371","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460371-00","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460371","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460371-01","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460371","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460371-02","Blue Advantage Bronze HMO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460371","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460371-03","Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.616297841072083","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$2,400","$0","$600","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$14300 per group","30.00%","$6,850","$6850 per person","$14300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460241-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460421","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460421-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470282","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS011","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470282-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500002","BlueCare Dental? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500002","BlueCare Dental? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470282","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS011","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470282-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460421","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460421-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460421","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460421-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470274","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS021","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470274-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500005","BlueCare Dental? 2A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500005-00","BlueCare Dental? 2A","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500005","BlueCare Dental? 2A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500005-01","BlueCare Dental? 2A","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470274","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS021","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470274-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460421","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460421-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460421","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460421-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470275","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS031","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470275-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470275","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS031","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470275-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460452","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460452-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470277","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS051","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470277-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470277","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS051","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470277-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460452","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460452-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470284","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS121","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470284-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470284","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS121","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470284-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460456","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460456-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460469","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460469-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460452","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460452-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470278","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS061","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470278-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460452","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460452-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460452","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460452-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470279","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS071","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470279-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470279","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS071","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470279-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460452","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460452-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460453","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460453-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460454","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460454-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470280","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS081","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470280-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470280","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS081","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470280-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460453","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460453-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460453","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460453-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470281","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS091","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470281-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470281","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS091","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470281-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460453","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460453-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460453","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460453-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470014","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS101","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470014-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470014","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS101","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470014-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460453","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460453-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460453","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460453-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470283","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS111","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470283-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470283","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS111","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470283-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460454","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460454-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460454","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460454-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460454","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460454-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470285","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS131","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470285-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460457","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460457-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460464","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460464-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460465","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460465-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460465","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460465-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460465","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460465-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460465","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460465-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460465","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460465-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470285","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS131","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470285-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460454","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460454-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460454","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460454-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460454","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460454-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460455","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460455-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460455","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460455-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460455","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460455-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460455","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460455-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460455","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460455-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460455","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460455-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460455","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460455-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460456","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460456-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460456","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460456-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460456","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460456-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460456","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460456-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460456","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460456-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460456","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460456-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460457","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460457-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460457","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460457-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460457","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460457-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460457","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460457-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460457","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460457-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460457","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460457-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460458","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460458-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460458","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460458-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460458","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460458-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460458","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460458-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460458","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460458-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460458","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460458-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460458","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460458-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460459","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460459-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460459","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460459-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460459","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460459-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460459","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460459-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460459","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460459-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460459","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460459-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460459","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460459-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460460","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460460-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460460","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460460-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460460","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460460-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460460","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460460-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460460","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460460-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460460","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460460-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460460","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460460-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460461","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460461-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460461","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460461-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460461","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460461-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460461","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460461-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460461","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460461-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460461","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460461-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460461","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460461-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460462","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460462-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460462","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460462-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460462","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460462-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460462","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460462-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460462","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460462-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460462","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460462-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460462","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460462-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460463","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460463-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460463","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460463-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460463","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460463-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460463","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460463-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460463","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460463-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460463","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460463-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460463","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460463-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460464","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460464-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460464","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460464-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460464","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460464-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460464","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460464-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460464","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460464-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460464","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460464-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460465","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460465-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460465","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460465-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460466","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460466-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460466","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460466-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460466","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460466-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460466","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460466-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460466","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460466-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460466","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460466-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460466","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460466-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460467","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460467-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460467","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460467-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460467","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460467-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460467","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460467-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460467","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460467-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460467","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460467-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460467","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460467-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460468","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460468-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460468","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460468-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460468","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460468-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460468","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460468-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460468","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460468-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460468","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460468-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460468","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460468-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460469","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460469-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460469","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460469-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460469","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460469-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470296","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS241","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470296-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460284","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460284-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460291","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460291-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460304-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460304-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460312-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460316-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470291","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS191","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470291-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470291","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS191","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470291-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470292","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS201","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470292-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460469","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460469-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460469","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460469-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460469","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460469-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460470","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460470-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460470","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460470-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460470","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460470-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460470","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460470-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460470","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460470-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460470","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460470-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460470","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460470-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460471","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460471-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460471","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460471-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460471","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460471-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460471","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460471-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460471","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460471-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460471","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460471-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460471","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460471-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460472","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460472-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460472","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460472-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460472","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460472-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460472","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460472-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460472","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460472-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460472","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460472-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460472","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460472-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460473","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460473-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460473","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460473-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460473","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460473-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460473","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460473-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460473","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460473-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460473","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460473-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460473","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460473-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460474","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460474-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460474","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460474-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460474","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460474-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460474","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460474-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460474","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460474-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460474","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460474-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460474","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460474-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460475","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460475-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460475","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460475-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460475","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460475-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460475","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460475-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460475","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460475-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460475","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460475-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460475","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460475-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460476","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460476-00","Blue Advantage Silver HMO? 107","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460476","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460476-01","Blue Advantage Silver HMO? 107","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460476","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460476-02","Blue Advantage Silver HMO? 107","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460476","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460476-03","Blue Advantage Silver HMO? 107","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$2,800","$20","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460476","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460476-04","Blue Advantage Silver HMO? 107","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460476","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460476-05","Blue Advantage Silver HMO? 107","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460476","Blue Advantage Silver HMO? 107","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Design 1","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460476-06","Blue Advantage Silver HMO? 107","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460421-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470286","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS141","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470286-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500004","BlueCare Dental 4 Kids? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","Yes","36-1236610","33602TX0500004","BlueCare Dental 4 Kids? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470286","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS141","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470286-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470287","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS151","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470287-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470287","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS151","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470287-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470288","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS161","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470288-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470288","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS161","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470288-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470289","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS171","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470289-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470289","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS171","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470289-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470290","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS181","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470290-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470290","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS181","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470290-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470292","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS201","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470292-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470297","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS251","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470297-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470298","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS261","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470298-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470024","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS021","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470024-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470024","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS021","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470024-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460272","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460272-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470293","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS211","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470293-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470293","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS211","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470293-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470294","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS221","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470294-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470294","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS221","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470294-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470295","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS231","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470295-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470295","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS231","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470295-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470296","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS241","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470296-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470297","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS251","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470297-00","Blue Advantage Gold HMO 014","Standard Gold Off Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470298","Blue Advantage Gold HMO 014","33602TX047",,"TXN011","TXS261","TXF012","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0470298-01","Blue Advantage Gold HMO 014","Standard Gold On Exchange Plan",,"0.810230493545532","No","Yes","Yes","60%","40%","$1,000","$200","$1,000","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470014-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460272","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460272-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470032","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS011","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470032-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470032","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS011","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470032-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460272","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460272-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460272","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460272-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460273","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460273-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470025","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS031","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470025-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470025","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS031","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470025-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470030","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS081","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470030-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460275","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460275-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460276","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460276-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470031","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS091","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470031-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470031","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS091","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470031-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460273","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460273-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460273","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460273-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470026","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS041","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470026-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470026","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS041","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470026-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460273","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460273-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460274","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460274-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470027","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS051","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470027-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470027","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS051","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470027-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460274","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460274-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460274","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460274-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470028","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS061","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470028-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470028","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS061","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470028-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460274","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460274-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460275","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460275-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470029","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS071","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470029-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470029","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS071","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470029-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460275","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460275-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460275","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460275-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470030","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS081","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470030-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460276","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460276-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460276","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460276-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470001","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS101","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470001-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460279","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460279-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460280","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460280-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460280","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460280-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460280","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460280-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460280","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460280-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470001","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS101","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470001-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460276","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460276-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460277","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460277-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470033","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS111","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470033-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470033","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS111","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470033-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460277","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460277-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460277","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460277-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470034","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS121","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470034-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470034","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS121","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470034-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460277","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460277-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460278","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460278-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470035","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS131","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470035-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470035","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS131","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470035-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460278","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460278-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460278","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460278-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460278","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460278-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460279","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460279-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460279","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460279-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460279","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460279-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460281","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460281-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460281","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460281-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460286","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460286-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460286","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460286-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460237","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460237-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460237","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460237-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460237","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460237-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460237","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460237-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460281","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460281-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460281","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460281-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460282","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460282-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460282","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460282-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460282","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460282-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460282","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460282-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460283","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460283-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460283","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460283-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460283","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460283-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460283","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460283-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460284","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460284-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460284","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460284-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460284","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460284-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460285","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460285-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460285","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460285-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460285","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460285-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460285","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460285-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460286","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460286-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460286","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460286-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460287","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460287-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460287","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460287-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460287","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460287-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460287","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460287-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460288","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460288-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460288","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460288-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460288","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460288-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460288","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460288-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460289","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460289-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460289","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460289-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460289","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460289-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460289","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460289-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460290","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460290-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460290","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460290-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460290","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460290-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460290","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460290-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460291","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460291-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460291","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460291-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460291","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460291-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460292","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460292-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460292","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460292-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460292","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460292-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460292","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460292-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460268","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460268-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460268","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460268-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460268","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460268-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460268","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460268-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460269","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460269-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460297-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470038","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS161","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470038-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470038","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS161","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470038-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460269","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460269-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460269","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460269-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460269","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460269-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460270","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460270-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460270","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460270-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460270","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460270-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460270","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460270-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460271","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460271-00","Blue Advantage Gold HMO? 101","Standard Gold Off Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460271","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460271-01","Blue Advantage Gold HMO? 101","Standard Gold On Exchange Plan","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460271","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460271-02","Blue Advantage Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460271","Blue Advantage Gold HMO? 101","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460271-03","Blue Advantage Gold HMO? 101","Limited Cost Sharing Plan Variation","79.26%","0","Yes","Yes","Yes","60%","40%","$500","$300","$200","$200","$500","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%","$500","$500 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460237-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460297-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470036","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS141","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470036-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470036","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS141","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470036-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460297-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460297-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470037","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS151","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470037-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470037","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS151","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470037-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460297-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460297-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460297-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470039","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS171","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470039-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470039","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS171","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470039-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460298-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460299-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460299-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470045","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS231","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470045-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460298-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470040","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS181","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470040-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470040","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS181","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470040-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460298-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460298-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470041","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS191","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470041-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470041","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS191","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470041-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460298-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460298-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470042","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS201","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470042-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470042","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS201","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470042-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460298-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460299-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470043","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS211","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470043-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470043","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS211","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470043-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460299-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460299-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470044","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS221","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470044-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470044","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS221","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470044-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470045","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS231","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470045-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460301-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460305-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460305-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460305-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460294-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460295-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460295-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460299-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460299-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470046","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS241","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470046-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470046","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS241","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470046-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460300-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460300-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470047","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS251","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470047-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470047","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS251","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470047-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460300-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460300-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470048","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS261","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470048-00","Blue Advantage Gold HMO 001","Standard Gold Off Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470048","Blue Advantage Gold HMO 001","33602TX047",,"TXN011","TXS261","TXF010","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470048-01","Blue Advantage Gold HMO 001","Standard Gold On Exchange Plan","80.11%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460300-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460300-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460300-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460301-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460301-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460301-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460301-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460301-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460301-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460302-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460302-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460302-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460302-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460302-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460302-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460302-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460303-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460303-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460303-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460303-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460303-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460303-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460303-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460304-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460304-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460304-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460304-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460304-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460305-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460305-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460305-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460305-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460306-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460306-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460306-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460306-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460306-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460306-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460306-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460307-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460307-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460307-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460307-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460307-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460307-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460307-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460308-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460308-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460308-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460308-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460308-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460308-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460308-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460309-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460309-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460309-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460309-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460309-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460309-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460309-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460310-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460310-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460310-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460310-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460310-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460310-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460310-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460311-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460311-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460311-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460311-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460311-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460311-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460311-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460312-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460312-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460312-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460312-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460312-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460312-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460313-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460313-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460313-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460313-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460313-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460313-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460313-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460314-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460314-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460314-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460314-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460314-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460314-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460314-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460315-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460315-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460315-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460315-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460315-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460315-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460315-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460316-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460316-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460316-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460316-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460316-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460316-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460317-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460317-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460317-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460317-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460317-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460317-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460317-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460238-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460238-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460238-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460238-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460238-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460238-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460238-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460293-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460293-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460293-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460293-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460293-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460293-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460293-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460294-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460294-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460294-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460294-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460294-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460294-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460295-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460295-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460295-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460295-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460295-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460296-00","Blue Advantage Silver HMO? 102","Standard Silver Off Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460296-01","Blue Advantage Silver HMO? 102","Standard Silver On Exchange Plan","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460296-02","Blue Advantage Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460296-03","Blue Advantage Silver HMO? 102","Limited Cost Sharing Plan Variation","70.31%","0","Yes","Yes","Yes","60%","40%","$3,000","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460296-04","Blue Advantage Silver HMO? 102","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,900","$500","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460296-05","Blue Advantage Silver HMO? 102","87% AV Level Silver Plan","87.03%","0","Yes","Yes","Yes","60%","40%","$200","$500","$200","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO? 102","33602TX046",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460296-06","Blue Advantage Silver HMO? 102","94% AV Level Silver Plan","93.62%","0","Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460238-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770008","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770008-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470080","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS011","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470080-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470080","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS011","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470080-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770008","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770008-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770008","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770008-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470074","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS021","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470074-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470074","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS021","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470074-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770008","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770008-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770009","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770009-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470075","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS031","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470075-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470075","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS031","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470075-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770009","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770009-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770009","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770009-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470076","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS041","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470076-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470076","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS041","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470076-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770009","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770009-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770010","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770010-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470077","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS051","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470077-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470077","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS051","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470077-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770010","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770010-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770010","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770010-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470078","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS061","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470078-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470078","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS061","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470078-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770010","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770010-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770011","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770011-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470079","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS071","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470079-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470079","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS071","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470079-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770011","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770011-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770011","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770011-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470003","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS081","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470003-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470003","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS081","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470003-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770011","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770011-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770012","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770012-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470081","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS091","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470081-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470081","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS091","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470081-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770012","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770012-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770012","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770012-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470082","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS101","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470082-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470082","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS101","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470082-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770012","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770012-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770013","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770013-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770023","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770023-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470090","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS181","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470090-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470090","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS181","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470090-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770038-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770042-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770042-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470083","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS111","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470083-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470083","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS111","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470083-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770013","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770013-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770013","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770013-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470084","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS121","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470084-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470084","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS121","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470084-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770013","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770013-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770014","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770014-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470085","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS131","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470085-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470085","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS131","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470085-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770014","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770014-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770014","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770014-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770014","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770014-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770015","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770015-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770015","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770015-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770015","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770015-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770015","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770015-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770016","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770016-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770016","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770016-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770016","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770016-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770016","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770016-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770017","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770017-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770017","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770017-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770017","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770017-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770017","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770017-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770018","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770018-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770018","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770018-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770018","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770018-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770004","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770004-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770004","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770004-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770004","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770004-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770004","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770004-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770005","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770005-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770005","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770005-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770018","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770018-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770019","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770019-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770019","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770019-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770019","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770019-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770019","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770019-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770020","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770020-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770020","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770020-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770020","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770020-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770020","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770020-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770021","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770021-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770021","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770021-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770021","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770021-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770021","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770021-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770022","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770022-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770022","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770022-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770022","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770022-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770022","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770022-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770023","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770023-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770023","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770023-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770023","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770023-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770024","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770024-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770024","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770024-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770024","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770024-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770024","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770024-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770025","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770025-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770025","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770025-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770025","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770025-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770025","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770025-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770026","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770026-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770026","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770026-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770026","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770026-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770026","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770026-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770027","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770027-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770027","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770027-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770027","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770027-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770027","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770027-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770028","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770028-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770028","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770028-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770028","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770028-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770028","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770028-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770001","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770001-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770001","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770001-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770001","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770001-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770001","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770001-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770005","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770005-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770005","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770005-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770006","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770006-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770006","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770006-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770006","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770006-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770006","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770006-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770007","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770007-00","Blue Advantage Plus Gold? 101","Standard Gold Off Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770007","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770007-01","Blue Advantage Plus Gold? 101","Standard Gold On Exchange Plan","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770007","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770007-02","Blue Advantage Plus Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770007","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770007-03","Blue Advantage Plus Gold? 101","Limited Cost Sharing Plan Variation","79.29%","0","Yes","Yes","Yes","60%","40%","$2,800","$200","$10","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770033-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470086","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS141","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470086-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470086","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS141","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470086-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770033-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770033-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470087","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS151","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470087-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470087","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS151","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470087-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770033-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770033-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470088","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS161","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470088-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470088","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS161","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470088-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770033-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770033-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470089","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS171","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470089-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470089","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS171","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470089-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770034-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770034-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770034-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770034-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470091","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS191","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470091-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470091","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS191","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470091-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770034-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770034-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470092","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS201","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470092-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470092","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS201","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470092-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770034-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770035-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470093","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS211","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470093-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470093","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS211","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470093-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770035-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770035-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470094","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS221","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470094-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470094","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS221","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470094-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770035-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770035-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470095","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS231","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470095-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470095","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS231","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470095-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770035-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770035-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470096","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS241","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470096-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470096","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS241","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470096-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770036-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770038-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770046-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770049-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770050-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770031-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770036-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470097","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS251","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470097-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470097","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS251","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470097-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770036-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770036-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470098","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS261","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470098-00","Blue Advantage Silver HMO 003","Standard Silver Off Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470098","Blue Advantage Silver HMO 003","33602TX047",,"TXN011","TXS261","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470098-01","Blue Advantage Silver HMO 003","Standard Silver On Exchange Plan","70.05%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770036-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770036-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770036-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770037-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770037-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770037-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770037-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770037-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770037-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770037-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770038-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770038-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770038-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770038-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770038-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770039-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770039-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770039-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770039-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770039-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770039-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770039-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770040-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770040-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770040-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770040-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770040-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770040-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770040-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770041-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770041-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770041-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770041-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770041-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770041-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770041-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770042-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770042-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770042-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770042-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770042-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770043-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770043-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770043-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770043-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770043-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770043-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770043-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770044-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770044-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770044-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770044-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770044-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770044-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770044-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770045-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770045-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770045-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770045-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770045-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770045-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770045-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770046-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770046-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770046-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770046-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770046-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770046-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770032-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770032-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770032-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770063","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS061","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770063-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770070","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS131","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770070-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770077","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS201","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770077-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770084","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS011","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770084-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770047-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770047-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770047-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770047-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770047-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770047-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770047-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770048-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770048-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770048-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770048-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770048-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770048-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770048-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770049-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770049-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770049-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770049-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770049-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770049-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770050-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770050-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770050-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770050-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770050-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770050-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770051-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770051-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770051-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770051-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770051-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770051-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770051-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770052-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770052-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770052-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770052-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770052-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770052-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770052-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770053-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770053-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770053-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770053-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770053-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770053-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770053-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770002-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770002-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770002-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770002-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770002-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770002-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770002-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770029-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770029-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770029-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770029-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770029-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770029-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770029-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770030-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770030-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770030-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770030-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770030-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770030-05","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,000","$200","$500","$0","$200","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770030-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770031-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770031-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770031-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770031-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770031-04","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770031-06","Blue Advantage Plus Silver? 102 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770032-00","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770032-01","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Standard Silver On Exchange Plan","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770032-02","Blue Advantage Plus Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770032-03","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","70.87%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770058","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS011","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770058-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470107","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS011","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470107-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470107","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS011","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470107-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770058","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS011","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770058-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770058","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS011","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770058-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470099","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS021","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470099-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470099","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS021","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470099-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770058","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS011","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770058-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770059","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS021","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770059-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470100","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS031","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470100-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470100","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS031","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470100-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770059","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS021","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770059-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770059","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS021","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770059-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470101","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS041","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470101-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470101","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS041","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470101-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770059","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS021","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770059-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770060","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS031","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770060-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470102","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS051","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470102-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470102","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS051","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470102-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770060","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS031","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770060-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770060","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS031","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770060-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470103","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS061","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470103-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470103","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS061","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470103-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770060","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS031","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770060-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770061","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS041","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770061-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470104","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS071","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470104-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470104","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS071","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470104-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770061","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS041","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770061-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770061","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS041","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770061-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470105","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS081","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470105-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470105","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS081","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470105-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770061","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS041","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770061-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770062","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS051","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770062-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470106","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS091","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470106-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470106","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS091","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470106-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770062","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS051","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770062-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770062","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS051","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770062-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470004","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS101","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470004-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470004","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS101","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470004-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770062","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS051","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770062-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770063","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS061","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770063-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470108","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS111","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470108-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470108","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS111","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470108-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770063","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS061","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770063-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770063","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS061","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770063-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470109","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS121","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470109-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770067","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS101","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770067-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770068","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS111","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770068-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770068","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS111","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770068-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770075","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS181","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770075-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770075","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS181","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770075-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770075","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS181","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770075-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470109","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS121","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470109-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770064","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS071","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770064-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470110","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS131","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470110-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470110","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS131","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470110-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770064","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS071","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770064-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770064","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS071","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770064-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770064","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS071","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770064-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770065","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS081","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770065-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770065","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS081","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770065-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770065","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS081","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770065-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770065","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS081","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770065-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770066","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS091","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770066-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770066","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS091","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770066-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770066","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS091","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770066-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770066","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS091","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770066-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770067","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS101","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770067-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770067","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS101","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770067-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770067","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS101","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770067-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770068","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS111","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770068-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770068","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS111","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770068-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770069","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS121","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770069-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770069","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS121","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770069-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770069","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS121","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770069-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770069","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS121","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770069-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770070","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS131","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770070-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770070","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS131","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770070-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770070","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS131","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770070-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770071","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS141","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770071-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770071","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS141","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770071-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770071","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS141","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770071-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770071","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS141","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770071-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770072","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS151","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770072-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770072","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS151","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770072-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770072","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS151","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770072-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770072","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS151","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770072-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770073","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS161","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770073-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770073","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS161","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770073-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770073","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS161","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770073-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770073","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS161","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770073-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770074","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS171","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770074-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770074","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS171","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770074-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770074","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS171","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770074-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770074","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS171","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770074-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770075","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS181","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770075-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770076","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS191","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770076-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770076","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS191","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770076-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770055","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS241","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770055-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770055","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS241","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770055-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770055","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS241","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770055-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770055","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS241","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770055-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770056","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS251","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770056-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770076","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS191","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770076-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770076","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS191","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770076-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770077","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS201","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770077-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770077","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS201","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770077-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770077","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS201","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770077-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770078","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS211","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770078-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770078","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS211","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770078-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770078","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS211","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770078-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770078","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS211","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770078-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770003","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS221","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770003-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770003","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS221","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770003-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770003","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS221","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770003-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770003","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS221","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770003-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770054","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS231","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770054-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770054","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS231","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770054-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770054","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS231","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770054-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770054","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS231","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770054-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770056","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS251","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770056-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770056","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS251","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770056-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770056","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS251","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770056-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770057","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS261","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770057-00","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770057","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS261","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770057-01","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770057","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS261","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770057-02","Blue Advantage Plus Bronze? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770057","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS261","TXF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770057-03","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.59%","0","Yes","Yes","Yes","60%","40%","$6,600","$600","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$14300 per group","20.00%","$6,600","$6600 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770084","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS011","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770084-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470111","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS141","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470111-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470111","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS141","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470111-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770084","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS011","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770084-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470112","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS151","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470112-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470112","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS151","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470112-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770084","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS011","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770084-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770085","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS021","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770085-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470113","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS161","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470113-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470113","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS161","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470113-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770085","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS021","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770085-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770085","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS021","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770085-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470114","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS171","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470114-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470114","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS171","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470114-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770085","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS021","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770085-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770086","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS031","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770086-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470115","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS181","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470115-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470115","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS181","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470115-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770086","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS031","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770086-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770088","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS051","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770088-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770089","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS061","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770089-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470121","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS241","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470121-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430006","Blue Choice Bronze PPO 006","33602TX043",,"TXN012","TXS002","TXF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430006-01","Blue Choice Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770100","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS171","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770100-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460136","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460136-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460143","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460143-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770086","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS031","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770086-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470116","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS191","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470116-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470116","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS191","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470116-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770086","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS031","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770086-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770087","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS041","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770087-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770091","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS081","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770091-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770097","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS141","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770097-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770103","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS201","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770103-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460140","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460140-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460146","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460146-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460329-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460329-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470117","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS201","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470117-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470117","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS201","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470117-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770087","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS041","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770087-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770087","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS041","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770087-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470118","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS211","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470118-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470118","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS211","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470118-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770087","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS041","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770087-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770088","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS051","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770088-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470119","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS221","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470119-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470119","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS221","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470119-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770088","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS051","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770088-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770088","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS051","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770088-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470120","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS231","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470120-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470120","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS231","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470120-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470121","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS241","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470121-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770089","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS061","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770089-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770089","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS061","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770089-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470122","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS251","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470122-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470122","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS251","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470122-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770089","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS061","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770089-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770090","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS071","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770090-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470123","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS261","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470123-00","Blue Advantage Silver HMO 004","Standard Silver Off Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0470123","Blue Advantage Silver HMO 004","33602TX047",,"TXN011","TXS261","TXF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0470123-01","Blue Advantage Silver HMO 004","Standard Silver On Exchange Plan","71.47%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0470004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770090","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS071","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770090-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770090","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS071","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770090-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770090","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS071","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770090-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770091","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS081","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770091-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770091","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS081","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770091-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770091","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS081","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770091-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770092","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS091","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770092-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770092","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS091","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770092-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770092","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS091","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770092-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770092","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS091","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770092-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770093","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS101","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770093-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430005","Blue Choice Bronze PPO 005","33602TX043",,"TXN012","TXS002","TXF020","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430005-00","Blue Choice Bronze PPO 005","Standard Bronze Off Exchange Plan",,"0.616537094116211","Yes","Yes","Yes","60%","40%","$5,800","$0","$400","$200","$2,400","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","30.00%","$5,750","$5750 per person","$11500 per group","30.00%","$11,000","$11000 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430005-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430005","Blue Choice Bronze PPO 005","33602TX043",,"TXN012","TXS002","TXF020","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430005-01","Blue Choice Bronze PPO 005","Standard Bronze On Exchange Plan",,"0.616537094116211","Yes","Yes","Yes","60%","40%","$5,800","$0","$400","$200","$2,400","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","30.00%","$5,750","$5750 per person","$11500 per group","30.00%","$11,000","$11000 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430005-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770093","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS101","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770093-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770093","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS101","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770093-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430006","Blue Choice Bronze PPO 006","33602TX043",,"TXN012","TXS002","TXF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430006-00","Blue Choice Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770093","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS101","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770093-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770094","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS111","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770094-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770094","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS111","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770094-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770094","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS111","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770094-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770094","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS111","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770094-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770095","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS121","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770095-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770095","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS121","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770095-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770095","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS121","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770095-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770095","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS121","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770095-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770096","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS131","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770096-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770096","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS131","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770096-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770096","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS131","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770096-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770096","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS131","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770096-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770097","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS141","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770097-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770097","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS141","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770097-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770097","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS141","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770097-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770098","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS151","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770098-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770098","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS151","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770098-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770098","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS151","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770098-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770098","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS151","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770098-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770099","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS161","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770099-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770099","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS161","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770099-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770099","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS161","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770099-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770099","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS161","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770099-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770100","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS171","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770100-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770100","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS171","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770100-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770100","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS171","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770100-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770101","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS181","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770101-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770101","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS181","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770101-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770101","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS181","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770101-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770101","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS181","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770101-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770102","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS191","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770102-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430020","Blue Choice Gold PPO 020","33602TX043",,"TXN012","TXS002","TXF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0430020-00","Blue Choice Gold PPO 020","Standard Gold Off Exchange Plan",,"0.812825441360474","No","Yes","Yes","60%","40%","$1,000","$20","$1,300","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","$7,800","$7800 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430020-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430020","Blue Choice Gold PPO 020","33602TX043",,"TXN012","TXS002","TXF017","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_3T_EX.pdf","33602TX0430020-01","Blue Choice Gold PPO 020","Standard Gold On Exchange Plan",,"0.812825441360474","No","Yes","Yes","60%","40%","$1,000","$20","$1,300","$200","$1,000","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","$7,800","$7800 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430020-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770102","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS191","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770102-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770102","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS191","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770102-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770102","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS191","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770102-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770103","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS201","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770103-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770103","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS201","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770103-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770103","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS201","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770103-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770104","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS211","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770104-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770104","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS211","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770104-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770104","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS211","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770104-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770104","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS211","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770104-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770079","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS221","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770079-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770079","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS221","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770079-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770079","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS221","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770079-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770079","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS221","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770079-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770080","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS231","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770080-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770080","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS231","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770080-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770080","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS231","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770080-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770080","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS231","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770080-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770081","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS241","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770081-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770081","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS241","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770081-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770081","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS241","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770081-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770081","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS241","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770081-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770082","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS251","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770082-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770082","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS251","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770082-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770082","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS251","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770082-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770082","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS251","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770082-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770083","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS261","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770083-00","Blue Advantage Plus Bronze? 104","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770083","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS261","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770083-01","Blue Advantage Plus Bronze? 104","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770083","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS261","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770083-02","Blue Advantage Plus Bronze? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0770083","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS261","TXF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services to receive in-network benefits. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0770083-03","Blue Advantage Plus Bronze? 104","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0770079-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460142","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460142-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430001","Blue Choice Gold PPO 001","33602TX043",,"TXN012","TXS002","TXF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430001-00","Blue Choice Gold PPO 001","Standard Gold Off Exchange Plan","79.92%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430001-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430001","Blue Choice Gold PPO 001","33602TX043",,"TXN012","TXS002","TXF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430001-01","Blue Choice Gold PPO 001","Standard Gold On Exchange Plan","79.92%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0.00%","$3,000","$3000 per person","$9000 per group","0.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460142","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460142-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460142","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460142-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430003","Blue Choice Silver PPO 003","33602TX043",,"TXN012","TXS002","TXF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430003-00","Blue Choice Silver PPO 003","Standard Silver Off Exchange Plan","69.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","$12,000","$12000 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","$12,000","$12000 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430003-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430003","Blue Choice Silver PPO 003","33602TX043",,"TXN012","TXS002","TXF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430003-01","Blue Choice Silver PPO 003","Standard Silver On Exchange Plan","69.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","$12,000","$12000 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0.00%","$6,000","$6000 per person","$13700 per group","0.00%","$12,000","$12000 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460142","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460142-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460136","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460136-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430004","Blue Choice Silver PPO 004","33602TX043",,"TXN012","TXS002","TXF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430004-00","Blue Choice Silver PPO 004","Standard Silver Off Exchange Plan","71.37%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$3,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","$6,100","$6100 per person","$18300 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430004-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","36-1236610","33602TX0430004","Blue Choice Silver PPO 004","33602TX043",,"TXN012","TXS002","TXF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0430004-01","Blue Choice Silver PPO 004","Standard Silver On Exchange Plan","71.37%","0","No","Yes","Yes","60%","40%","$3,000","$300","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$3,050","$3050 per person","$9150 per group","20.00%","$3,050","$3050 per person","$9150 per group","20.00%","$6,100","$6100 per person","$18300 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0430004-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460136","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460136-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460136","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460136-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460137","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460137-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460137","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460137-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460137","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460137-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460137","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460137-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460138","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460138-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460138","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460138-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460138","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460138-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460138","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460138-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460139","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460139-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460139","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460139-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460139","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460139-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460139","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460139-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460140","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460140-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460140","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460140-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460140","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460140-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460141","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460141-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460141","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460141-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460141","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460141-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460141","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460141-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460006-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460006-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460006-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460006-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460143","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460143-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460143","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460143-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460148","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460148-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460148","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460148-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460149","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460149-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460149","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460149-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460149","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460149-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460149","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460149-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460150","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460150-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460143","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460143-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460144","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460144-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460144","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460144-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460144","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460144-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460144","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460144-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460145","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460145-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460145","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460145-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460145","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460145-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460145","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460145-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460146","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460146-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460146","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460146-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460146","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460146-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460147","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460147-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460147","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460147-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460147","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460147-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460147","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460147-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460148","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460148-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460148","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460148-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460150","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460150-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460155","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460155-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460155","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460155-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460155","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460155-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460156","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460156-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460156","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460156-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460156","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460156-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460156","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460156-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460150","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460150-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460150","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460150-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460151","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460151-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460151","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460151-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460151","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460151-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460151","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460151-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460152","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460152-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460152","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460152-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460152","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460152-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460152","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460152-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460153","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460153-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460153","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460153-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460153","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460153-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460153","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460153-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460154","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460154-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460154","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460154-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460154","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460154-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460154","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460154-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460155","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460155-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460157","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460157-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460322-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460322-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460322-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460323-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460323-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460326-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460327-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460157","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460157-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460157","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460157-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460157","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460157-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460158","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460158-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460158","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460158-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460158","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460158-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460158","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460158-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460159","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460159-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460159","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460159-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460159","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460159-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460159","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460159-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460160","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460160-00","Blue Advantage Bronze HMO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460160","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460160-01","Blue Advantage Bronze HMO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460160","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460160-02","Blue Advantage Bronze HMO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460160","Blue Advantage Bronze HMO? 006","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460160-03","Blue Advantage Bronze HMO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460006-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460322-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460322-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460322-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460322-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460323-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460323-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460323-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460323-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460323-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460324-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460324-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460324-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460324-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460324-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460324-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460324-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460325-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460325-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460325-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460325-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460325-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460325-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460325-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460326-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460326-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460326-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460326-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460326-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460326-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460327-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460327-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460327-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460330-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460330-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460330-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460330-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460330-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460327-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460327-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460327-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460328-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460328-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460328-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460328-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460328-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460328-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460328-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460329-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460329-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460329-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460329-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460329-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460330-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460330-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460331-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460331-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460331-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460334-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460334-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460334-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460334-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460334-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460331-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460331-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460331-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460331-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460332-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460332-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460332-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460332-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460332-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460332-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460332-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460333-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460333-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460333-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460333-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460333-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460333-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460333-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460334-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460334-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460335-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460335-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460338-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460338-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460341-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460342-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460342-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460335-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460335-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460335-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460335-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460335-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460336-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460336-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460336-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460336-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460336-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460336-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460336-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460337-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460337-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460337-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460337-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460337-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460337-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460337-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460338-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460338-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460338-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460338-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460338-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460339-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460339-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460339-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460339-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460339-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460339-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460339-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460340-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460340-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460340-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460340-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460340-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460340-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460340-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460341-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010005-06","Silver 50","94% AV Level Silver Plan",,"0.934321820735931","Yes","Yes","No","100%",,"$350","$230","$0","$150","$0","$670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS53T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS53T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010009","Bronze 7","37392TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010009-00","Bronze 7","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB7T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB7T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010009","Bronze 7","37392TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010009-01","Bronze 7","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB7T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB7T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010009","Bronze 7","37392TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010009-02","Bronze 7","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010009","Bronze 7","37392TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010009-03","Bronze 7","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB7T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB7T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010010","Bronze 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010010-00","Bronze 10","Standard Bronze Off Exchange Plan",,"0.608298003673553","No","Yes","No","100%",,"$2,080","$4,020","$0","$150","$1,270","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB10T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB10T.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460341-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460341-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460341-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460341-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460341-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460342-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460342-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460342-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460342-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460342-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460319-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460319-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460320-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460239-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460239-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460239-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460239-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460239-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460239-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460239-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460318-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460318-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460318-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460318-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460318-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460318-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460318-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460319-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460319-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460319-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460319-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460319-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460320-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460320-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460320-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460320-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460320-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460320-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460321-00","Blue Advantage Silver HMO? 103","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-00.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460321-01","Blue Advantage Silver HMO? 103","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460321-02","Blue Advantage Silver HMO? 103","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460321-03","Blue Advantage Silver HMO? 103","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,800","$0","$0","$200","$3,800","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460321-04","Blue Advantage Silver HMO? 103","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460321-05","Blue Advantage Silver HMO? 103","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","HIOS","2017-01-25 02:20:17","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO? 103","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0460321-06","Blue Advantage Silver HMO? 103","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0460239-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010008","Gold 2","37392TX001",,"TXN001","TXS001","TXF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010008-00","Gold 2","Standard Gold Off Exchange Plan",,"0.81959080696106","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXG2T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXG2T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010008","Gold 2","37392TX001",,"TXN001","TXS001","TXF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010008-01","Gold 2","Standard Gold On Exchange Plan",,"0.81959080696106","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXG2T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXG2T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010008","Gold 2","37392TX001",,"TXN001","TXS001","TXF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010008-02","Gold 2","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010008","Gold 2","37392TX001",,"TXN001","TXS001","TXF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010008-03","Gold 2","Limited Cost Sharing Plan Variation",,"0.81959080696106","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXG2T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXG2T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010005-00","Silver 50","Standard Silver Off Exchange Plan",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS50T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS50T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010005-01","Silver 50","Standard Silver On Exchange Plan",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS50T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS50T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010005-02","Silver 50","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010005-03","Silver 50","Limited Cost Sharing Plan Variation",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS50T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS50T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010005-04","Silver 50","73% AV Level Silver Plan",,"0.729396104812622","Yes","Yes","No","100%",,"$4,000","$270","$140","$150","$0","$1,570","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS51T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS51T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010005-05","Silver 50","87% AV Level Silver Plan",,"0.870619297027588","Yes","Yes","No","100%",,"$1,000","$250","$0","$150","$0","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS52T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS52T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010010","Bronze 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010010-01","Bronze 10","Standard Bronze On Exchange Plan",,"0.608298003673553","No","Yes","No","100%",,"$2,080","$4,020","$0","$150","$1,270","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB10T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB10T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010010","Bronze 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010010-02","Bronze 10","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010010","Bronze 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010010-03","Bronze 10","Limited Cost Sharing Plan Variation",,"0.608298003673553","No","Yes","No","100%",,"$2,080","$4,020","$0","$150","$1,270","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB10T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXB10T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010011","HSA 1","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010011-00","HSA 1","Standard Bronze Off Exchange Plan",,"0.619737446308136","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXHSAT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXHSAT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010011","HSA 1","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010011-01","HSA 1","Standard Bronze On Exchange Plan",,"0.619737446308136","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXHSAT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXHSAT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010011","HSA 1","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010011-02","HSA 1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010011","HSA 1","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010011-03","HSA 1","Limited Cost Sharing Plan Variation",,"0.619737446308136","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXHSAT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXHSAT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010013","Silver 70","37392TX001",,"TXN001","TXS001","TXF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010013-00","Silver 70","Standard Silver Off Exchange Plan",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS70T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS70T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010013","Silver 70","37392TX001",,"TXN001","TXS001","TXF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010013-01","Silver 70","Standard Silver On Exchange Plan",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS70T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS70T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010013","Silver 70","37392TX001",,"TXN001","TXS001","TXF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010013-02","Silver 70","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXAIT.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010013","Silver 70","37392TX001",,"TXN001","TXS001","TXF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010013-03","Silver 70","Limited Cost Sharing Plan Variation",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS70T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS70T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010013","Silver 70","37392TX001",,"TXN001","TXS001","TXF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010013-04","Silver 70","73% AV Level Silver Plan",,"0.739166557788849","Yes","Yes","No","100%",,"$2,250","$2,440","$30","$150","$0","$1,620","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS71T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS71T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010013","Silver 70","37392TX001",,"TXN001","TXS001","TXF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010013-05","Silver 70","87% AV Level Silver Plan",,"0.87384307384491","Yes","Yes","No","100%",,"$500","$1,720","$20","$150","$0","$1,270","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS72T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS72T.pdf"
"2017","TX","37392","HIOS","2017-01-19 02:20:17","Individual","No","80-0959546","37392TX0010013","Silver 70","37392TX001",,"TXN001","TXS001","TXF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Texas-formulary_FINAL.pdf","37392TX0010013-06","Silver 70","94% AV Level Silver Plan",,"0.938101172447205","Yes","Yes","No","100%",,"$0","$710","$20","$150","$0","$970","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS73T.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/10/7XHEXS73T.pdf"
"2017","TX","40540","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","40540TX0030001","Renaissance Group Dental PPO, EHB Certified","40540TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0030001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","40540","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","40540TX0020001","Renaissance Individual Dental PPO, EHB Certified","40540TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","40540","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","40540TX0020002","Renaissance Individual Dental PPO, EHB Certified","40540TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","40540","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","40540TX0030002","Renaissance Group Dental PPO, EHB Certified","40540TX003",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0030002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","40540","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","40540TX0080001","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0080001-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_Group_High_2017","http://www.renaissancedental.com/TX_EHB_Group_High_2017"
"2017","TX","40540","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","40540TX0060001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","40540TX006",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0060001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_High_2017","http://www.renaissancedental.com/TX_EHB_High_2017"
"2017","TX","40540","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","40540TX0060002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","40540TX006",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0060002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_Low_2017","http://www.renaissancedental.com/TX_EHB_Low_2017"
"2017","TX","40540","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","40540TX0080002","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0080002-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_Group_Low_2017","http://www.renaissancedental.com/TX_EHB_Group_Low_2017"
"2017","TX","40540","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","40540TX0080003","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0080003-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_50_50_High_2017","http://www.renaissancedental.com/TX_50_50_High_2017"
"2017","TX","40540","HIOS","2016-06-25 15:13:19","SHOP (Small Group)","Yes","47-0397286","40540TX0080004","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0080004-01","Renaissance Group Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_50_50_Low_2017","http://www.renaissancedental.com/TX_50_50_Low_2017"
"2017","TX","40540","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","40540TX0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified","40540TX005",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0050001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","40540","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","40540TX0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified","40540TX005",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0050002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","40540","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","40540TX0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","40540TX007",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0070001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_Ped_High_2017","http://www.renaissancedental.com/TX_Ped_High_2017"
"2017","TX","40540","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","40540TX0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","40540TX007",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0070002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_Ped_Low_2017","http://www.renaissancedental.com/TX_Ped_Low_2017"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010001-00","Molina Marketplace Gold Plan","Standard Gold Off Exchange Plan",,"0.790111780166626","No","Yes","No","100%",,"$0","$450","$890","$150","$0","$1,640","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-gold-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010001-01","Molina Marketplace Gold Plan","Standard Gold On Exchange Plan",,"0.790111780166626","No","Yes","No","100%",,"$0","$450","$890","$150","$0","$1,640","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-gold-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010001-02","Molina Marketplace Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-zero-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010001-03","Molina Marketplace Gold Plan","Limited Cost Sharing Plan Variation",,"0.790111780166626","No","Yes","No","100%",,"$0","$450","$890","$150","$0","$1,640","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-gold-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010002-00","Molina Marketplace Silver Plan","Standard Silver Off Exchange Plan",,"0.716642260551453","No","Yes","No","100%",,"$0","$540","$2,240","$150","$0","$1,830","$640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010002-01","Molina Marketplace Silver Plan","Standard Silver On Exchange Plan",,"0.716642260551453","No","Yes","No","100%",,"$0","$540","$2,240","$150","$0","$1,830","$640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010002-02","Molina Marketplace Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-zero-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010002-03","Molina Marketplace Silver Plan","Limited Cost Sharing Plan Variation",,"0.716642260551453","No","Yes","No","100%",,"$0","$540","$2,240","$150","$0","$1,830","$640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010002-04","Molina Marketplace Silver Plan","73% AV Level Silver Plan",,"0.739868581295013","No","Yes","No","100%",,"$0","$540","$2,240","$150","$0","$1,780","$640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-200-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010002-05","Molina Marketplace Silver Plan","87% AV Level Silver Plan",,"0.879230499267578","No","Yes","No","100%",,"$0","$450","$1,120","$150","$0","$640","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-150-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0010002-06","Molina Marketplace Silver Plan","94% AV Level Silver Plan",,"0.943055033683777","No","Yes","No","100%",,"$0","$220","$450","$150","$0","$220","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-100-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0040001-00","Molina Marketplace Options Silver Plan","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0040001-01","Molina Marketplace Options Silver Plan","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0040001-02","Molina Marketplace Options Silver Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-zero-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0040001-03","Molina Marketplace Options Silver Plan","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0040001-04","Molina Marketplace Options Silver Plan","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0040001-05","Molina Marketplace Options Silver Plan","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,010","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0040001-06","Molina Marketplace Options Silver Plan","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020001-00","Molina Marketplace Choice Gold Plan","Standard Gold Off Exchange Plan",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-gold-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020001-01","Molina Marketplace Choice Gold Plan","Standard Gold On Exchange Plan",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-gold-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020001-02","Molina Marketplace Choice Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-zero-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020001-03","Molina Marketplace Choice Gold Plan","Limited Cost Sharing Plan Variation",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-gold-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020002-00","Molina Marketplace Choice Silver Plan","Standard Silver Off Exchange Plan",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020002-01","Molina Marketplace Choice Silver Plan","Standard Silver On Exchange Plan",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020002-02","Molina Marketplace Choice Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-zero-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020002-03","Molina Marketplace Choice Silver Plan","Limited Cost Sharing Plan Variation",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-250-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020002-04","Molina Marketplace Choice Silver Plan","73% AV Level Silver Plan",,"0.739960968494415","No","Yes","No","100%",,"$2,270","$290","$1,340","$150","$2,270","$400","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,275","$2275 per person","$4550 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,275","$2275 per person","$4550 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-200-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020002-05","Molina Marketplace Choice Silver Plan","87% AV Level Silver Plan",,"0.879880011081696","No","Yes","No","100%",,"$500","$180","$890","$150","$500","$320","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-150-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020002-06","Molina Marketplace Choice Silver Plan","94% AV Level Silver Plan",,"0.9497309923172","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-100-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020003-00","Molina Marketplace Choice Bronze Plan","Standard Bronze Off Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-bronze-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020003-01","Molina Marketplace Choice Bronze Plan","Standard Bronze On Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-bronze-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020003-02","Molina Marketplace Choice Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-zero-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","45786","HIOS","2017-04-26 02:48:20","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2017.pdf","45786TX0020003-03","Molina Marketplace Choice Bronze Plan","Limited Cost Sharing Plan Variation",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-bronze-2017.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47665TX0020003","BESTOne Advantage Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010007","BESTDental Premium","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Premium_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010007","BESTDental Premium","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Premium_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47665TX0020003","BESTOne Advantage Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47665TX0020004","BESTOne Plus Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010008","BESTDental Standard - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Standard-H_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010008","BESTDental Standard - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Standard-H_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47665TX0020004","BESTOne Plus Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010010","BESTDental Choice - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Choice-H_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010010","BESTDental Choice - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Choice-H_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010009","BESTDental Standard - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Standard-L_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47665TX0020005","BESTOne Plus Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47665TX0020005","BESTOne Plus Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010009","BESTDental Standard - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Standard-L_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010011","BESTDental Choice - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Choice-L_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47665TX0020006","BESTOne Basic Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47665TX0020006","BESTOne Basic Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010011","BESTDental Choice - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Choice-L_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010012","BESTDental Value","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Value_Plan.pdf"
"2017","TX","47665","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47665TX0010012","BESTDental Value","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2017/TX_BESTDental_Value_Plan.pdf"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050001-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050001-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050001-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050001-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739931523799896","No","Yes","No","100%",,"$3,300","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050001-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.864413619041443","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050001-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.944842338562012","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","48364","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","75-2046497","48364TX0030001","Family Basic Dental Plan (Low)","48364TX003",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0030001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48056"
"2017","TX","48364","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","75-2046497","48364TX0030001","Family Basic Dental Plan (Low)","48364TX003",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0030001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48056"
"2017","TX","48364","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","75-2046497","48364TX0040001","Family Enhanced Dental Plan (High)","48364TX004",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0040001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49127"
"2017","TX","48364","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","75-2046497","48364TX0040001","Family Enhanced Dental Plan (High)","48364TX004",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0040001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49127"
"2017","TX","55409","HIOS","2016-07-01 08:12:23","Individual","Yes","59-1031071","55409TX0030001","Cigna Dental Pediatric","55409TX003","7730182962","TXN003","TXS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","55409TX0030001-01","Cigna Dental Pediatric","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","TX","55409","HIOS","2016-07-01 08:12:23","Individual","Yes","59-1031071","55409TX0030002","Cigna Dental Family + Pediatric","55409TX003","7730182962","TXN003","TXS004",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","55409TX0030002-01","Cigna Dental Family + Pediatric","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-family-pediatric-fedvip"
"2017","TX","53108","HIOS","2016-08-20 07:40:33","Individual","Yes","47-0098400","53108TX0010002","EHB High PPO","53108TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","53108TX0010002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","TX","53108","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","Yes","47-0098400","53108TX0030002","EHB High Passive","53108TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","53108TX0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","TX","53108","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","Yes","47-0098400","53108TX0030001","EHB Low Passive","53108TX003",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","53108TX0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","TX","53108","HIOS","2016-08-20 07:40:33","Individual","Yes","47-0098400","53108TX0010001","EHB Low PPO","53108TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","53108TX0010001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","TX","55409","HIOS","2016-07-01 08:12:23","Individual","Yes","59-1031071","55409TX0030001","Cigna Dental Pediatric","55409TX003","7730182962","TXN003","TXS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","55409TX0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-fedvip"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","Individual","Yes","20-2970185","58609TX0010001","DentaQuest PPO  Pediatric High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","20-2970185","58609TX0020003","DentaQuest PPO Family High","58609TX002","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0020003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","20-2970185","58609TX0020003","DentaQuest PPO Family High","58609TX002","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0020003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","Individual","Yes","20-2970185","58609TX0010001","DentaQuest PPO  Pediatric High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","20-2970185","58609TX0020004","DentaQuest PPO Family Low","58609TX002","7083617218","TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0020004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","20-2970185","58609TX0020004","DentaQuest PPO Family Low","58609TX002","7083617218","TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0020004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","Individual","Yes","20-2970185","58609TX0010003","DentaQuest PPO Family High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","Individual","Yes","20-2970185","58609TX0010003","DentaQuest PPO Family High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","Individual","Yes","20-2970185","58609TX0010004","DentaQuest PPO Family Low","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","58609","HIOS","2016-07-01 08:12:23","Individual","Yes","20-2970185","58609TX0010004","DentaQuest PPO Family Low","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2017","TX","61315","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","61315TX0020001","TruAssure Preferred Adult or Child Dental Plan","61315TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX"
"2017","TX","61315","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","61315TX0020001","TruAssure Preferred Adult or Child Dental Plan","61315TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX"
"2017","TX","63141","HIOS","2016-07-06 06:54:55","Individual","Yes","39-1263473","63141TX0760001","Humana Dental Smart Choice","63141TX076",,"TXN002","TXS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9861","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","63141TX0760001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857153"
"2017","TX","63141","HIOS","2016-07-06 06:54:55","Individual","Yes","39-1263473","63141TX0760001","Humana Dental Smart Choice","63141TX076",,"TXN002","TXS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9861","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","63141TX0760001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857153"
"2017","TX","61315","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","61315TX0010001","TruAssure Basic Adult or Child Dental Plan","61315TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX"
"2017","TX","61315","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","61315TX0030001","TruAssure Dental Small Group Basic Plan","61315TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","61315TX0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","61315","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","61315TX0040001","TruAssure Dental Small Group Preferred Plan","61315TX004",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","61315TX0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","61315","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","61315TX0010001","TruAssure Basic Adult or Child Dental Plan","61315TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010001","CHP TX Catastrophic","66252TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010001-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010001","CHP TX Catastrophic","66252TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010001-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze","66252TX003",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9975",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030001-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze","66252TX003",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9975",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030001-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze","66252TX003",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9975",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030001-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze","66252TX003",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9975",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030001-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040001-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040001-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040001-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040001-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040001-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.722358047962189","No","Yes","No","100%",,"$4,400","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040001-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.860265672206879","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040001-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.94161456823349","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050001-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070001","CHP TX Gold","66252TX007",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070001-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070001","CHP TX Gold","66252TX007",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070001-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070001","CHP TX Gold","66252TX007",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070001-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070001","CHP TX Gold","66252TX007",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070001-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010002","CHP TX Catastrophic","66252TX001",,"TXN001","TXS002","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010002-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010002","CHP TX Catastrophic","66252TX001",,"TXN001","TXS002","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010002-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze","66252TX003",,"TXN001","TXS002","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030002-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze","66252TX003",,"TXN001","TXS002","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030002-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze","66252TX003",,"TXN001","TXS002","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030002-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze","66252TX003",,"TXN001","TXS002","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030002-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040002-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040002-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040002-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040002-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040002-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.722358047962189","No","Yes","No","100%",,"$4,400","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040002-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.860265672206879","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040002-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.94161456823349","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050002-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050002-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050002-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050002-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050002-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739931523799896","No","Yes","No","100%",,"$3,300","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050002-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.864413619041443","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050002-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.944842338562012","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070002","CHP TX Gold","66252TX007",,"TXN001","TXS002","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070002-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070002","CHP TX Gold","66252TX007",,"TXN001","TXS002","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070002-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070002","CHP TX Gold","66252TX007",,"TXN001","TXS002","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070002-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070002","CHP TX Gold","66252TX007",,"TXN001","TXS002","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070002-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010003","CHP TX Catastrophic","66252TX001",,"TXN001","TXS003","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010003-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010003","CHP TX Catastrophic","66252TX001",,"TXN001","TXS003","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010003-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze","66252TX003",,"TXN001","TXS003","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030003-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze","66252TX003",,"TXN001","TXS003","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030003-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze","66252TX003",,"TXN001","TXS003","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030003-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze","66252TX003",,"TXN001","TXS003","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030003-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040003-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040003-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040003-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040003-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040003-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.722358047962189","No","Yes","No","100%",,"$4,400","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040003-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.860265672206879","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040003-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.94161456823349","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050003-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050003-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050003-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050003-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050003-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739931523799896","No","Yes","No","100%",,"$3,300","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050003-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.864413619041443","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050003-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.944842338562012","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070003","CHP TX Gold","66252TX007",,"TXN001","TXS003","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070003-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070003","CHP TX Gold","66252TX007",,"TXN001","TXS003","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070003-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070003","CHP TX Gold","66252TX007",,"TXN001","TXS003","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070003-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070003","CHP TX Gold","66252TX007",,"TXN001","TXS003","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070003-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010004","CHP TX Catastrophic","66252TX001",,"TXN001","TXS004","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010004-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010004","CHP TX Catastrophic","66252TX001",,"TXN001","TXS004","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010004-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze","66252TX003",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030004-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze","66252TX003",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030004-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze","66252TX003",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030004-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze","66252TX003",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030004-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040004-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040004-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040004-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040004-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040004-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.722358047962189","No","Yes","No","100%",,"$4,400","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040004-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.860265672206879","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040004-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.94161456823349","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050004-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050004-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050004-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050004-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050004-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739931523799896","No","Yes","No","100%",,"$3,300","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050004-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.864413619041443","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050004-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.944842338562012","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070004","CHP TX Gold","66252TX007",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070004-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070004","CHP TX Gold","66252TX007",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070004-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070004","CHP TX Gold","66252TX007",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070004-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070004","CHP TX Gold","66252TX007",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070004-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010005","CHP TX Catastrophic","66252TX001",,"TXN001","TXS005","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010005-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010005","CHP TX Catastrophic","66252TX001",,"TXN001","TXS005","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010005-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030005","CHP TX Bronze","66252TX003",,"TXN001","TXS005","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030005-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030005","CHP TX Bronze","66252TX003",,"TXN001","TXS005","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030005-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030005","CHP TX Bronze","66252TX003",,"TXN001","TXS005","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030005-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030005","CHP TX Bronze","66252TX003",,"TXN001","TXS005","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030005-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040005-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040005-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040005-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040005-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040005-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.722358047962189","No","Yes","No","100%",,"$4,400","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040005-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.860265672206879","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040005-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.94161456823349","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050005-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050005-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050005-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050005-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050005-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739931523799896","No","Yes","No","100%",,"$3,300","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050005-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.864413619041443","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN001","TXS005","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050005-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.944842338562012","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070005","CHP TX Gold","66252TX007",,"TXN001","TXS005","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070005-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070005","CHP TX Gold","66252TX007",,"TXN001","TXS005","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070005-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070005","CHP TX Gold","66252TX007",,"TXN001","TXS005","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070005-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070005","CHP TX Gold","66252TX007",,"TXN001","TXS005","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070005-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010006","CHP TX Catastrophic","66252TX001",,"TXN001","TXS006","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9978",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010006-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0010006","CHP TX Catastrophic","66252TX001",,"TXN001","TXS006","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9978",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0010006-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030006","CHP TX Bronze","66252TX003",,"TXN001","TXS006","TXF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030006-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030006","CHP TX Bronze","66252TX003",,"TXN001","TXS006","TXF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030006-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030006","CHP TX Bronze","66252TX003",,"TXN001","TXS006","TXF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030006-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0030006","CHP TX Bronze","66252TX003",,"TXN001","TXS006","TXF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0030006-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040006-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040006-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040006-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040006-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040006-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.722358047962189","No","Yes","No","100%",,"$4,400","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040006-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.860265672206879","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0040006-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.94161456823349","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050006-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050006-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050006-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050006-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050006-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739931523799896","No","Yes","No","100%",,"$3,300","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050006-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.864413619041443","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0050006-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.944842338562012","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070006","CHP TX Gold","66252TX007",,"TXN001","TXS006","TXF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070006-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070006","CHP TX Gold","66252TX007",,"TXN001","TXS006","TXF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070006-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070006","CHP TX Gold","66252TX007",,"TXN001","TXS006","TXF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070006-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","66252","HIOS","2016-11-19 04:47:33","Individual","No","45-2106295","66252TX0070006","CHP TX Gold","66252TX007",,"TXN001","TXS006","TXF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2017healthexchangeformulary","66252TX0070006-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitstexas2017","http://www.christushealthplan.org/planinformationtexas"
"2017","TX","91476","HIOS","2016-10-21 02:45:44","Individual","Yes","20-4023720","91476TX0010001","EMI Health Choice (High)","91476TX001",,"TXN001","TXS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010001-01","EMI Health Choice PPO (High)","Standard High On Exchange Plan","84.64%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,"$0","$0 per person","$0 per group",,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/texas-products/federal-marketplace-dental.aspx"
"2017","TX","91476","HIOS","2016-10-21 02:45:44","Individual","Yes","20-4023720","91476TX0010002","EMI Health Choice (Low)","91476TX001",,"TXN001","TXS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010002-00","EMI Health Choice PPO (Low)","Standard Low Off Exchange Plan","70.02%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/texas-products/federal-marketplace-dental.aspx"
"2017","TX","69758","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","69758TX0030002","EHB High Passive","69758TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","69758TX0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","TX","69758","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","69758TX0030001","EHB Low Passive","69758TX003",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","69758TX0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010001","Sendero Health Plans IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.991878069245985",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-00","Sendero Health Plans IdealCare Complete","Standard Silver Off Exchange Plan",,"0.691962659358978","Yes","Yes","No","100%",,"$840","$460","$210","$60","$110","$715","$30","$1,785","$550","$625","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,100","$6100 per person","$12200 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000101_Complete_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010001","Sendero Health Plans IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.991878069245985",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-01","Sendero Health Plans IdealCare Complete","Standard Silver On Exchange Plan",,"0.691962659358978","Yes","Yes","No","100%",,"$840","$460","$210","$60","$110","$715","$30","$1,785","$550","$625","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,100","$6100 per person","$12200 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000101_Complete_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010001","Sendero Health Plans IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.991878069245985",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-02","Sendero Health Plans IdealCare Complete","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000102_Complete_Zero.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010001","Sendero Health Plans IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.991878069245985",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-03","Sendero Health Plans IdealCare Complete","Limited Cost Sharing Plan Variation",,"0.691962659358978","Yes","Yes","No","100%",,"$840","$460","$210","$60","$110","$715","$30","$1,785","$550","$625","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,100","$6100 per person","$12200 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000103_Complete_Ltd_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010001","Sendero Health Plans IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.991878069245985",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-04","Sendero Health Plans IdealCare Complete","73% AV Level Silver Plan",,"0.735793232917786","Yes","Yes","No","100%",,"$845","$460","$205","$60","$110","$640","$27","$1,785","$555","$590","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,900","$4900 per person","$9800 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000104_Complete_73_AV.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010001","Sendero Health Plans IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.991878069245985",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-05","Sendero Health Plans IdealCare Complete","87% AV Level Silver Plan",,"0.878434062004089","Yes","Yes","No","100%",,"$500","$460","$105","$60","$120","$400","$15","$1,785","$500","$520","$25","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000105_Complete_87_AV.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010001","Sendero Health Plans IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.991878069245985",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-06","Sendero Health Plans IdealCare Complete","94% AV Level Silver Plan",,"0.948566436767578","Yes","Yes","No","100%",,"$0","$215","$100","$60","$0","$340","$15","$1,785","$0","$345","$15","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000106_Complete_94_AV.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010003","Sendero Health Plans IdealCare Essential","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.992436756994212",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010003-00","Sendero Health Plans IdealCare Essential","Standard Bronze Off Exchange Plan",,"0.616290867328644","Yes","Yes","No","100%",,"$2,370","$1,245","$1,045","$60","$3,365","$845","$135","$1,785","$400","$1,075","$180","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000301_Essential_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010003","Sendero Health Plans IdealCare Essential","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.992436756994212",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010003-01","Sendero Health Plans IdealCare Essential","Standard Bronze On Exchange Plan",,"0.616290867328644","Yes","Yes","No","100%",,"$2,370","$1,245","$1,045","$60","$3,365","$845","$135","$1,785","$400","$1,075","$180","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000301_Essential_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010003","Sendero Health Plans IdealCare Essential","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.992436756994212",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010003-02","Sendero Health Plans IdealCare Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000302_Essential_Zero_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010003","Sendero Health Plans IdealCare Essential","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.992436756994212",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010003-03","Sendero Health Plans IdealCare Essential","Limited Cost Sharing Plan Variation",,"0.616290867328644","Yes","Yes","No","100%",,"$2,370","$1,245","$1,045","$60","$3,365","$845","$135","$1,785","$400","$1,075","$180","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000303_Essential_Ltd_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010002","Sendero Health Plans IdealCare Total","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.99250268873247",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010002-00","Sendero Health Plans IdealCare Total","Standard Gold Off Exchange Plan",,"0.790962338447571","Yes","Yes","No","100%",,"$0","$460","$525","$60","$0","$665","$70","$1,785","$0","$380","$225","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000201_Total_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010002","Sendero Health Plans IdealCare Total","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.99250268873247",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010002-01","Sendero Health Plans IdealCare Total","Standard Gold On Exchange Plan",,"0.790962338447571","Yes","Yes","No","100%",,"$0","$460","$525","$60","$0","$665","$70","$1,785","$0","$380","$225","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000201_Total_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010002","Sendero Health Plans IdealCare Total","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.99250268873247",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010002-02","Sendero Health Plans IdealCare Total","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000202_Total_Zero.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","71837","HIOS","2016-10-12 08:34:00","Individual","No","27-5219887","71837TX0010002","Sendero Health Plans IdealCare Total","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.99250268873247",,,"2017-01-01",,"No",,"No",,"No","https://www.senderohealth.com/idealcareeng/ccpayments.html","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010002-03","Sendero Health Plans IdealCare Total","Limited Cost Sharing Plan Variation",,"0.790962338447571","Yes","Yes","No","100%",,"$0","$460","$525","$60","$0","$665","$70","$1,785","$0","$380","$225","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2017/71837TX001000203_Total_Ltd_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2017","TX","90453","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","Yes","42-0127290","90453TX0050001","Principal Plan Dental 70","90453TX005",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"0.72","Estimated Rate","2017-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","90453TX0050001-00","Principal Plan Dental 70","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","TX","91476","HIOS","2016-10-21 02:45:44","Individual","Yes","20-4023720","91476TX0010001","EMI Health Choice (High)","91476TX001",,"TXN001","TXS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010001-00","EMI Health Choice PPO (High)","Standard High Off Exchange Plan","84.64%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,"$0","$0 per person","$0 per group",,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/texas-products/federal-marketplace-dental.aspx"
"2017","TX","91476","HIOS","2016-10-21 02:45:44","Individual","Yes","20-4023720","91476TX0010002","EMI Health Choice (Low)","91476TX001",,"TXN001","TXS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010002-01","EMI Health Choice PPO (Low)","Standard Low On Exchange Plan","70.02%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/texas-products/federal-marketplace-dental.aspx"
"2017","TX","91476","HIOS","2016-10-21 02:45:44","Individual","Yes","20-4023720","91476TX0010003","EMI Health Advantage Co-Pay","91476TX001",,"TXN002","TXS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010003-00","EMI Health Advantage Co-Pay","Standard Low Off Exchange Plan","68.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/texas-products/federal-marketplace-dental.aspx"
"2017","TX","91476","HIOS","2016-10-21 02:45:44","Individual","Yes","20-4023720","91476TX0010003","EMI Health Advantage Co-Pay","91476TX001",,"TXN002","TXS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010003-01","EMI Health Advantage Co-Pay","Standard Low On Exchange Plan","68.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/texas-products/federal-marketplace-dental.aspx"
"2017","TX","92388","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","92388TX0190001","Family Basic Dental Plan (Low)","92388TX019",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0190001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48058"
"2017","TX","92388","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","92388TX0190001","Family Basic Dental Plan (Low)","92388TX019",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0190001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48058"
"2017","TX","92388","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","92388TX0200001","Family Enhanced Dental Plan (High)","92388TX020",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0200001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49125"
"2017","TX","92388","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","92388TX0200001","Family Enhanced Dental Plan (High)","92388TX020",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0200001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49125"
"2017","TX","98899","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","Yes","93-0242990","98899TX0030002","EHB High Passive","98899TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","98899TX0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","TX","98899","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","Yes","93-0242990","98899TX0030001","EHB Low Passive","98899TX003",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","98899TX0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010001","Together Bronze","14630WI001",,"WIN001","WIS001","WIF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010001-00","Together Bronze","Standard Bronze Off Exchange Plan",,"0.602093040943146","Yes","Yes","No","100%",,"$6,250","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/bronze","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010001","Together Bronze","14630WI001",,"WIN001","WIS001","WIF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010001-01","Together Bronze","Standard Bronze On Exchange Plan",,"0.602093040943146","Yes","Yes","No","100%",,"$6,250","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/bronze","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010001","Together Bronze","14630WI001",,"WIN001","WIS001","WIF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010001-02","Together Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/bronze-zero","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010001","Together Bronze","14630WI001",,"WIN001","WIS001","WIF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010001-03","Together Bronze Limited","Limited Cost Sharing Plan Variation",,"0.602093040943146","Yes","Yes","No","100%",,"$6,250","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/bronze-limited","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010002-00","Together Standard Silver","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$330","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/standard-silver","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010002-01","Together Standard Silver","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$330","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/standard-silver","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010002-02","Together Standard Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/standard-silver-zero","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010002-03","Together Standard Silver Limited","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$330","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/stanard-silver-limited","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010002-04","Together Standard Silver 200","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$500","$430","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/standard-silver-200","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010002-05","Together Standard Silver 150","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$170","$890","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/standard-silver-150","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010002-06","Together Standard Silver 100","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$90","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/standard-silver-100","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010003-00","Together Silver","Standard Silver Off Exchange Plan",,"0.682361900806427","No","Yes","No","100%",,"$3,000","$500","$870","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/silver","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010003-01","Together Silver","Standard Silver On Exchange Plan",,"0.682361900806427","No","Yes","No","100%",,"$3,000","$500","$870","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/silver","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010003-02","Together Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/silver-zero","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010003-03","Together Silver Limited","Limited Cost Sharing Plan Variation",,"0.682361900806427","No","Yes","No","100%",,"$3,000","$500","$870","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/silver-limited","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010003-04","Together Silver 200","73% AV Level Silver Plan",,"0.722720503807068","No","Yes","No","100%",,"$2,250","$500","$880","$150","$2,250","$600","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/silver-200","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010003-05","Together Silver 150","87% AV Level Silver Plan",,"0.875140428543091","No","Yes","No","100%",,"$300","$440","$930","$150","$300","$470","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/silver-150","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010003-06","Together Silver 100","94% AV Level Silver Plan",,"0.948324084281921","No","Yes","No","100%",,"$0","$110","$460","$150","$0","$60","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/silver-100","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010004","Together Gold","14630WI001",,"WIN001","WIS001","WIF010","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010004-00","Together Gold","Standard Gold Off Exchange Plan",,"0.819128394126892","No","Yes","No","100%",,"$700","$170","$890","$150","$700","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/gold","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010004","Together Gold","14630WI001",,"WIN001","WIS001","WIF010","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010004-01","Together Gold","Standard Gold On Exchange Plan",,"0.819128394126892","No","Yes","No","100%",,"$700","$170","$890","$150","$700","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/gold","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010004","Together Gold","14630WI001",,"WIN001","WIS001","WIF010","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010004-02","Together Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/gold-zero","http://TogetherCCHP.org/benefits"
"2017","WI","14630","HIOS","2017-01-25 02:20:17","Individual","No","27-1494977","14630WI0010004","Together Gold","14630WI001",,"WIN001","WIS001","WIF010","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://secure.togetherforyourhealth.com/marketplace/CCHP/FFM/pay.aspx","http://togetherCCHP.org/formulary","14630WI0010004-03","Together Gold Limited","Limited Cost Sharing Plan Variation",,"0.819128394126892","No","Yes","No","100%",,"$700","$170","$890","$150","$700","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/gold-limited","http://TogetherCCHP.org/benefits"
"2017","WI","16837","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","16837WI0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","16837WI002",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0020001-17"
"2017","WI","16837","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","16837WI0010001","Dentegra Dental PPO Pediatric Basic Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010001-17"
"2017","WI","16837","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","16837WI0010008","Dentegra Dental PPO Family Preferred Plan","16837WI001",,"WIN001","WIS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010008-17"
"2017","WI","16837","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","16837WI0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","16837WI002",,"WIN001","WIS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0020008-17"
"2017","WI","16837","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","75-1233841","16837WI0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","16837WI002",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0020007-17"
"2017","WI","16837","HIOS","2016-07-01 08:12:23","Individual","Yes","75-1233841","16837WI0010007","Dentegra Dental PPO Family Basic Plan","16837WI001",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010007-17"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2200 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-01","Atlas Individual $2200 Plus Silver","Standard Silver On Exchange Plan","71.52%","0.705226182937622","Yes","Yes","No","100%",,"$2,200","$0","$1,300","$200","$2,200","$150","$500","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","25.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187526.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2200 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-02","Atlas Individual Plus Silver Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187527.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2200 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-03","Atlas Individual $2200 Plus Silver Limited Cost Share Plan","Limited Cost Sharing Plan Variation","71.52%","0.705226182937622","Yes","Yes","No","100%",,"$2,200","$0","$1,300","$200","$2,200","$150","$500","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","25.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187528.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2200 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-04","Atlas Individual $2000 Plus Silver Cost Share Plan","73% AV Level Silver Plan","73.68%","0.728327810764313","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$150","$500","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187531.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2200 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-05","Atlas Individual $750 Plus Silver Cost Share Plan","87% AV Level Silver Plan","86.24%","0.862298786640167","Yes","Yes","No","100%",,"$750","$0","$700","$200","$750","$150","$400","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187530.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2200 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-06","Atlas Individual $100 Plus Silver Cost Share Plan","94% AV Level Silver Plan","93.03%","0.933826684951782","Yes","Yes","No","100%",,"$100","$0","$400","$200","$100","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187529.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130023","Atlas Individual $6850 Plus Bronze","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130023-01","Atlas Individual $6850 Plus Bronze","Standard Bronze On Exchange Plan","61.97%","0.618523180484772","Yes","Yes","No","100%",,"$6,850","$0","$200","$200","$4,360","$250","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187538.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130023","Atlas Individual $6850 Plus Bronze","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130023-02","Atlas Individual Plus Bronze Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187539.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130023","Atlas Individual $6850 Plus Bronze","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130023-03","Atlas Individual $6850 Plus Bronze Limited Cost Share Plan","Limited Cost Sharing Plan Variation","61.97%","0.618523180484772","Yes","Yes","No","100%",,"$6,850","$0","$200","$200","$4,360","$250","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187540.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130024","Atlas Individual $7150 Bronze","20173WI013",,"WIN001","WIS001","WIF004","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130024-01","Atlas Individual $7150 Bronze","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$4,980","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187541.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130024","Atlas Individual $7150 Bronze","20173WI013",,"WIN001","WIS001","WIF004","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130024-02","Atlas Individual Bronze Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187542.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130024","Atlas Individual $7150 Bronze","20173WI013",,"WIN001","WIS001","WIF004","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130024-03","Atlas Individual $7150 Bronze Limited Cost Share Plan","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$4,980","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187543.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130025","Atlas Individual $7150 Catastrophic","20173WI013",,"WIN001","WIS001","WIF004","New","PPO","Catastrophic","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130025-01","Atlas Individual $7150 Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$4,680","$90","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187544.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-01","Atlas Individual $3000 HSA Silver","Standard Silver On Exchange Plan","68.23%","0.67793220281601","Yes","Yes","No","100%",,"$3,000","$0","$600","$200","$3,000","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187545.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-02","Atlas Individual Silver Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187546.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-03","Atlas Individual $3000 HSA Silver Limited Cost Share Plan","Limited Cost Sharing Plan Variation","68.23%","0.67793220281601","Yes","Yes","No","100%",,"$3,000","$0","$600","$200","$3,000","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187547.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-04","Atlas Individual $2250 Silver Cost Share Plan","73% AV Level Silver Plan","72.08%","0.7336545586586","Yes","Yes","No","100%",,"$2,250","$0","$500","$200","$2,250","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187550.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-05","Atlas Individual $700 Silver Cost Share Plan","87% AV Level Silver Plan","86.28%","0.862833380699158","Yes","Yes","No","100%",,"$700","$0","$700","$200","$700","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187549.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-06","Atlas Individual $200 Silver Cost Share Plan","94% AV Level Silver Plan","93.10%","0.931036353111267","Yes","Yes","No","100%",,"$200","$0","$400","$200","$200","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","5.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187548.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130027","Atlas Individual $6550 HSA Bronze","20173WI013",,"WIN001","WIS001","WIF004","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130027-01","Atlas Individual $6550 HSA Bronze","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$4,980","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187551.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130027","Atlas Individual $6550 HSA Bronze","20173WI013",,"WIN001","WIS001","WIF004","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130027-02","Atlas Individual HSA Bronze Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187552.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130027","Atlas Individual $6550 HSA Bronze","20173WI013",,"WIN001","WIS001","WIF004","New","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130027-03","Atlas Individual $6550 HSA Bronze Limited Cost Share Plan","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$4,980","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187553.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130020","Atlas Individual $500 w/Copay Gold","20173WI013",,"WIN001","WIS001","WIF001","New","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130020-01","Atlas Individual $500 w/Copay Gold","Standard Gold On Exchange Plan","81.26%","0.806439340114594","Yes","Yes","No","100%",,"$500","$0","$1,300","$200","$500","$100","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187524.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130020","Atlas Individual $500 w/Copay Gold","20173WI013",,"WIN001","WIS001","WIF001","New","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130020-02","Atlas Individual Gold Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187525.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130020","Atlas Individual $500 w/Copay Gold","20173WI013",,"WIN001","WIS001","WIF001","New","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130020-03","Atlas Individual $500 w/Copay Gold Limited Cost Share Plan","Limited Cost Sharing Plan Variation","81.26%","0.806439340114594","Yes","Yes","No","100%",,"$500","$0","$1,300","$200","$500","$100","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187690.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130022","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF006","New","PPO","Silver","Design 1","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130022-01","Atlas Individual $3500 Plus Silver","Standard Silver On Exchange Plan","70.63%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,410","$2,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187532.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130022","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF006","New","PPO","Silver","Design 1","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130022-02","Atlas Individual $3500 Plus Silver Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187533.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130022","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF006","New","PPO","Silver","Design 1","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130022-03","Atlas Individual $3500 Plus Silver Limited Cost Share Plan","Limited Cost Sharing Plan Variation","70.63%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,410","$2,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187534.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130022","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF006","New","PPO","Silver","Design 1","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130022-04","Atlas Individual $3000 Plus Silver Cost Share Plan","73% AV Level Silver Plan","73.55%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$200","$200","$1,410","$2,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187537.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130022","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF006","New","PPO","Silver","Design 1","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130022-05","Atlas Individual $700 Plus Silver Cost Share Plan","87% AV Level Silver Plan","87.47%","0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$200","$700","$1,090","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187536.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","20173","HIOS","2017-01-19 02:20:17","Individual","No","41-1683523","20173WI0130022","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF006","New","PPO","Silver","Design 1","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130022-06","Atlas Individual $250 Plus Silver Cost Share Plan","94% AV Level Silver Plan","94.30%","0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$1,000","$200","$250","$250","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_187535.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_186882.pdf"
"2017","WI","31248","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","31248WI0030001","TruAssure Dental Small Group Basic Plan","31248WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","31248WI0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","31248","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","31248WI0010001","TruAssure Basic Adult or Child Dental Plan","31248WI001",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$145","$145 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI"
"2017","WI","31248","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","31248WI0010001","TruAssure Basic Adult or Child Dental Plan","31248WI001",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$145","$145 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI"
"2017","WI","31248","HIOS","2016-08-16 03:04:39","SHOP (Small Group)","Yes","36-3757528","31248WI0040001","TruAssure Dental Small Group Preferred Plan","31248WI004",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","31248WI0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","31248","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","31248WI0020001","TruAssure Preferred Adult or Child Dental Plan","31248WI002",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI"
"2017","WI","31248","HIOS","2016-08-16 03:04:39","Individual","Yes","36-3757528","31248WI0020001","TruAssure Preferred Adult or Child Dental Plan","31248WI002",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI"
"2017","WI","34210","HIOS","2016-08-05 02:57:02","Individual","Yes","47-0397286","34210WI0020003","Renaissance Individual Dental PPO, EHB Certified","34210WI002",,"WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34210WI0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","34210","HIOS","2016-08-05 02:57:02","Individual","Yes","47-0397286","34210WI0020004","Renaissance Individual Dental PPO, EHB Certified","34210WI002",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34210WI0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","34210","HIOS","2016-08-05 02:57:02","Individual","Yes","47-0397286","34210WI0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","34210WI004",,"WIN001","WIS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34210","","34210WI0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WI_EHB_High_2017","http://www.renaissancedental.com/WI_EHB_High_2017"
"2017","WI","34210","HIOS","2016-08-05 02:57:02","Individual","Yes","47-0397286","34210WI0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","34210WI004",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34210","","34210WI0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WI_EHB_Low_2017","http://www.renaissancedental.com/WI_EHB_Low_2017"
"2017","WI","34210","HIOS","2016-08-05 02:57:02","Individual","Yes","47-0397286","34210WI0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","34210WI006",,"WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34210WI0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","34210","HIOS","2016-08-05 02:57:02","Individual","Yes","47-0397286","34210WI0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","34210WI006",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34210WI0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","34210","HIOS","2016-08-05 02:57:02","Individual","Yes","47-0397286","34210WI0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","34210WI005",,"WIN001","WIS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34210","","34210WI0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WI_Ped_High_2017","http://www.renaissancedental.com/WI_Ped_High_2017"
"2017","WI","34210","HIOS","2016-08-05 02:57:02","Individual","Yes","47-0397286","34210WI0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","34210WI005",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34210","","34210WI0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WI_Ped_Low_2017","http://www.renaissancedental.com/WI_Ped_Low_2017"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540001","Prime Gold Deductible","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540001-00","Prime Gold Deductible","Standard Gold Off Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0101","https://unityhealth.com/2017/prime/brochure/gold/INDP0101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510030","Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-00","Prime Silver Maintenance","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP3001","https://unityhealth.com/2017/prime/brochure/silver/INDP3001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510030","Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-01","Prime Silver Maintenance","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP3001","https://unityhealth.com/2017/prime/brochure/silver/INDP3001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510030","Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-02","Prime Silver Maintenance","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP3002","https://unityhealth.com/2017/prime/brochure/silver/INDP3001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510030","Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-03","Prime Silver Maintenance","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP3003","https://unityhealth.com/2017/prime/brochure/silver/INDP3001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510030","Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-04","Prime Silver Maintenance","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP3004","https://unityhealth.com/2017/prime/brochure/silver/INDP3001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510030","Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-05","Prime Silver Maintenance","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP3005","https://unityhealth.com/2017/prime/brochure/silver/INDP3001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510032","Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-02","Elite Silver Maintenance","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE3202","https://unityhealth.com/2017/elite/brochure/silver/INDE3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510030","Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-06","Prime Silver Maintenance","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP3006","https://unityhealth.com/2017/prime/brochure/silver/INDP3001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510008","Prime Silver 25/50 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-00","Prime Silver 25/50 Value","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0801","https://unityhealth.com/2017/prime/brochure/silver/INDP0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510008","Prime Silver 25/50 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-01","Prime Silver 25/50 Value","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0801","https://unityhealth.com/2017/prime/brochure/silver/INDP0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510008","Prime Silver 25/50 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-02","Prime Silver 25/50 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0802","https://unityhealth.com/2017/prime/brochure/silver/INDP0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510008","Prime Silver 25/50 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-03","Prime Silver 25/50 Value","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0803","https://unityhealth.com/2017/prime/brochure/silver/INDP0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540001","Prime Gold Deductible","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540001-01","Prime Gold Deductible","Standard Gold On Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0101","https://unityhealth.com/2017/prime/brochure/gold/INDP0101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540001","Prime Gold Deductible","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540001-02","Prime Gold Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0102","https://unityhealth.com/2017/prime/brochure/gold/INDP0101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540001","Prime Gold Deductible","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540001-03","Prime Gold Deductible","Limited Cost Sharing Plan Variation",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0103","https://unityhealth.com/2017/prime/brochure/gold/INDP0101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510003","Prime Gold 30/60","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510003-00","Prime Gold 30/60","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0301","https://unityhealth.com/2017/prime/brochure/gold/INDP0301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510003","Prime Gold 30/60","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510003-01","Prime Gold 30/60","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0301","https://unityhealth.com/2017/prime/brochure/gold/INDP0301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510003","Prime Gold 30/60","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510003-02","Prime Gold 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0302","https://unityhealth.com/2017/prime/brochure/gold/INDP0301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510003","Prime Gold 30/60","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510003-03","Prime Gold 30/60","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0303","https://unityhealth.com/2017/prime/brochure/gold/INDP0301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510007","Prime Silver 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-00","Prime Silver 30/60","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0701","https://unityhealth.com/2017/prime/brochure/silver/INDP0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510007","Prime Silver 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-01","Prime Silver 30/60","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0701","https://unityhealth.com/2017/prime/brochure/silver/INDP0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510007","Prime Silver 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-02","Prime Silver 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0702","https://unityhealth.com/2017/prime/brochure/silver/INDP0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510007","Prime Silver 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-03","Prime Silver 30/60","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0703","https://unityhealth.com/2017/prime/brochure/silver/INDP0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510007","Prime Silver 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-04","Prime Silver 30/60","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0704","https://unityhealth.com/2017/prime/brochure/silver/INDP0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510007","Prime Silver 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-05","Prime Silver 20/40","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0705","https://unityhealth.com/2017/prime/brochure/silver/INDP0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510007","Prime Silver 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-06","Prime Silver 10/20","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0706","https://unityhealth.com/2017/prime/brochure/silver/INDP0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540002","Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-00","Prime Silver Deductible","Standard Silver Off Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0201","https://unityhealth.com/2017/prime/brochure/silver/INDP0201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540002","Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-01","Prime Silver Deductible","Standard Silver On Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0201","https://unityhealth.com/2017/prime/brochure/silver/INDP0201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540002","Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-02","Prime Silver Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0202","https://unityhealth.com/2017/prime/brochure/silver/INDP0201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540002","Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-03","Prime Silver Deductible","Limited Cost Sharing Plan Variation",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0203","https://unityhealth.com/2017/prime/brochure/silver/INDP0201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540002","Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-04","Prime Silver Deductible","73% AV Level Silver Plan",,"0.739121675491333","Yes","Yes","No","100%",,"$1,850","$0","$1,700","$30","$1,850","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$5700 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$3700 per person","$3700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0204","https://unityhealth.com/2017/prime/brochure/silver/INDP0201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540002","Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-05","Prime Silver Deductible","87% AV Level Silver Plan",,"0.87995970249176","Yes","Yes","No","100%",,"$750","$0","$500","$30","$750","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0205","https://unityhealth.com/2017/prime/brochure/silver/INDP0201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540002","Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-06","Prime Silver Deductible","94% AV Level Silver Plan",,"0.94882071018219","Yes","Yes","No","100%",,"$250","$0","$250","$30","$250","$0","$250","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0206","https://unityhealth.com/2017/prime/brochure/silver/INDP0201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510008","Prime Silver 25/50 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-04","Prime Silver 25/50 Value","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0804","https://unityhealth.com/2017/prime/brochure/silver/INDP0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510008","Prime Silver 25/50 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-05","Prime Silver 10/25 Value","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0805","https://unityhealth.com/2017/prime/brochure/silver/INDP0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510008","Prime Silver 25/50 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-06","Prime Silver 5/10 Value","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0806","https://unityhealth.com/2017/prime/brochure/silver/INDP0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510009","Prime Silver 40/90 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-00","Prime Silver 40/90 Value","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0901","https://unityhealth.com/2017/prime/brochure/silver/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510009","Prime Silver 40/90 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-01","Prime Silver 40/90 Value","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0901","https://unityhealth.com/2017/prime/brochure/silver/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510009","Prime Silver 40/90 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-02","Prime Silver 40/90 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0902","https://unityhealth.com/2017/prime/brochure/silver/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510009","Prime Silver 40/90 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-03","Prime Silver 40/90 Value","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0903","https://unityhealth.com/2017/prime/brochure/silver/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510009","Prime Silver 40/90 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-04","Prime Silver 30/70 Value","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0904","https://unityhealth.com/2017/prime/brochure/silver/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510009","Prime Silver 40/90 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-05","Prime Silver 30/70 Value","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0905","https://unityhealth.com/2017/prime/brochure/silver/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510009","Prime Silver 40/90 Value","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-06","Prime Silver 10/25 Value","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP0906","https://unityhealth.com/2017/prime/brochure/silver/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510035","Prime Bronze 55/125","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510035-00","Prime Bronze 55/125","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP3501","https://unityhealth.com/2017/prime/brochure/bronze/INDP3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510035","Prime Bronze 55/125","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510035-01","Prime Bronze 55/125","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP3501","https://unityhealth.com/2017/prime/brochure/bronze/INDP3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510035","Prime Bronze 55/125","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510035-02","Prime Bronze 55/125","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP3502","https://unityhealth.com/2017/prime/brochure/bronze/INDP3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510035","Prime Bronze 55/125","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510035-03","Prime Bronze 55/125","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP3503","https://unityhealth.com/2017/prime/brochure/bronze/INDP3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510013","Elite Gold 30/60","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510013-00","Elite Gold 30/60","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE1301","https://unityhealth.com/2017/elite/brochure/gold/INDE1301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510013","Elite Gold 30/60","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510013-01","Elite Gold 30/60","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE1301","https://unityhealth.com/2017/elite/brochure/gold/INDE1301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510013","Elite Gold 30/60","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510013-02","Elite Gold 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE1302","https://unityhealth.com/2017/elite/brochure/gold/INDE1301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510013","Elite Gold 30/60","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510013-03","Elite Gold 30/60","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE1303","https://unityhealth.com/2017/elite/brochure/gold/INDE1301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510017","Elite Silver 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-00","Elite Silver 30/60","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1701","https://unityhealth.com/2017/elite/brochure/silver/INDE1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510017","Elite Silver 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-01","Elite Silver 30/60","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1701","https://unityhealth.com/2017/elite/brochure/silver/INDE1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510017","Elite Silver 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-02","Elite Silver 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1702","https://unityhealth.com/2017/elite/brochure/silver/INDE1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510017","Elite Silver 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-03","Elite Silver 30/60","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1703","https://unityhealth.com/2017/elite/brochure/silver/INDE1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510017","Elite Silver 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-04","Elite Silver 30/60","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1704","https://unityhealth.com/2017/elite/brochure/silver/INDE1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510017","Elite Silver 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-05","Elite Silver 20/40","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1705","https://unityhealth.com/2017/elite/brochure/silver/INDE1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510017","Elite Silver 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-06","Elite Silver 10/20","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1706","https://unityhealth.com/2017/elite/brochure/silver/INDE1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510032","Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-00","Elite Silver Maintenance","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE3201","https://unityhealth.com/2017/elite/brochure/silver/INDE3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510032","Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-01","Elite Silver Maintenance","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE3201","https://unityhealth.com/2017/elite/brochure/silver/INDE3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510032","Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-03","Elite Silver Maintenance","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE3203","https://unityhealth.com/2017/elite/brochure/silver/INDE3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510037","Elite Bronze 55/125","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510037-03","Elite Bronze 55/125","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE3703","https://unityhealth.com/2017/elite/brochure/bronze/INDE3701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510022","Beloit One Gold 30/60","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510022-00","Beloit One Gold 30/60","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB2201","https://unityhealth.com/2017/beloitone/brochure/gold/INDB2201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 40/90 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-03","Beloit One Silver 40/90 Value","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB2403","https://unityhealth.com/2017/beloitone/brochure/silver/INDB2401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510039","Beloit One Bronze 55/125","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510039-02","Beloit One Bronze 55/125","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB3902","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB3901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510039","Beloit One Bronze 55/125","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510039-03","Beloit One Bronze 55/125","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB3903","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB3901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380042","Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-02","Prime Silver Maintenance with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP4202","https://unityhealth.com/2017/prime/brochure/silver/INDP4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380027","Elite Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-00","Elite Silver 30/60 with Dental","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2701","https://unityhealth.com/2017/elite/brochure/silver/INDE2701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 40/90 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-04","Beloit One Silver 30/70 Value","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB2404","https://unityhealth.com/2017/beloitone/brochure/silver/INDB2401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510051-03","ProHealth Silver 25/50 Value","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5103","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510051-04","ProHealth Silver 25/50 Value","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5104","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510032","Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-04","Elite Silver Maintenance","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE3204","https://unityhealth.com/2017/elite/brochure/silver/INDE3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510032","Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-05","Elite Silver Maintenance","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE3205","https://unityhealth.com/2017/elite/brochure/silver/INDE3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510032","Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-06","Elite Silver Maintenance","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE3206","https://unityhealth.com/2017/elite/brochure/silver/INDE3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510018","Elite Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-00","Elite Silver 25/50 Value","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1801","https://unityhealth.com/2017/elite/brochure/silver/INDE1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510018","Elite Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-01","Elite Silver 25/50 Value","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1801","https://unityhealth.com/2017/elite/brochure/silver/INDE1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510018","Elite Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-02","Elite Silver 25/50 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1802","https://unityhealth.com/2017/elite/brochure/silver/INDE1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510018","Elite Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-03","Elite Silver 25/50 Value","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1803","https://unityhealth.com/2017/elite/brochure/silver/INDE1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510018","Elite Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-04","Elite Silver 25/50 Value","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1804","https://unityhealth.com/2017/elite/brochure/silver/INDE1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510018","Elite Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-05","Elite Silver 10/25 Value","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1805","https://unityhealth.com/2017/elite/brochure/silver/INDE1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510018","Elite Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-06","Elite Silver 5/10 Value","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1806","https://unityhealth.com/2017/elite/brochure/silver/INDE1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510019","Elite Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-00","Elite Silver 40/90 Value","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1901","https://unityhealth.com/2017/elite/brochure/silver/INDE1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510019","Elite Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-01","Elite Silver 40/90 Value","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1901","https://unityhealth.com/2017/elite/brochure/silver/INDE1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510019","Elite Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-02","Elite Silver 40/90 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1902","https://unityhealth.com/2017/elite/brochure/silver/INDE1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510019","Elite Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-03","Elite Silver 40/90 Value","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1903","https://unityhealth.com/2017/elite/brochure/silver/INDE1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510019","Elite Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-04","Elite Silver 30/70 Value","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1904","https://unityhealth.com/2017/elite/brochure/silver/INDE1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510019","Elite Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-05","Elite Silver 30/70 Value","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1905","https://unityhealth.com/2017/elite/brochure/silver/INDE1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510019","Elite Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-06","Elite Silver 10/25 Value","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE1906","https://unityhealth.com/2017/elite/brochure/silver/INDE1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510037","Elite Bronze 55/125","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510037-00","Elite Bronze 55/125","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE3701","https://unityhealth.com/2017/elite/brochure/bronze/INDE3701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510037","Elite Bronze 55/125","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510037-01","Elite Bronze 55/125","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE3701","https://unityhealth.com/2017/elite/brochure/bronze/INDE3701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510037","Elite Bronze 55/125","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510037-02","Elite Bronze 55/125","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE3702","https://unityhealth.com/2017/elite/brochure/bronze/INDE3701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510022","Beloit One Gold 30/60","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510022-01","Beloit One Gold 30/60","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB2201","https://unityhealth.com/2017/beloitone/brochure/gold/INDB2201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510022","Beloit One Gold 30/60","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510022-02","Beloit One Gold 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB2202","https://unityhealth.com/2017/beloitone/brochure/gold/INDB2201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510022","Beloit One Gold 30/60","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510022-03","Beloit One Gold 30/60","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB2203","https://unityhealth.com/2017/beloitone/brochure/gold/INDB2201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510042","Beloit One Silver 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-00","Beloit One Silver 30/60","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4201","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510042","Beloit One Silver 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-01","Beloit One Silver 30/60","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4201","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510042","Beloit One Silver 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-02","Beloit One Silver 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4202","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510042","Beloit One Silver 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-03","Beloit One Silver 30/60","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4203","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510042","Beloit One Silver 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-04","Beloit One Silver 30/60","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4204","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510042","Beloit One Silver 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-05","Beloit One Silver 20/40","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4205","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510042","Beloit One Silver 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-06","Beloit One Silver 10/20","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4206","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510043","Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-00","Beloit One Silver Maintenance","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4301","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510043","Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-01","Beloit One Silver Maintenance","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4301","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510043","Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-02","Beloit One Silver Maintenance","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4302","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510043","Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-03","Beloit One Silver Maintenance","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4303","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510043","Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-04","Beloit One Silver Maintenance","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4304","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510043","Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-05","Beloit One Silver Maintenance","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4305","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510043","Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-06","Beloit One Silver Maintenance","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4306","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 25/50 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-00","Beloit One Silver 25/50 Value","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4401","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 25/50 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-01","Beloit One Silver 25/50 Value","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4401","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 25/50 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-02","Beloit One Silver 25/50 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4402","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 25/50 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-03","Beloit One Silver 25/50 Value","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4403","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 25/50 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-04","Beloit One Silver 25/50 Value","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4404","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 25/50 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-05","Beloit One Silver 10/25 Value","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4405","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 25/50 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-06","Beloit One Silver 5/10 Value","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB4406","https://unityhealth.com/2017/beloitone/brochure/silver/INDB4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 40/90 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-00","Beloit One Silver 40/90 Value","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB2401","https://unityhealth.com/2017/beloitone/brochure/silver/INDB2401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 40/90 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-01","Beloit One Silver 40/90 Value","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB2401","https://unityhealth.com/2017/beloitone/brochure/silver/INDB2401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 40/90 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-02","Beloit One Silver 40/90 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB2402","https://unityhealth.com/2017/beloitone/brochure/silver/INDB2401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 40/90 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-05","Beloit One Silver 30/70 Value","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB2405","https://unityhealth.com/2017/beloitone/brochure/silver/INDB2401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 40/90 Value","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-06","Beloit One Silver 10/25 Value","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB2406","https://unityhealth.com/2017/beloitone/brochure/silver/INDB2401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510039","Beloit One Bronze 55/125","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510039-00","Beloit One Bronze 55/125","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB3901","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB3901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510039","Beloit One Bronze 55/125","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510039-01","Beloit One Bronze 55/125","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB3901","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB3901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510045","ProHealth Gold 30/60","37833WI051","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510045-00","ProHealth Gold 30/60","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH4501","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH4501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510045","ProHealth Gold 30/60","37833WI051","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510045-01","ProHealth Gold 30/60","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH4501","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH4501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510045","ProHealth Gold 30/60","37833WI051","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510045-02","ProHealth Gold 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH4502","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH4501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510045","ProHealth Gold 30/60","37833WI051","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510045-03","ProHealth Gold 30/60","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH4503","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH4501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510047","ProHealth Silver 30/60","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510047-00","ProHealth Silver 30/60","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4701","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510047","ProHealth Silver 30/60","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510047-01","ProHealth Silver 30/60","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4701","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510047","ProHealth Silver 30/60","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510047-02","ProHealth Silver 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4702","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510047","ProHealth Silver 30/60","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510047-03","ProHealth Silver 30/60","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4703","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510047","ProHealth Silver 30/60","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510047-04","ProHealth Silver 30/60","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4704","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510047","ProHealth Silver 30/60","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510047-05","ProHealth Silver 20/40","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4705","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510047","ProHealth Silver 30/60","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510047-06","ProHealth Silver 10/20","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4706","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510049","ProHealth Silver Maintenance","37833WI051","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510049-00","ProHealth Silver Maintenance","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4901","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510049","ProHealth Silver Maintenance","37833WI051","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510049-01","ProHealth Silver Maintenance","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4901","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510049","ProHealth Silver Maintenance","37833WI051","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510049-02","ProHealth Silver Maintenance","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4902","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510049","ProHealth Silver Maintenance","37833WI051","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510049-03","ProHealth Silver Maintenance","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4903","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510049","ProHealth Silver Maintenance","37833WI051","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510049-04","ProHealth Silver Maintenance","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4904","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510049","ProHealth Silver Maintenance","37833WI051","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510049-05","ProHealth Silver Maintenance","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4905","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510049","ProHealth Silver Maintenance","37833WI051","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510049-06","ProHealth Silver Maintenance","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH4906","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH4901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510051-00","ProHealth Silver 25/50 Value","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5101","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510051-01","ProHealth Silver 25/50 Value","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5101","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510051-02","ProHealth Silver 25/50 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5102","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510051-05","ProHealth Silver 10/25 Value","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5105","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 25/50 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510051-06","ProHealth Silver 5/10 Value","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5106","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510053-00","ProHealth Silver 40/90 Value","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5301","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380017","Prime Silver 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-06","Prime Silver 10/20 with Dental","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1706","https://unityhealth.com/2017/prime/brochure/silver/INDP1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380042","Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-00","Prime Silver Maintenance with Dental","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP4201","https://unityhealth.com/2017/prime/brochure/silver/INDP4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380042","Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-01","Prime Silver Maintenance with Dental","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP4201","https://unityhealth.com/2017/prime/brochure/silver/INDP4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510053-01","ProHealth Silver 40/90 Value","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5301","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510053-02","ProHealth Silver 40/90 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5302","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510053-03","ProHealth Silver 40/90 Value","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5303","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380044","Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-02","Elite Silver Maintenance with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE4402","https://unityhealth.com/2017/elite/brochure/silver/INDE4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380044","Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-03","Elite Silver Maintenance with Dental","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE4403","https://unityhealth.com/2017/elite/brochure/silver/INDE4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380032","Beloit One Gold 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380032-02","Beloit One Gold 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB3202","https://unityhealth.com/2017/beloitone/brochure/gold/INDB3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380032","Beloit One Gold 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380032-03","Beloit One Gold 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB3203","https://unityhealth.com/2017/beloitone/brochure/gold/INDB3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380059","Beloit One Silver 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-00","Beloit One Silver 30/60 with Dental","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB5901","https://unityhealth.com/2017/beloitone/brochure/silver/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510053-04","ProHealth Silver 30/70 Value","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5304","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510053-05","ProHealth Silver 30/70 Value","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5305","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 40/90 Value","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510053-06","ProHealth Silver 10/25 Value","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH5306","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH5301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510055","ProHealth Bronze 55/125","37833WI051","7114920342","WIN002","WIS004","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510055-00","ProHealth Bronze 55/125","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH5501","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH5501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510055","ProHealth Bronze 55/125","37833WI051","7114920342","WIN002","WIS004","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510055-01","ProHealth Bronze 55/125","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH5501","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH5501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510055","ProHealth Bronze 55/125","37833WI051","7114920342","WIN002","WIS004","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510055-02","ProHealth Bronze 55/125","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH5502","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH5501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510055","ProHealth Bronze 55/125","37833WI051","7114920342","WIN002","WIS004","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510055-03","ProHealth Bronze 55/125","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH5503","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH5501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380009","Prime Gold 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380009-00","Prime Gold 30/60 with Dental","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0901","https://unityhealth.com/2017/prime/brochure/gold/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380009","Prime Gold 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380009-01","Prime Gold 30/60 with Dental","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0901","https://unityhealth.com/2017/prime/brochure/gold/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380009","Prime Gold 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380009-02","Prime Gold 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0902","https://unityhealth.com/2017/prime/brochure/gold/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380009","Prime Gold 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380009-03","Prime Gold 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP0903","https://unityhealth.com/2017/prime/brochure/gold/INDP0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380017","Prime Silver 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-00","Prime Silver 30/60 with Dental","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1701","https://unityhealth.com/2017/prime/brochure/silver/INDP1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380017","Prime Silver 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-01","Prime Silver 30/60 with Dental","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1701","https://unityhealth.com/2017/prime/brochure/silver/INDP1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380017","Prime Silver 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-02","Prime Silver 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1702","https://unityhealth.com/2017/prime/brochure/silver/INDP1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380017","Prime Silver 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-03","Prime Silver 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1703","https://unityhealth.com/2017/prime/brochure/silver/INDP1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380017","Prime Silver 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-04","Prime Silver 30/60 with Dental","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1704","https://unityhealth.com/2017/prime/brochure/silver/INDP1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380017","Prime Silver 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-05","Prime Silver 20/40 with Dental","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1705","https://unityhealth.com/2017/prime/brochure/silver/INDP1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380042","Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-03","Prime Silver Maintenance with Dental","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP4203","https://unityhealth.com/2017/prime/brochure/silver/INDP4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380042","Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-04","Prime Silver Maintenance with Dental","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP4204","https://unityhealth.com/2017/prime/brochure/silver/INDP4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380042","Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-05","Prime Silver Maintenance with Dental","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP4205","https://unityhealth.com/2017/prime/brochure/silver/INDP4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380042","Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-06","Prime Silver Maintenance with Dental","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP4206","https://unityhealth.com/2017/prime/brochure/silver/INDP4201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380018","Prime Silver 25/50 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-00","Prime Silver 25/50 Value with Dental","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1801","https://unityhealth.com/2017/prime/brochure/silver/INDP1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380018","Prime Silver 25/50 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-01","Prime Silver 25/50 Value with Dental","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1801","https://unityhealth.com/2017/prime/brochure/silver/INDP1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380018","Prime Silver 25/50 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-02","Prime Silver 25/50 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1802","https://unityhealth.com/2017/prime/brochure/silver/INDP1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380018","Prime Silver 25/50 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-03","Prime Silver 25/50 Value with Dental","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1803","https://unityhealth.com/2017/prime/brochure/silver/INDP1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380018","Prime Silver 25/50 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-04","Prime Silver 25/50 Value with Dental","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1804","https://unityhealth.com/2017/prime/brochure/silver/INDP1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380018","Prime Silver 25/50 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-05","Prime Silver 10/25 Value with Dental","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1805","https://unityhealth.com/2017/prime/brochure/silver/INDP1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380018","Prime Silver 25/50 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-06","Prime Silver 5/10 Value with Dental","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1806","https://unityhealth.com/2017/prime/brochure/silver/INDP1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380019","Prime Silver 40/90 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-00","Prime Silver 40/90 Value with Dental","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1901","https://unityhealth.com/2017/prime/brochure/silver/INDP1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380019","Prime Silver 40/90 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-01","Prime Silver 40/90 Value with Dental","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1901","https://unityhealth.com/2017/prime/brochure/silver/INDP1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380019","Prime Silver 40/90 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-02","Prime Silver 40/90 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1902","https://unityhealth.com/2017/prime/brochure/silver/INDP1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380019","Prime Silver 40/90 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-03","Prime Silver 40/90 Value with Dental","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1903","https://unityhealth.com/2017/prime/brochure/silver/INDP1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380019","Prime Silver 40/90 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-04","Prime Silver 30/70 Value with Dental","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1904","https://unityhealth.com/2017/prime/brochure/silver/INDP1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380019","Prime Silver 40/90 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-05","Prime Silver 30/70 Value with Dental","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1905","https://unityhealth.com/2017/prime/brochure/silver/INDP1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380019","Prime Silver 40/90 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-06","Prime Silver 10/25 Value with Dental","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP1906","https://unityhealth.com/2017/prime/brochure/silver/INDP1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380052","Prime Bronze 55/125 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380052-00","Prime Bronze 55/125 with Dental","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP5201","https://unityhealth.com/2017/prime/brochure/bronze/INDP5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380052","Prime Bronze 55/125 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380052-01","Prime Bronze 55/125 with Dental","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP5201","https://unityhealth.com/2017/prime/brochure/bronze/INDP5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380052","Prime Bronze 55/125 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380052-02","Prime Bronze 55/125 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP5202","https://unityhealth.com/2017/prime/brochure/bronze/INDP5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380052","Prime Bronze 55/125 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380052-03","Prime Bronze 55/125 with Dental","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP5203","https://unityhealth.com/2017/prime/brochure/bronze/INDP5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380023","Elite Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380023-00","Elite Gold 30/60 with Dental","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE2301","https://unityhealth.com/2017/elite/brochure/gold/INDE2301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380023","Elite Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380023-01","Elite Gold 30/60 with Dental","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE2301","https://unityhealth.com/2017/elite/brochure/gold/INDE2301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380023","Elite Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380023-02","Elite Gold 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE2302","https://unityhealth.com/2017/elite/brochure/gold/INDE2301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380023","Elite Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380023-03","Elite Gold 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE2303","https://unityhealth.com/2017/elite/brochure/gold/INDE2301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380027","Elite Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-01","Elite Silver 30/60 with Dental","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2701","https://unityhealth.com/2017/elite/brochure/silver/INDE2701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380027","Elite Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-02","Elite Silver 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2702","https://unityhealth.com/2017/elite/brochure/silver/INDE2701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380027","Elite Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-03","Elite Silver 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2703","https://unityhealth.com/2017/elite/brochure/silver/INDE2701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380027","Elite Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-04","Elite Silver 30/60 with Dental","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2704","https://unityhealth.com/2017/elite/brochure/silver/INDE2701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380027","Elite Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-05","Elite Silver 20/40 with Dental","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2705","https://unityhealth.com/2017/elite/brochure/silver/INDE2701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380029","Elite Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-05","Elite Silver 30/70 Value with Dental","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2905","https://unityhealth.com/2017/elite/brochure/silver/INDE2901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380029","Elite Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-06","Elite Silver 10/25 Value with Dental","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2906","https://unityhealth.com/2017/elite/brochure/silver/INDE2901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380054","Elite Bronze 55/125 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380054-00","Elite Bronze 55/125 with Dental","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE5401","https://unityhealth.com/2017/elite/brochure/bronze/INDE5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380027","Elite Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-06","Elite Silver 10/20 with Dental","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2706","https://unityhealth.com/2017/elite/brochure/silver/INDE2701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380044","Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-00","Elite Silver Maintenance with Dental","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE4401","https://unityhealth.com/2017/elite/brochure/silver/INDE4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380044","Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-01","Elite Silver Maintenance with Dental","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE4401","https://unityhealth.com/2017/elite/brochure/silver/INDE4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380044","Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-04","Elite Silver Maintenance with Dental","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE4404","https://unityhealth.com/2017/elite/brochure/silver/INDE4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380044","Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-05","Elite Silver Maintenance with Dental","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE4405","https://unityhealth.com/2017/elite/brochure/silver/INDE4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380044","Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-06","Elite Silver Maintenance with Dental","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE4406","https://unityhealth.com/2017/elite/brochure/silver/INDE4401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380028","Elite Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-00","Elite Silver 25/50 Value with Dental","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2801","https://unityhealth.com/2017/elite/brochure/silver/INDE2801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380028","Elite Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-01","Elite Silver 25/50 Value with Dental","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2801","https://unityhealth.com/2017/elite/brochure/silver/INDE2801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380028","Elite Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-02","Elite Silver 25/50 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2802","https://unityhealth.com/2017/elite/brochure/silver/INDE2801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380028","Elite Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-03","Elite Silver 25/50 Value with Dental","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2803","https://unityhealth.com/2017/elite/brochure/silver/INDE2801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380028","Elite Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-04","Elite Silver 25/50 Value with Dental","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2804","https://unityhealth.com/2017/elite/brochure/silver/INDE2801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380028","Elite Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-05","Elite Silver 10/25 Value with Dental","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2805","https://unityhealth.com/2017/elite/brochure/silver/INDE2801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380028","Elite Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-06","Elite Silver 5/10 Value with Dental","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2806","https://unityhealth.com/2017/elite/brochure/silver/INDE2801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380029","Elite Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-00","Elite Silver 40/90 Value with Dental","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2901","https://unityhealth.com/2017/elite/brochure/silver/INDE2901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380029","Elite Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-01","Elite Silver 40/90 Value with Dental","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2901","https://unityhealth.com/2017/elite/brochure/silver/INDE2901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380029","Elite Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-02","Elite Silver 40/90 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2902","https://unityhealth.com/2017/elite/brochure/silver/INDE2901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380029","Elite Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-03","Elite Silver 40/90 Value with Dental","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2903","https://unityhealth.com/2017/elite/brochure/silver/INDE2901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380029","Elite Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-04","Elite Silver 30/70 Value with Dental","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE2904","https://unityhealth.com/2017/elite/brochure/silver/INDE2901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380054","Elite Bronze 55/125 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380054-01","Elite Bronze 55/125 with Dental","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE5401","https://unityhealth.com/2017/elite/brochure/bronze/INDE5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-00","Beloit One Silver 25/50 Value with Dental","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6101","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-01","Beloit One Silver 25/50 Value with Dental","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6101","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-02","Beloit One Silver 25/50 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6102","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-03","Beloit One Silver 25/50 Value with Dental","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6103","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380071","ProHealth Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380071-02","ProHealth Silver Maintenance with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7102","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380071","ProHealth Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380071-03","ProHealth Silver Maintenance with Dental","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7103","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380071","ProHealth Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380071-04","ProHealth Silver Maintenance with Dental","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7104","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380054","Elite Bronze 55/125 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380054-02","Elite Bronze 55/125 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE5402","https://unityhealth.com/2017/elite/brochure/bronze/INDE5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380054","Elite Bronze 55/125 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380054-03","Elite Bronze 55/125 with Dental","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE5403","https://unityhealth.com/2017/elite/brochure/bronze/INDE5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380032","Beloit One Gold 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380032-00","Beloit One Gold 30/60 with Dental","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB3201","https://unityhealth.com/2017/beloitone/brochure/gold/INDB3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380032","Beloit One Gold 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380032-01","Beloit One Gold 30/60 with Dental","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB3201","https://unityhealth.com/2017/beloitone/brochure/gold/INDB3201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380059","Beloit One Silver 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-01","Beloit One Silver 30/60 with Dental","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB5901","https://unityhealth.com/2017/beloitone/brochure/silver/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380059","Beloit One Silver 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-02","Beloit One Silver 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB5902","https://unityhealth.com/2017/beloitone/brochure/silver/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380075-01","ProHealth Silver 40/90 Value with Dental","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7501","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380075-02","ProHealth Silver 40/90 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7502","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540008","Elite Catastrophic","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540008-00","Elite Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/catastrophic/INDE0801","https://unityhealth.com/2017/elite/brochure/catastrophic/INDE0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540008","Elite Catastrophic","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540008-01","Elite Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/catastrophic/INDE0801","https://unityhealth.com/2017/elite/brochure/catastrophic/INDE0801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540011","Beloit One Catastrophic","37833WI054","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540011-00","Beloit One Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/catastrophic/INDB1101","https://unityhealth.com/2017/beloitone/brochure/catastrophic/INDB1101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540011","Beloit One Catastrophic","37833WI054","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540011-01","Beloit One Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/catastrophic/INDB1101","https://unityhealth.com/2017/beloitone/brochure/catastrophic/INDB1101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380059","Beloit One Silver 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-03","Beloit One Silver 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB5903","https://unityhealth.com/2017/beloitone/brochure/silver/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380059","Beloit One Silver 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-04","Beloit One Silver 30/60 with Dental","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB5904","https://unityhealth.com/2017/beloitone/brochure/silver/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380059","Beloit One Silver 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-05","Beloit One Silver 20/40 with Dental","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB5905","https://unityhealth.com/2017/beloitone/brochure/silver/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380059","Beloit One Silver 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-06","Beloit One Silver 10/20 with Dental","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB5906","https://unityhealth.com/2017/beloitone/brochure/silver/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380060","Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-00","Beloit One Silver Maintenance with Dental","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6001","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380060","Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-01","Beloit One Silver Maintenance with Dental","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6001","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380060","Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-02","Beloit One Silver Maintenance with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6002","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380060","Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-03","Beloit One Silver Maintenance with Dental","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6003","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380060","Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-04","Beloit One Silver Maintenance with Dental","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6004","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380060","Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-05","Beloit One Silver Maintenance with Dental","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6005","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380060","Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-06","Beloit One Silver Maintenance with Dental","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6006","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-04","Beloit One Silver 25/50 Value with Dental","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6104","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-05","Beloit One Silver 10/25 Value with Dental","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6105","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-06","Beloit One Silver 5/10 Value with Dental","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6106","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-00","Beloit One Silver 40/90 Value with Dental","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB3501","https://unityhealth.com/2017/beloitone/brochure/silver/INDB3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-01","Beloit One Silver 40/90 Value with Dental","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB3501","https://unityhealth.com/2017/beloitone/brochure/silver/INDB3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-02","Beloit One Silver 40/90 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB3502","https://unityhealth.com/2017/beloitone/brochure/silver/INDB3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-03","Beloit One Silver 40/90 Value with Dental","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB3503","https://unityhealth.com/2017/beloitone/brochure/silver/INDB3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-04","Beloit One Silver 30/70 Value with Dental","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB3504","https://unityhealth.com/2017/beloitone/brochure/silver/INDB3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-05","Beloit One Silver 30/70 Value with Dental","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB3505","https://unityhealth.com/2017/beloitone/brochure/silver/INDB3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-06","Beloit One Silver 10/25 Value with Dental","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB3506","https://unityhealth.com/2017/beloitone/brochure/silver/INDB3501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380056","Beloit One Bronze 55/125 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380056-00","Beloit One Bronze 55/125 with Dental","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB5601","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB5601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380056","Beloit One Bronze 55/125 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380056-01","Beloit One Bronze 55/125 with Dental","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB5601","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB5601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380056","Beloit One Bronze 55/125 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380056-02","Beloit One Bronze 55/125 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB5602","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB5601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380056","Beloit One Bronze 55/125 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380056-03","Beloit One Bronze 55/125 with Dental","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB5603","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB5601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380062","ProHealth Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380062-00","ProHealth Gold 30/60 with Dental","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6201","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380062","ProHealth Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380062-01","ProHealth Gold 30/60 with Dental","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6201","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380062","ProHealth Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380062-02","ProHealth Gold 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6202","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380062","ProHealth Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380062-03","ProHealth Gold 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6203","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380069","ProHealth Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380069-00","ProHealth Silver 30/60 with Dental","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH6901","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380069","ProHealth Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380069-01","ProHealth Silver 30/60 with Dental","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH6901","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380069","ProHealth Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380069-02","ProHealth Silver 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH6902","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380069","ProHealth Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380069-03","ProHealth Silver 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH6903","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380069","ProHealth Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380069-04","ProHealth Silver 30/60 with Dental","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH6904","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380069","ProHealth Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380069-05","ProHealth Silver 20/40 with Dental","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH6905","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380069","ProHealth Silver 30/60 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380069-06","ProHealth Silver 10/20 with Dental","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH6906","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380071","ProHealth Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380071-00","ProHealth Silver Maintenance with Dental","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7101","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380071","ProHealth Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380071-01","ProHealth Silver Maintenance with Dental","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7101","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380071","ProHealth Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380071-05","ProHealth Silver Maintenance with Dental","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7105","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380071","ProHealth Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380071-06","ProHealth Silver Maintenance with Dental","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7106","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510072","Prime Bronze Standard","37833WI051","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510072-02","Prime Bronze Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP7202","https://unityhealth.com/2017/prime/brochure/bronze/INDP7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510072","Prime Bronze Standard","37833WI051","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510072-03","Prime Bronze Standard","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP7203","https://unityhealth.com/2017/prime/brochure/bronze/INDP7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510073","Elite Bronze Standard","37833WI051","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510073-00","Elite Bronze Standard","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE7301","https://unityhealth.com/2017/elite/brochure/bronze/INDE7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510062","Prime Gold Standard","37833WI051","7114920342","WIN001","WIS001","WIF004","New","HMO","Gold","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510062-03","Prime Gold Standard","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP6203","https://unityhealth.com/2017/prime/brochure/gold/INDP6201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard","37833WI051","7114920342","WIN001","WIS001","WIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510067-00","Prime Silver Standard","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP6701","https://unityhealth.com/2017/prime/brochure/silver/INDP6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard","37833WI051","7114920342","WIN001","WIS001","WIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510067-01","Prime Silver Standard","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP6701","https://unityhealth.com/2017/prime/brochure/silver/INDP6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380073-00","ProHealth Silver 25/50 Value with Dental","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7301","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380073-01","ProHealth Silver 25/50 Value with Dental","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7301","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380073-02","ProHealth Silver 25/50 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7302","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380073-03","ProHealth Silver 25/50 Value with Dental","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7303","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380073-04","ProHealth Silver 25/50 Value with Dental","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7304","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380073-05","ProHealth Silver 10/25 Value with Dental","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7305","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 25/50 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380073-06","ProHealth Silver 5/10 Value with Dental","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7306","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380075-00","ProHealth Silver 40/90 Value with Dental","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7501","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380075-03","ProHealth Silver 40/90 Value with Dental","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7503","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380075-04","ProHealth Silver 30/70 Value with Dental","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7504","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380075-05","ProHealth Silver 30/70 Value with Dental","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7505","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 40/90 Value with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380075-06","ProHealth Silver 10/25 Value with Dental","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7506","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380077","ProHealth Bronze 55/125 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380077-00","ProHealth Bronze 55/125 with Dental","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH7701","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH7701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380077","ProHealth Bronze 55/125 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380077-01","ProHealth Bronze 55/125 with Dental","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH7701","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH7701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380077","ProHealth Bronze 55/125 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380077-02","ProHealth Bronze 55/125 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH7702","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH7701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380077","ProHealth Bronze 55/125 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380077-03","ProHealth Bronze 55/125 with Dental","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH7703","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH7701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510072","Prime Bronze Standard","37833WI051","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510072-00","Prime Bronze Standard","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP7201","https://unityhealth.com/2017/prime/brochure/bronze/INDP7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510072","Prime Bronze Standard","37833WI051","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510072-01","Prime Bronze Standard","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP7201","https://unityhealth.com/2017/prime/brochure/bronze/INDP7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510073","Elite Bronze Standard","37833WI051","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510073-01","Elite Bronze Standard","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE7301","https://unityhealth.com/2017/elite/brochure/bronze/INDE7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510073","Elite Bronze Standard","37833WI051","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510073-02","Elite Bronze Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE7302","https://unityhealth.com/2017/elite/brochure/bronze/INDE7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510073","Elite Bronze Standard","37833WI051","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510073-03","Elite Bronze Standard","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE7303","https://unityhealth.com/2017/elite/brochure/bronze/INDE7301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510074","Beloit One Bronze Standard","37833WI051","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510074-00","Beloit One Bronze Standard","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB7401","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510074","Beloit One Bronze Standard","37833WI051","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510074-01","Beloit One Bronze Standard","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB7401","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510074","Beloit One Bronze Standard","37833WI051","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510074-02","Beloit One Bronze Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB7402","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510074","Beloit One Bronze Standard","37833WI051","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510074-03","Beloit One Bronze Standard","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB7403","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510075","ProHealth Bronze Standard","37833WI051","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510075-00","ProHealth Bronze Standard","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH7501","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510075","ProHealth Bronze Standard","37833WI051","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510075-01","ProHealth Bronze Standard","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH7501","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510075","ProHealth Bronze Standard","37833WI051","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510075-02","ProHealth Bronze Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH7502","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510075","ProHealth Bronze Standard","37833WI051","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510075-03","ProHealth Bronze Standard","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH7503","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH7501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510076","Pioneer One Bronze Standard","37833WI051","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510076-00","Pioneer One Bronze Standard","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW7601","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510076","Pioneer One Bronze Standard","37833WI051","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510076-01","Pioneer One Bronze Standard","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW7601","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510076","Pioneer One Bronze Standard","37833WI051","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510076-02","Pioneer One Bronze Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW7602","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510076","Pioneer One Bronze Standard","37833WI051","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510076-03","Pioneer One Bronze Standard","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$100","$300","$30","$2,500","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW7603","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540004","Prime Catastrophic","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540004-00","Prime Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/catastrophic/INDP0401","https://unityhealth.com/2017/prime/brochure/catastrophic/INDP0401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540004","Prime Catastrophic","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540004-01","Prime Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/catastrophic/INDP0401","https://unityhealth.com/2017/prime/brochure/catastrophic/INDP0401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540021","ProHealth Catastrophic","37833WI054","7114920342","WIN002","WIS004","WIF008","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540021-00","ProHealth Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/catastrophic/INDPH2101","https://unityhealth.com/2017/prohealth/brochure/catastrophic/INDPH2101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380063","Pioneer One Gold 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380063-01","Pioneer One Gold 30/60 with Dental","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6301","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380063","Pioneer One Gold 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380063-02","Pioneer One Gold 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6302","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380076-01","Pioneer One Silver 40/90 Value with Dental","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7601","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380076-02","Pioneer One Silver 40/90 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7602","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380076-03","Pioneer One Silver 40/90 Value with Dental","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7603","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380076-04","Pioneer One Silver 30/70 Value with Dental","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7604","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380078","Pioneer One Bronze 55/125 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380078-00","Pioneer One Bronze 55/125 with Dental","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW7801","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW7801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540021","ProHealth Catastrophic","37833WI054","7114920342","WIN002","WIS004","WIF008","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540021-01","ProHealth Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/catastrophic/INDPH2101","https://unityhealth.com/2017/prohealth/brochure/catastrophic/INDPH2101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510062","Prime Gold Standard","37833WI051","7114920342","WIN001","WIS001","WIF004","New","HMO","Gold","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510062-00","Prime Gold Standard","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP6201","https://unityhealth.com/2017/prime/brochure/gold/INDP6201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510062","Prime Gold Standard","37833WI051","7114920342","WIN001","WIS001","WIF004","New","HMO","Gold","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510062-01","Prime Gold Standard","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP6201","https://unityhealth.com/2017/prime/brochure/gold/INDP6201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510062","Prime Gold Standard","37833WI051","7114920342","WIN001","WIS001","WIF004","New","HMO","Gold","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510062-02","Prime Gold Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP6202","https://unityhealth.com/2017/prime/brochure/gold/INDP6201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard","37833WI051","7114920342","WIN001","WIS001","WIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510067-02","Prime Silver Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP6702","https://unityhealth.com/2017/prime/brochure/silver/INDP6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard","37833WI051","7114920342","WIN001","WIS001","WIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510067-03","Prime Silver Standard","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP6703","https://unityhealth.com/2017/prime/brochure/silver/INDP6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard","37833WI051","7114920342","WIN001","WIS001","WIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510067-04","Prime Silver Standard","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$500","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP6704","https://unityhealth.com/2017/prime/brochure/silver/INDP6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard","37833WI051","7114920342","WIN001","WIS001","WIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510067-05","Prime Silver Standard","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$200","$900","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP6705","https://unityhealth.com/2017/prime/brochure/silver/INDP6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard","37833WI051","7114920342","WIN003","WIS003","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510069-04","Beloit One Silver Standard","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$500","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6904","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard","37833WI051","7114920342","WIN003","WIS003","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510069-05","Beloit One Silver Standard","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$200","$900","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6905","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard","37833WI051","7114920342","WIN003","WIS003","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510069-06","Beloit One Silver Standard","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$90","$200","$30","$100","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6906","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510065","ProHealth Gold Standard","37833WI051","7114920342","WIN002","WIS004","WIF004","New","HMO","Gold","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510065-00","ProHealth Gold Standard","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6501","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard","37833WI051","7114920342","WIN001","WIS001","WIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510067-06","Prime Silver Standard","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$90","$200","$30","$100","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/silver/INDP6706","https://unityhealth.com/2017/prime/brochure/silver/INDP6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510063","Elite Gold Standard","37833WI051","7114920342","WIN002","WIS002","WIF004","New","HMO","Gold","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510063-00","Elite Gold Standard","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE6301","https://unityhealth.com/2017/elite/brochure/gold/INDE6301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510063","Elite Gold Standard","37833WI051","7114920342","WIN002","WIS002","WIF004","New","HMO","Gold","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510063-01","Elite Gold Standard","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE6301","https://unityhealth.com/2017/elite/brochure/gold/INDE6301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510063","Elite Gold Standard","37833WI051","7114920342","WIN002","WIS002","WIF004","New","HMO","Gold","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510063-02","Elite Gold Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE6302","https://unityhealth.com/2017/elite/brochure/gold/INDE6301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510063","Elite Gold Standard","37833WI051","7114920342","WIN002","WIS002","WIF004","New","HMO","Gold","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510063-03","Elite Gold Standard","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE6303","https://unityhealth.com/2017/elite/brochure/gold/INDE6301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard","37833WI051","7114920342","WIN002","WIS002","WIF006","New","HMO","Silver","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510068-00","Elite Silver Standard","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE6801","https://unityhealth.com/2017/elite/brochure/silver/INDE6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard","37833WI051","7114920342","WIN002","WIS002","WIF006","New","HMO","Silver","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510068-01","Elite Silver Standard","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE6801","https://unityhealth.com/2017/elite/brochure/silver/INDE6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard","37833WI051","7114920342","WIN002","WIS002","WIF006","New","HMO","Silver","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510068-02","Elite Silver Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE6802","https://unityhealth.com/2017/elite/brochure/silver/INDE6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard","37833WI051","7114920342","WIN002","WIS002","WIF006","New","HMO","Silver","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510068-03","Elite Silver Standard","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE6803","https://unityhealth.com/2017/elite/brochure/silver/INDE6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard","37833WI051","7114920342","WIN002","WIS002","WIF006","New","HMO","Silver","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510068-04","Elite Silver Standard","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$500","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE6804","https://unityhealth.com/2017/elite/brochure/silver/INDE6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard","37833WI051","7114920342","WIN002","WIS002","WIF006","New","HMO","Silver","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510068-05","Elite Silver Standard","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$200","$900","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE6805","https://unityhealth.com/2017/elite/brochure/silver/INDE6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard","37833WI051","7114920342","WIN002","WIS002","WIF006","New","HMO","Silver","Design 2","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510068-06","Elite Silver Standard","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$90","$200","$30","$100","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE6806","https://unityhealth.com/2017/elite/brochure/silver/INDE6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510064","Beloit One Gold Standard","37833WI051","7114920342","WIN003","WIS003","WIF004","New","HMO","Gold","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510064-00","Beloit One Gold Standard","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB6401","https://unityhealth.com/2017/beloitone/brochure/gold/INDB6401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510064","Beloit One Gold Standard","37833WI051","7114920342","WIN003","WIS003","WIF004","New","HMO","Gold","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510064-01","Beloit One Gold Standard","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB6401","https://unityhealth.com/2017/beloitone/brochure/gold/INDB6401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510064","Beloit One Gold Standard","37833WI051","7114920342","WIN003","WIS003","WIF004","New","HMO","Gold","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510064-02","Beloit One Gold Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB6402","https://unityhealth.com/2017/beloitone/brochure/gold/INDB6401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510064","Beloit One Gold Standard","37833WI051","7114920342","WIN003","WIS003","WIF004","New","HMO","Gold","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510064-03","Beloit One Gold Standard","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB6403","https://unityhealth.com/2017/beloitone/brochure/gold/INDB6401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard","37833WI051","7114920342","WIN003","WIS003","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510069-00","Beloit One Silver Standard","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6901","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard","37833WI051","7114920342","WIN003","WIS003","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510069-01","Beloit One Silver Standard","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6901","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard","37833WI051","7114920342","WIN003","WIS003","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510069-02","Beloit One Silver Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6902","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard","37833WI051","7114920342","WIN003","WIS003","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510069-03","Beloit One Silver Standard","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB6903","https://unityhealth.com/2017/beloitone/brochure/silver/INDB6901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510065","ProHealth Gold Standard","37833WI051","7114920342","WIN002","WIS004","WIF004","New","HMO","Gold","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510065-01","ProHealth Gold Standard","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6501","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510065","ProHealth Gold Standard","37833WI051","7114920342","WIN002","WIS004","WIF004","New","HMO","Gold","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510065-02","ProHealth Gold Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6502","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510065","ProHealth Gold Standard","37833WI051","7114920342","WIN002","WIS004","WIF004","New","HMO","Gold","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510065-03","ProHealth Gold Standard","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6503","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard","37833WI051","7114920342","WIN002","WIS004","WIF006","New","HMO","Silver","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510070-00","ProHealth Silver Standard","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7001","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard","37833WI051","7114920342","WIN002","WIS004","WIF006","New","HMO","Silver","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510070-01","ProHealth Silver Standard","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7001","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard","37833WI051","7114920342","WIN002","WIS004","WIF006","New","HMO","Silver","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510070-02","ProHealth Silver Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7002","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard","37833WI051","7114920342","WIN002","WIS004","WIF006","New","HMO","Silver","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510070-03","ProHealth Silver Standard","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7003","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard","37833WI051","7114920342","WIN002","WIS004","WIF006","New","HMO","Silver","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510070-04","ProHealth Silver Standard","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$500","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7004","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard","37833WI051","7114920342","WIN002","WIS004","WIF006","New","HMO","Silver","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510070-05","ProHealth Silver Standard","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$200","$900","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7005","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard","37833WI051","7114920342","WIN002","WIS004","WIF006","New","HMO","Silver","Design 4","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510070-06","ProHealth Silver Standard","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$90","$200","$30","$100","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH7006","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510066","Pioneer One Gold Standard","37833WI051","7114920342","WIN004","WIS005","WIF004","New","HMO","Gold","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510066-00","Pioneer One Gold Standard","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6601","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510066","Pioneer One Gold Standard","37833WI051","7114920342","WIN004","WIS005","WIF004","New","HMO","Gold","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510066-01","Pioneer One Gold Standard","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6601","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510066","Pioneer One Gold Standard","37833WI051","7114920342","WIN004","WIS005","WIF004","New","HMO","Gold","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510066-02","Pioneer One Gold Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6602","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510066","Pioneer One Gold Standard","37833WI051","7114920342","WIN004","WIS005","WIF004","New","HMO","Gold","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510066-03","Pioneer One Gold Standard","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$400","$700","$30","$100","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6603","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard","37833WI051","7114920342","WIN004","WIS005","WIF006","New","HMO","Silver","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510071-00","Pioneer One Silver Standard","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7101","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard","37833WI051","7114920342","WIN004","WIS005","WIF006","New","HMO","Silver","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510071-01","Pioneer One Silver Standard","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7101","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard","37833WI051","7114920342","WIN004","WIS005","WIF006","New","HMO","Silver","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510071-02","Pioneer One Silver Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7102","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard","37833WI051","7114920342","WIN004","WIS005","WIF006","New","HMO","Silver","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510071-03","Pioneer One Silver Standard","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$500","$300","$30","$100","$1,800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7103","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard","37833WI051","7114920342","WIN004","WIS005","WIF006","New","HMO","Silver","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510071-04","Pioneer One Silver Standard","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$500","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7104","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard","37833WI051","7114920342","WIN004","WIS005","WIF006","New","HMO","Silver","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510071-05","Pioneer One Silver Standard","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$200","$900","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7105","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard","37833WI051","7114920342","WIN004","WIS005","WIF006","New","HMO","Silver","Design 5","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510071-06","Pioneer One Silver Standard","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$90","$200","$30","$100","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7106","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380063","Pioneer One Gold 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380063-00","Pioneer One Gold 30/60 with Dental","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6301","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380063","Pioneer One Gold 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380063-03","Pioneer One Gold 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6303","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380070","Pioneer One Silver 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380070-00","Pioneer One Silver 30/60 with Dental","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7001","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380070","Pioneer One Silver 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380070-01","Pioneer One Silver 30/60 with Dental","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7001","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380070","Pioneer One Silver 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380070-02","Pioneer One Silver 30/60 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7002","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380070","Pioneer One Silver 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380070-03","Pioneer One Silver 30/60 with Dental","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7003","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380070","Pioneer One Silver 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380070-04","Pioneer One Silver 30/60 with Dental","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7004","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380070","Pioneer One Silver 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380070-05","Pioneer One Silver 20/40 with Dental","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7005","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380076-05","Pioneer One Silver 30/70 Value with Dental","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7605","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380076-06","Pioneer One Silver 10/25 Value with Dental","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7606","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510056","Pioneer One Bronze 55/125","37833WI051","7114920342","WIN004","WIS005","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510056-03","Pioneer One Bronze 55/125","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW5603","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW5601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540022","Pioneer One Catastrophic","37833WI054","7114920342","WIN004","WIS005","WIF008","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540022-00","Pioneer One Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/catastrophic/INDSW2201","https://unityhealth.com/2017/pioneerone/brochure/catastrophic/INDSW2201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380070","Pioneer One Silver 30/60 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380070-06","Pioneer One Silver 10/20 with Dental","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7006","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380072","Pioneer One Silver Maintenance with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380072-00","Pioneer One Silver Maintenance with Dental","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7201","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380072","Pioneer One Silver Maintenance with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380072-01","Pioneer One Silver Maintenance with Dental","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7201","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380072","Pioneer One Silver Maintenance with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380072-02","Pioneer One Silver Maintenance with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7202","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380072","Pioneer One Silver Maintenance with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380072-03","Pioneer One Silver Maintenance with Dental","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7203","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380072","Pioneer One Silver Maintenance with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380072-04","Pioneer One Silver Maintenance with Dental","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7204","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380072","Pioneer One Silver Maintenance with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380072-05","Pioneer One Silver Maintenance with Dental","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7205","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380072","Pioneer One Silver Maintenance with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380072-06","Pioneer One Silver Maintenance with Dental","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7206","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380074-00","Pioneer One Silver 25/50 Value with Dental","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7401","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380074-01","Pioneer One Silver 25/50 Value with Dental","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7401","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380074-02","Pioneer One Silver 25/50 Value with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7402","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380074-03","Pioneer One Silver 25/50 Value with Dental","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7403","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380074-04","Pioneer One Silver 25/50 Value with Dental","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7404","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380074-05","Pioneer One Silver 10/25 Value with Dental","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7405","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 25/50 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380074-06","Pioneer One Silver 5/10 Value with Dental","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7406","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 40/90 Value with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380076-00","Pioneer One Silver 40/90 Value with Dental","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW7601","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW7601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380078","Pioneer One Bronze 55/125 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380078-01","Pioneer One Bronze 55/125 with Dental","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW7801","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW7801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380078","Pioneer One Bronze 55/125 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380078-02","Pioneer One Bronze 55/125 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW7802","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW7801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380078","Pioneer One Bronze 55/125 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380078-03","Pioneer One Bronze 55/125 with Dental","Limited Cost Sharing Plan Variation",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW7803","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW7801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540016","Pioneer One Gold Deductible","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540016-00","Pioneer One Gold Deductible","Standard Gold Off Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW1601","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW1601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540016","Pioneer One Gold Deductible","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540016-01","Pioneer One Gold Deductible","Standard Gold On Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW1601","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW1601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540016","Pioneer One Gold Deductible","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540016-02","Pioneer One Gold Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW1602","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW1601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540016","Pioneer One Gold Deductible","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540016-03","Pioneer One Gold Deductible","Limited Cost Sharing Plan Variation",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW1603","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW1601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510046","Pioneer One Gold 30/60","37833WI051","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510046-00","Pioneer One Gold 30/60","Standard Gold Off Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW4601","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW4601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510046","Pioneer One Gold 30/60","37833WI051","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510046-01","Pioneer One Gold 30/60","Standard Gold On Exchange Plan",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW4601","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW4601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510046","Pioneer One Gold 30/60","37833WI051","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510046-02","Pioneer One Gold 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW4602","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW4601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510046","Pioneer One Gold 30/60","37833WI051","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510046-03","Pioneer One Gold 30/60","Limited Cost Sharing Plan Variation",,"0.780738770961761","No","Yes","No","100%",,"$1,200","$500","$800","$30","$100","$1,500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW4603","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW4601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510048","Pioneer One Silver 30/60","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510048-00","Pioneer One Silver 30/60","Standard Silver Off Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW4801","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW4801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510048","Pioneer One Silver 30/60","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510048-01","Pioneer One Silver 30/60","Standard Silver On Exchange Plan",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW4801","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW4801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510048","Pioneer One Silver 30/60","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510048-02","Pioneer One Silver 30/60","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW4802","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW4801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510048","Pioneer One Silver 30/60","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510048-03","Pioneer One Silver 30/60","Limited Cost Sharing Plan Variation",,"0.680406451225281","No","Yes","No","100%",,"$5,000","$500","$0","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW4803","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW4801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510048","Pioneer One Silver 30/60","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510048-04","Pioneer One Silver 30/60","73% AV Level Silver Plan",,"0.739802598953247","No","Yes","No","100%",,"$2,750","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW4804","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW4801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510048","Pioneer One Silver 30/60","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510048-05","Pioneer One Silver 20/40","87% AV Level Silver Plan",,"0.879046380519867","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW4805","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW4801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510048","Pioneer One Silver 30/60","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510048-06","Pioneer One Silver 10/20","94% AV Level Silver Plan",,"0.949699342250824","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW4806","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW4801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver Deductible","37833WI054","7114920342","WIN004","WIS005","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540018-00","Pioneer One Silver Deductible","Standard Silver Off Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW1801","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver Deductible","37833WI054","7114920342","WIN004","WIS005","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540018-01","Pioneer One Silver Deductible","Standard Silver On Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW1801","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver Deductible","37833WI054","7114920342","WIN004","WIS005","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540018-02","Pioneer One Silver Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW1802","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver Deductible","37833WI054","7114920342","WIN004","WIS005","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540018-03","Pioneer One Silver Deductible","Limited Cost Sharing Plan Variation",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW1803","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver Deductible","37833WI054","7114920342","WIN004","WIS005","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540018-04","Pioneer One Silver Deductible","73% AV Level Silver Plan",,"0.739121675491333","Yes","Yes","No","100%",,"$1,850","$0","$1,700","$30","$1,850","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$5700 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$3700 per person","$3700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW1804","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver Deductible","37833WI054","7114920342","WIN004","WIS005","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540018-05","Pioneer One Silver Deductible","87% AV Level Silver Plan",,"0.87995970249176","Yes","Yes","No","100%",,"$750","$0","$500","$30","$750","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW1805","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver Deductible","37833WI054","7114920342","WIN004","WIS005","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540018-06","Pioneer One Silver Deductible","94% AV Level Silver Plan",,"0.94882071018219","Yes","Yes","No","100%",,"$250","$0","$250","$30","$250","$0","$250","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW1806","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW1801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510050","Pioneer One Silver Maintenance","37833WI051","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510050-00","Pioneer One Silver Maintenance","Standard Silver Off Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5001","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510050","Pioneer One Silver Maintenance","37833WI051","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510050-01","Pioneer One Silver Maintenance","Standard Silver On Exchange Plan",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5001","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510050","Pioneer One Silver Maintenance","37833WI051","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510050-02","Pioneer One Silver Maintenance","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5002","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510050","Pioneer One Silver Maintenance","37833WI051","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510050-03","Pioneer One Silver Maintenance","Limited Cost Sharing Plan Variation",,"0.706706345081329","No","Yes","No","100%",,"$500","$3,000","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5003","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510050","Pioneer One Silver Maintenance","37833WI051","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510050-04","Pioneer One Silver Maintenance","73% AV Level Silver Plan",,"0.739547431468964","No","Yes","No","100%",,"$500","$2,900","$0","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5004","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510050","Pioneer One Silver Maintenance","37833WI051","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510050-05","Pioneer One Silver Maintenance","87% AV Level Silver Plan",,"0.879371106624603","No","Yes","No","100%",,"$250","$1,700","$0","$30","$100","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5005","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510050","Pioneer One Silver Maintenance","37833WI051","7114920342","WIN004","WIS005","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510050-06","Pioneer One Silver Maintenance","94% AV Level Silver Plan",,"0.948872685432434","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5006","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 25/50 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510052-00","Pioneer One Silver 25/50 Value","Standard Silver Off Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5201","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 25/50 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510052-01","Pioneer One Silver 25/50 Value","Standard Silver On Exchange Plan",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5201","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 25/50 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510052-02","Pioneer One Silver 25/50 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5202","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 25/50 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510052-03","Pioneer One Silver 25/50 Value","Limited Cost Sharing Plan Variation",,"0.71981143951416","No","Yes","No","100%",,"$3,200","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$6400 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5203","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 25/50 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510052-04","Pioneer One Silver 25/50 Value","73% AV Level Silver Plan",,"0.739889025688171","No","Yes","No","100%",,"$2,875","$400","$400","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,875","$5700 per person","$5750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5204","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 25/50 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510052-05","Pioneer One Silver 10/25 Value","87% AV Level Silver Plan",,"0.879672229290009","No","Yes","No","100%",,"$700","$200","$900","$30","$100","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$1400 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5205","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 25/50 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510052-06","Pioneer One Silver 5/10 Value","94% AV Level Silver Plan",,"0.94959545135498","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5206","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540020","Pioneer One Bronze HSA","37833WI054","7114920342","WIN004","WIS005","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540020-00","Pioneer One Bronze HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW2001","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW2001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540020","Pioneer One Bronze HSA","37833WI054","7114920342","WIN004","WIS005","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540020-01","Pioneer One Bronze HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW2001","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW2001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540020","Pioneer One Bronze HSA","37833WI054","7114920342","WIN004","WIS005","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540020-02","Pioneer One Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW2002","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW2001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540020","Pioneer One Bronze HSA","37833WI054","7114920342","WIN004","WIS005","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540020-03","Pioneer One Bronze HSA","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW2003","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW2001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 40/90 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510054-00","Pioneer One Silver 40/90 Value","Standard Silver Off Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5401","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 40/90 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510054-01","Pioneer One Silver 40/90 Value","Standard Silver On Exchange Plan",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5401","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 40/90 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510054-02","Pioneer One Silver 40/90 Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5402","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 40/90 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510054-03","Pioneer One Silver 40/90 Value","Limited Cost Sharing Plan Variation",,"0.68007105588913","No","Yes","No","100%",,"$4,350","$700","$60","$30","$100","$1,700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7150 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,350","$7150 per person","$8700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5403","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 40/90 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510054-04","Pioneer One Silver 30/70 Value","73% AV Level Silver Plan",,"0.739609718322754","No","Yes","No","100%",,"$2,600","$500","$200","$30","$100","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5404","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 40/90 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510054-05","Pioneer One Silver 30/70 Value","87% AV Level Silver Plan",,"0.879957616329193","No","Yes","No","100%",,"$85","$500","$0","$30","$85","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$85","$170 per person","$170 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5405","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 40/90 Value","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510054-06","Pioneer One Silver 10/25 Value","94% AV Level Silver Plan",,"0.949389398097992","No","Yes","No","100%",,"$0","$200","$0","$30","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2350 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/silver/INDSW5406","https://unityhealth.com/2017/pioneerone/brochure/silver/INDSW5401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510056","Pioneer One Bronze 55/125","37833WI051","7114920342","WIN004","WIS005","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510056-00","Pioneer One Bronze 55/125","Standard Bronze Off Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW5601","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW5601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510056","Pioneer One Bronze 55/125","37833WI051","7114920342","WIN004","WIS005","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510056-01","Pioneer One Bronze 55/125","Standard Bronze On Exchange Plan",,"0.619201362133026","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW5601","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW5601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510056","Pioneer One Bronze 55/125","37833WI051","7114920342","WIN004","WIS005","WIF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510056-02","Pioneer One Bronze 55/125","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/bronze/INDSW5602","https://unityhealth.com/2017/pioneerone/brochure/bronze/INDSW5601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540022","Pioneer One Catastrophic","37833WI054","7114920342","WIN004","WIS005","WIF008","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540022-01","Pioneer One Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/pioneerone/sbc/catastrophic/INDSW2201","https://unityhealth.com/2017/pioneerone/brochure/catastrophic/INDSW2201"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540003","Prime Bronze HSA","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540003-00","Prime Bronze HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP0301","https://unityhealth.com/2017/prime/brochure/bronze/INDP0301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540003","Prime Bronze HSA","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540003-01","Prime Bronze HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP0301","https://unityhealth.com/2017/prime/brochure/bronze/INDP0301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540009","Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-05","Beloit One Silver Deductible","87% AV Level Silver Plan",,"0.87995970249176","Yes","Yes","No","100%",,"$750","$0","$500","$30","$750","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB0905","https://unityhealth.com/2017/beloitone/brochure/silver/INDB0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540009","Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-06","Beloit One Silver Deductible","94% AV Level Silver Plan",,"0.94882071018219","Yes","Yes","No","100%",,"$250","$0","$250","$30","$250","$0","$250","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB0906","https://unityhealth.com/2017/beloitone/brochure/silver/INDB0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540010","Beloit One Bronze HSA","37833WI054","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540010-00","Beloit One Bronze HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB1001","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB1001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540010","Beloit One Bronze HSA","37833WI054","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540010-01","Beloit One Bronze HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB1001","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB1001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540010","Beloit One Bronze HSA","37833WI054","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540010-02","Beloit One Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB1002","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB1001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380067","ProHealth Gold Wise Savings with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380067-01","ProHealth Gold Wise Savings with Dental","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6701","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540014","Beloit One Gold Deductible","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540014-03","Beloit One Gold Deductible","Limited Cost Sharing Plan Variation",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB1403","https://unityhealth.com/2017/beloitone/brochure/gold/INDB1401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540009","Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-00","Beloit One Silver Deductible","Standard Silver Off Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB0901","https://unityhealth.com/2017/beloitone/brochure/silver/INDB0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540009","Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-01","Beloit One Silver Deductible","Standard Silver On Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB0901","https://unityhealth.com/2017/beloitone/brochure/silver/INDB0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540009","Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-02","Beloit One Silver Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB0902","https://unityhealth.com/2017/beloitone/brochure/silver/INDB0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380066","Beloit One Gold Wise Savings with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380066-03","Beloit One Gold Wise Savings with Dental","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB6603","https://unityhealth.com/2017/beloitone/brochure/gold/INDB6601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540003","Prime Bronze HSA","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540003-02","Prime Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP0302","https://unityhealth.com/2017/prime/brochure/bronze/INDP0301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540003","Prime Bronze HSA","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540003-03","Prime Bronze HSA","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prime/sbc/bronze/INDP0303","https://unityhealth.com/2017/prime/brochure/bronze/INDP0301"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540005","Elite Gold Deductible","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540005-00","Elite Gold Deductible","Standard Gold Off Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE0501","https://unityhealth.com/2017/elite/brochure/gold/INDE0501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540005","Elite Gold Deductible","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540005-01","Elite Gold Deductible","Standard Gold On Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE0501","https://unityhealth.com/2017/elite/brochure/gold/INDE0501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540005","Elite Gold Deductible","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540005-02","Elite Gold Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE0502","https://unityhealth.com/2017/elite/brochure/gold/INDE0501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540005","Elite Gold Deductible","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540005-03","Elite Gold Deductible","Limited Cost Sharing Plan Variation",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE0503","https://unityhealth.com/2017/elite/brochure/gold/INDE0501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540006","Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-00","Elite Silver Deductible","Standard Silver Off Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE0601","https://unityhealth.com/2017/elite/brochure/silver/INDE0601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540006","Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-01","Elite Silver Deductible","Standard Silver On Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE0601","https://unityhealth.com/2017/elite/brochure/silver/INDE0601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540006","Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-02","Elite Silver Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE0602","https://unityhealth.com/2017/elite/brochure/silver/INDE0601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540006","Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-03","Elite Silver Deductible","Limited Cost Sharing Plan Variation",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE0603","https://unityhealth.com/2017/elite/brochure/silver/INDE0601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540006","Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-04","Elite Silver Deductible","73% AV Level Silver Plan",,"0.739121675491333","Yes","Yes","No","100%",,"$1,850","$0","$1,700","$30","$1,850","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$5700 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$3700 per person","$3700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE0604","https://unityhealth.com/2017/elite/brochure/silver/INDE0601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540006","Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-05","Elite Silver Deductible","87% AV Level Silver Plan",,"0.87995970249176","Yes","Yes","No","100%",,"$750","$0","$500","$30","$750","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE0605","https://unityhealth.com/2017/elite/brochure/silver/INDE0601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540006","Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-06","Elite Silver Deductible","94% AV Level Silver Plan",,"0.94882071018219","Yes","Yes","No","100%",,"$250","$0","$250","$30","$250","$0","$250","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/silver/INDE0606","https://unityhealth.com/2017/elite/brochure/silver/INDE0601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540007","Elite Bronze HSA","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540007-00","Elite Bronze HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE0701","https://unityhealth.com/2017/elite/brochure/bronze/INDE0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540007","Elite Bronze HSA","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540007-01","Elite Bronze HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE0701","https://unityhealth.com/2017/elite/brochure/bronze/INDE0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540007","Elite Bronze HSA","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540007-02","Elite Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE0702","https://unityhealth.com/2017/elite/brochure/bronze/INDE0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540007","Elite Bronze HSA","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540007-03","Elite Bronze HSA","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/elite/sbc/bronze/INDE0703","https://unityhealth.com/2017/elite/brochure/bronze/INDE0701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540014","Beloit One Gold Deductible","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540014-00","Beloit One Gold Deductible","Standard Gold Off Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB1401","https://unityhealth.com/2017/beloitone/brochure/gold/INDB1401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540014","Beloit One Gold Deductible","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540014-01","Beloit One Gold Deductible","Standard Gold On Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB1401","https://unityhealth.com/2017/beloitone/brochure/gold/INDB1401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540014","Beloit One Gold Deductible","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540014-02","Beloit One Gold Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB1402","https://unityhealth.com/2017/beloitone/brochure/gold/INDB1401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540009","Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-03","Beloit One Silver Deductible","Limited Cost Sharing Plan Variation",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB0903","https://unityhealth.com/2017/beloitone/brochure/silver/INDB0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540009","Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-04","Beloit One Silver Deductible","73% AV Level Silver Plan",,"0.739121675491333","Yes","Yes","No","100%",,"$1,850","$0","$1,700","$30","$1,850","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$5700 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$3700 per person","$3700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/silver/INDB0904","https://unityhealth.com/2017/beloitone/brochure/silver/INDB0901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540010","Beloit One Bronze HSA","37833WI054","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540010-03","Beloit One Bronze HSA","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/beloitone/sbc/bronze/INDB1003","https://unityhealth.com/2017/beloitone/brochure/bronze/INDB1001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540015","ProHealth Gold Deductible","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540015-00","ProHealth Gold Deductible","Standard Gold Off Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH1501","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH1501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540015","ProHealth Gold Deductible","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540015-01","ProHealth Gold Deductible","Standard Gold On Exchange Plan",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH1501","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH1501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540015","ProHealth Gold Deductible","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540015-02","ProHealth Gold Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH1502","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH1501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540015","ProHealth Gold Deductible","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540015-03","ProHealth Gold Deductible","Limited Cost Sharing Plan Variation",,"0.788701474666595","Yes","Yes","No","100%",,"$1,500","$0","$600","$30","$1,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$7150 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH1503","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH1501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540017","ProHealth Silver Deductible","37833WI054","7114920342","WIN002","WIS004","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540017-00","ProHealth Silver Deductible","Standard Silver Off Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH1701","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540017","ProHealth Silver Deductible","37833WI054","7114920342","WIN002","WIS004","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540017-01","ProHealth Silver Deductible","Standard Silver On Exchange Plan",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH1701","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540017","ProHealth Silver Deductible","37833WI054","7114920342","WIN002","WIS004","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540017-02","ProHealth Silver Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH1702","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540017","ProHealth Silver Deductible","37833WI054","7114920342","WIN002","WIS004","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540017-03","ProHealth Silver Deductible","Limited Cost Sharing Plan Variation",,"0.680151462554932","Yes","Yes","No","100%",,"$2,650","$0","$1,400","$30","$2,650","$0","$800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$7150 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$5300 per person","$5300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH1703","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540017","ProHealth Silver Deductible","37833WI054","7114920342","WIN002","WIS004","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540017-04","ProHealth Silver Deductible","73% AV Level Silver Plan",,"0.739121675491333","Yes","Yes","No","100%",,"$1,850","$0","$1,700","$30","$1,850","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$5700 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$3700 per person","$3700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH1704","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540017","ProHealth Silver Deductible","37833WI054","7114920342","WIN002","WIS004","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540017-05","ProHealth Silver Deductible","87% AV Level Silver Plan",,"0.87995970249176","Yes","Yes","No","100%",,"$750","$0","$500","$30","$750","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH1705","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540017","ProHealth Silver Deductible","37833WI054","7114920342","WIN002","WIS004","WIF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540017-06","ProHealth Silver Deductible","94% AV Level Silver Plan",,"0.94882071018219","Yes","Yes","No","100%",,"$250","$0","$250","$30","$250","$0","$250","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/silver/INDPH1706","https://unityhealth.com/2017/prohealth/brochure/silver/INDPH1701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540019","ProHealth Bronze HSA","37833WI054","7114920342","WIN002","WIS004","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540019-00","ProHealth Bronze HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH1901","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540019","ProHealth Bronze HSA","37833WI054","7114920342","WIN002","WIS004","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540019-01","ProHealth Bronze HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH1901","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540019","ProHealth Bronze HSA","37833WI054","7114920342","WIN002","WIS004","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540019-02","ProHealth Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH1902","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0540019","ProHealth Bronze HSA","37833WI054","7114920342","WIN002","WIS004","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540019-03","ProHealth Bronze HSA","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2017/prohealth/sbc/bronze/INDPH1903","https://unityhealth.com/2017/prohealth/brochure/bronze/INDPH1901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510057","Prime Gold Wise Savings","37833WI051","7114920342","WIN001","WIS001","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510057-00","Prime Gold Wise Savings","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP5701","https://unityhealth.com/2017/prime/brochure/gold/INDP5701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510057","Prime Gold Wise Savings","37833WI051","7114920342","WIN001","WIS001","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510057-01","Prime Gold Wise Savings","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP5701","https://unityhealth.com/2017/prime/brochure/gold/INDP5701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510057","Prime Gold Wise Savings","37833WI051","7114920342","WIN001","WIS001","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510057-02","Prime Gold Wise Savings","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP5702","https://unityhealth.com/2017/prime/brochure/gold/INDP5701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510057","Prime Gold Wise Savings","37833WI051","7114920342","WIN001","WIS001","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510057-03","Prime Gold Wise Savings","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP5703","https://unityhealth.com/2017/prime/brochure/gold/INDP5701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510058","Elite Gold Wise Savings","37833WI051","7114920342","WIN002","WIS002","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510058-00","Elite Gold Wise Savings","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE5801","https://unityhealth.com/2017/elite/brochure/gold/INDE5801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510058","Elite Gold Wise Savings","37833WI051","7114920342","WIN002","WIS002","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510058-01","Elite Gold Wise Savings","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE5801","https://unityhealth.com/2017/elite/brochure/gold/INDE5801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510058","Elite Gold Wise Savings","37833WI051","7114920342","WIN002","WIS002","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510058-02","Elite Gold Wise Savings","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE5802","https://unityhealth.com/2017/elite/brochure/gold/INDE5801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510058","Elite Gold Wise Savings","37833WI051","7114920342","WIN002","WIS002","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510058-03","Elite Gold Wise Savings","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE5803","https://unityhealth.com/2017/elite/brochure/gold/INDE5801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510059","Beloit One Gold Wise Savings","37833WI051","7114920342","WIN003","WIS003","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510059-00","Beloit One Gold Wise Savings","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB5901","https://unityhealth.com/2017/beloitone/brochure/gold/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510059","Beloit One Gold Wise Savings","37833WI051","7114920342","WIN003","WIS003","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510059-01","Beloit One Gold Wise Savings","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB5901","https://unityhealth.com/2017/beloitone/brochure/gold/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510059","Beloit One Gold Wise Savings","37833WI051","7114920342","WIN003","WIS003","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510059-02","Beloit One Gold Wise Savings","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB5902","https://unityhealth.com/2017/beloitone/brochure/gold/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510059","Beloit One Gold Wise Savings","37833WI051","7114920342","WIN003","WIS003","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510059-03","Beloit One Gold Wise Savings","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB5903","https://unityhealth.com/2017/beloitone/brochure/gold/INDB5901"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510060","ProHealth Gold Wise Savings","37833WI051","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510060-00","ProHealth Gold Wise Savings","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6001","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510060","ProHealth Gold Wise Savings","37833WI051","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510060-01","ProHealth Gold Wise Savings","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6001","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510060","ProHealth Gold Wise Savings","37833WI051","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510060-02","ProHealth Gold Wise Savings","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6002","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510060","ProHealth Gold Wise Savings","37833WI051","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510060-03","ProHealth Gold Wise Savings","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6003","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6001"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510061","Pioneer One Gold Wise Savings","37833WI051","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510061-00","Pioneer One Gold Wise Savings","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6101","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510061","Pioneer One Gold Wise Savings","37833WI051","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510061-01","Pioneer One Gold Wise Savings","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6101","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510061","Pioneer One Gold Wise Savings","37833WI051","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510061-02","Pioneer One Gold Wise Savings","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6102","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0510061","Pioneer One Gold Wise Savings","37833WI051","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510061-03","Pioneer One Gold Wise Savings","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6103","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6101"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380064","Prime Gold Wise Savings with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380064-00","Prime Gold Wise Savings with Dental","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP6401","https://unityhealth.com/2017/prime/brochure/gold/INDP6401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380064","Prime Gold Wise Savings with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380064-01","Prime Gold Wise Savings with Dental","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP6401","https://unityhealth.com/2017/prime/brochure/gold/INDP6401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380064","Prime Gold Wise Savings with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380064-02","Prime Gold Wise Savings with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP6402","https://unityhealth.com/2017/prime/brochure/gold/INDP6401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380064","Prime Gold Wise Savings with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380064-03","Prime Gold Wise Savings with Dental","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prime/sbc/gold/INDP6403","https://unityhealth.com/2017/prime/brochure/gold/INDP6401"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380065","Elite Gold Wise Savings with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380065-00","Elite Gold Wise Savings with Dental","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE6501","https://unityhealth.com/2017/elite/brochure/gold/INDE6501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380065","Elite Gold Wise Savings with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380065-01","Elite Gold Wise Savings with Dental","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE6501","https://unityhealth.com/2017/elite/brochure/gold/INDE6501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380065","Elite Gold Wise Savings with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380065-02","Elite Gold Wise Savings with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE6502","https://unityhealth.com/2017/elite/brochure/gold/INDE6501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380065","Elite Gold Wise Savings with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380065-03","Elite Gold Wise Savings with Dental","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/elite/sbc/gold/INDE6503","https://unityhealth.com/2017/elite/brochure/gold/INDE6501"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380066","Beloit One Gold Wise Savings with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380066-00","Beloit One Gold Wise Savings with Dental","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB6601","https://unityhealth.com/2017/beloitone/brochure/gold/INDB6601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380066","Beloit One Gold Wise Savings with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380066-01","Beloit One Gold Wise Savings with Dental","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB6601","https://unityhealth.com/2017/beloitone/brochure/gold/INDB6601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380066","Beloit One Gold Wise Savings with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380066-02","Beloit One Gold Wise Savings with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/beloitone/sbc/gold/INDB6602","https://unityhealth.com/2017/beloitone/brochure/gold/INDB6601"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380067","ProHealth Gold Wise Savings with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380067-00","ProHealth Gold Wise Savings with Dental","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6701","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6701"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170002","Classic $3,750 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170002-03","Classic $3,750 HDHP","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic 3750-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140029","Tradition $1,500 - 10%","38166WI014",,"WIN003","WIS003","WIF010","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140029-01","Tradition $1,500 - 10%","Standard Gold On Exchange Plan",,"0.788633286952972","No","Yes","No","100%",,"$1,500","$930","$570","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%201500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140002","Tradition $2,000 - Copay","38166WI014",,"WIN003","WIS003","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140002-00","Tradition $2,000 - Copay","Standard Gold Off Exchange Plan",,"0.817467927932739","No","Yes","No","100%",,"$2,000","$40","$0","$0","$540","$720","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%202000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170002","Classic $3,750 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170002-04","Classic $3,250","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,250","$0","$0","$3,250","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%203250.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170002","Classic $3,750 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170002-05","Classic $1,250","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,250","$0","$0","$1,250","$1,250","$0","$0","$1,250","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%201250.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170010","Classic $6,500","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170010-00","Classic $6,500","Standard Bronze Off Exchange Plan",,"0.598379969596863","Yes","Yes","No","100%",,"$6,340","$120","$0","$6,460","$950","$1,120","$0","$2,070","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400719_Classic_6500_NQ-HDHP_SBC","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170010","Classic $6,500","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170010-01","Classic $6,500","Standard Bronze On Exchange Plan",,"0.598379969596863","Yes","Yes","No","100%",,"$6,340","$120","$0","$6,460","$950","$1,120","$0","$2,070","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%206500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380067","ProHealth Gold Wise Savings with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380067-02","ProHealth Gold Wise Savings with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6702","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380067","ProHealth Gold Wise Savings with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380067-03","ProHealth Gold Wise Savings with Dental","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/prohealth/sbc/gold/INDPH6703","https://unityhealth.com/2017/prohealth/brochure/gold/INDPH6701"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380068","Pioneer One Gold Wise Savings with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380068-00","Pioneer One Gold Wise Savings with Dental","Standard Gold Off Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6801","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380068","Pioneer One Gold Wise Savings with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380068-01","Pioneer One Gold Wise Savings with Dental","Standard Gold On Exchange Plan","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6801","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380068","Pioneer One Gold Wise Savings with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380068-02","Pioneer One Gold Wise Savings with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6802","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6801"
"2017","WI","37833","HIOS","2017-04-26 02:48:20","Individual","No","39-1450766","37833WI0380068","Pioneer One Gold Wise Savings with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9433",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380068-03","Pioneer One Gold Wise Savings with Dental","Limited Cost Sharing Plan Variation","78.49%","0.736870467662811","No","Yes","No","100%",,"$2,500","$400","$400","$30","$0","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2017/pioneerone/sbc/gold/INDSW6803","https://unityhealth.com/2017/pioneerone/brochure/gold/INDSW6801"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140001","Tradition $500 - 10%","38166WI014",,"WIN003","WIS003","WIF007","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140001-00","Tradition $500 - 10%","Standard Platinum Off Exchange Plan",,"0.905921518802643","No","Yes","No","100%",,"$500","$20","$480","$0","$500","$480","$20","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%20500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170001","Classic $1,500 - 20%","38166WI017",,"WIN001","WIS001","WIF012","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170001-00","Classic $1,500 - 20%","Standard Gold Off Exchange Plan",,"0.781687796115875","No","Yes","No","100%",,"$1,500","$1,030","$970","$3,500","$850","$930","$0","$1,780","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400700_Classic_1500-20_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170001","Classic $1,500 - 20%","38166WI017",,"WIN001","WIS001","WIF012","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170001-01","Classic $1,500 - 20%","Standard Gold On Exchange Plan",,"0.781687796115875","No","Yes","No","100%",,"$1,500","$1,030","$970","$3,500","$850","$930","$0","$1,780","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%201500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140001","Tradition $500 - 10%","38166WI014",,"WIN003","WIS003","WIF007","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140001-01","Tradition $500 - 10%","Standard Platinum On Exchange Plan",,"0.905921518802643","No","Yes","No","100%",,"$500","$20","$480","$0","$500","$480","$20","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%20500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140014","Tradition $750","38166WI014",,"WIN003","WIS003","WIF007","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140014-00","Tradition $750","Standard Platinum Off Exchange Plan",,"0.917586207389832","No","Yes","No","100%",,"$750","$40","$0","$0","$750","$570","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%20750.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170001","Classic $1,500 - 20%","38166WI017",,"WIN001","WIS001","WIF012","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170001-02","Classic $1,500 - 20%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-1500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170001","Classic $1,500 - 20%","38166WI017",,"WIN001","WIS001","WIF012","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170001-03","Classic $1,500 - 20%","Limited Cost Sharing Plan Variation",,"0.781687796115875","No","Yes","No","100%",,"$1,500","$1,030","$970","$3,500","$850","$930","$0","$1,780","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic%201500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140014","Tradition $750","38166WI014",,"WIN003","WIS003","WIF007","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140014-01","Tradition $750","Standard Platinum On Exchange Plan",,"0.917586207389832","No","Yes","No","100%",,"$750","$40","$0","$0","$750","$570","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%20750.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140004","Tradition $1,000 - 20%","38166WI014",,"WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140004-00","Tradition $1,000 - 20%","Standard Gold Off Exchange Plan",,"0.803269565105438","No","Yes","No","100%",,"$1,000","$40","$1,240","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%201000-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170002","Classic $3,750 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170002-00","Classic $3,750 HDHP","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400706_Classic_3750HDHP_SBC","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170002","Classic $3,750 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170002-01","Classic $3,750 HDHP","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%203750-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140004","Tradition $1,000 - 20%","38166WI014",,"WIN003","WIS003","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140004-01","Tradition $1,000 - 20%","Standard Gold On Exchange Plan",,"0.803269565105438","No","Yes","No","100%",,"$1,000","$40","$1,240","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%201000-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140029","Tradition $1,500 - 10%","38166WI014",,"WIN003","WIS003","WIF010","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140029-00","Tradition $1,500 - 10%","Standard Gold Off Exchange Plan",,"0.788633286952972","No","Yes","No","100%",,"$1,500","$930","$570","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%201500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170002","Classic $3,750 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170002-02","Classic $3,750 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-3750-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140002","Tradition $2,000 - Copay","38166WI014",,"WIN003","WIS003","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140002-01","Tradition $2,000 - Copay","Standard Gold On Exchange Plan",,"0.817467927932739","No","Yes","No","100%",,"$2,000","$40","$0","$0","$540","$720","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%202000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140011","Tradition $2,500 - 20%","38166WI014",,"WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140011-00","Tradition $2,500 - 20%","Standard Silver Off Exchange Plan",,"0.696598410606384","No","Yes","No","100%",,"$2,500","$120","$940","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%202500-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170002","Classic $3,750 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170002-06","Classic $450","94% AV Level Silver Plan",,"0.948019683361053","Yes","Yes","No","100%",,"$450","$0","$0","$450","$450","$0","$0","$450","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%20450.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170003-00","Classic $2,500 - 20%","Standard Silver Off Exchange Plan","69.70%","0.699726700782776","No","Yes","No","100%",,"$2,500","$270","$0","$3,540","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400702_Classic_2500-20_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140011","Tradition $2,500 - 20%","38166WI014",,"WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140011-01","Tradition $2,500 - 20%","Standard Silver On Exchange Plan",,"0.696598410606384","No","Yes","No","100%",,"$2,500","$120","$940","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%202500-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140030","Tradition $3,000 - Copay","38166WI014",,"WIN003","WIS003","WIF010","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140030-00","Tradition $3,000 - Copay","Standard Gold Off Exchange Plan",,"0.802570819854736","No","Yes","No","100%",,"$2,920","$80","$0","$0","$540","$1,270","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%203000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170003-01","Classic $2,500 - 20%","Standard Silver On Exchange Plan","69.70%","0.699726700782776","No","Yes","No","100%",,"$2,500","$270","$0","$3,540","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%202500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170003-02","Classic $2,500 - 20%","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-2500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170006-02","Classic $6,000 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-6000-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140022","Tradition $3,500 HDHP","38166WI014",,"WIN003","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140022-01","Tradition $3,500 HDHP","Standard Silver On Exchange Plan",,"0.682242512702942","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%203500-copay-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140023","Tradition $4,000 HDHP","38166WI014",,"WIN003","WIS003","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140023-00","Tradition $4,000 HDHP","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%204000-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170006-03","Classic $6,000 HDHP","Limited Cost Sharing Plan Variation",,"0.611644566059113","Yes","Yes","No","100%",,"$6,000","$40","$0","$6,040","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic 6000-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170007-00","Classic $5,500 HDHP","Standard Bronze Off Exchange Plan",,"0.617677092552185","Yes","Yes","No","100%",,"$5,500","$40","$0","$5,540","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400709_Classic_5500HDHP_SBC","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140023","Tradition $4,000 HDHP","38166WI014",,"WIN003","WIS003","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140023-01","Tradition $4,000 HDHP","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%204000-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140013","Tradition $6,000 - 20% HDHP","38166WI014",,"WIN003","WIS003","WIF011","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140013-00","Tradition $6,000 - 20% HDHP","Standard Bronze Off Exchange Plan",,"0.618660032749176","Yes","Yes","No","100%",,"$6,000","$40","$260","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%206000-20-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140030","Tradition $3,000 - Copay","38166WI014",,"WIN003","WIS003","WIF010","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140030-01","Tradition $3,000 - Copay","Standard Gold On Exchange Plan",,"0.802570819854736","No","Yes","No","100%",,"$2,920","$80","$0","$0","$540","$1,270","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%203000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140018","Tradition $4,000","38166WI014",,"WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140018-00","Tradition $4,000","Standard Silver Off Exchange Plan",,"0.70470255613327","No","Yes","No","100%",,"$4,000","$120","$0","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%204000.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170003-03","Classic $2,500 - 20%","Limited Cost Sharing Plan Variation","69.70%","0.699726700782776","No","Yes","No","100%",,"$2,500","$270","$0","$3,540","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic 2500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170003-04","Classic $2,000 - 20%","73% AV Level Silver Plan","73.48%","0.734838783740997","No","Yes","No","100%",,"$2,000","$40","$870","$2,910","$850","$850","$0","$1,700","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%202000-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140018","Tradition $4,000","38166WI014",,"WIN003","WIS003","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140018-01","Tradition $4,000","Standard Silver On Exchange Plan",,"0.70470255613327","No","Yes","No","100%",,"$4,000","$120","$0","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%204000.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140026","Tradition $1,500 - Copay HDHP","38166WI014",,"WIN003","WIS003","WIF006","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140026-00","Tradition $1,500 - Copay HDHP","Standard Gold Off Exchange Plan",,"0.817554116249084","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$3000 per person","$3000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%201500-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170003-05","Classic $750 - 10%","87% AV Level Silver Plan","86.50%","0.864985167980194","No","Yes","No","100%",,"$750","$40","$560","$1,350","$750","$700","$10","$1,460","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%20750-10.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170003-06","Classic $250 - 10% (A)","94% AV Level Silver Plan","94.18%","0.941839277744293","No","Yes","No","100%",,"$250","$20","$230","$500","$250","$230","$20","$500","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%20250-10-a.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140026","Tradition $1,500 - Copay HDHP","38166WI014",,"WIN003","WIS003","WIF006","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140026-01","Tradition $1,500 - Copay HDHP","Standard Gold On Exchange Plan",,"0.817554116249084","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$3000 per person","$3000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%201500-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140027","Tradition $2,000 HDHP","38166WI014",,"WIN003","WIS003","WIF006","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140027-00","Tradition $2,000 HDHP","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%202000-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170004-00","Classic $2,000 - 30%","Standard Silver Off Exchange Plan","71.20%","0.711601495742798","No","Yes","No","100%",,"$2,000","$570","$1,300","$3,870","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400703_Classic_2000-30_SBC","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170004-01","Classic $2,000 - 30%","Standard Silver On Exchange Plan","71.20%","0.711601495742798","No","Yes","No","100%",,"$2,000","$570","$1,300","$3,870","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%202000-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140027","Tradition $2,000 HDHP","38166WI014",,"WIN003","WIS003","WIF006","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140027-01","Tradition $2,000 HDHP","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%202000-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140028","Tradition $2,650 - Copay HDHP","38166WI014",,"WIN003","WIS003","WIF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140028-00","Tradition $2,650 - Copay HDHP","Standard Silver Off Exchange Plan",,"0.689679801464081","Yes","Yes","No","100%",,"$2,650","$40","$0","$0","$2,650","$220","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%202650-copay-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170004-02","Classic $2,000 - 30%","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-2000-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170004-03","Classic $2,000 - 30%","Limited Cost Sharing Plan Variation","71.20%","0.711601495742798","No","Yes","No","100%",,"$2,000","$570","$1,300","$3,870","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic%202000-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140028","Tradition $2,650 - Copay HDHP","38166WI014",,"WIN003","WIS003","WIF003","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140028-01","Tradition $2,650 - Copay HDHP","Standard Silver On Exchange Plan",,"0.689679801464081","Yes","Yes","No","100%",,"$2,650","$40","$0","$0","$2,650","$220","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%202650-copay-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140012","Tradition $3,000 HDHP","38166WI014",,"WIN003","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140012-00","Tradition $3,000 HDHP","Standard Silver Off Exchange Plan",,"0.704241394996643","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%203000-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170004-04","Classic $2,000 - 30% $4,790 MOOP","73% AV Level Silver Plan","73.40%","0.734016895294189","No","Yes","No","100%",,"$2,000","$1,700","$1,090","$4,790","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,790","$4790 per person","$9580 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,790","$4790 per person","$9580 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%202000-30-4790.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170004-05","Classic $250 - 20%","87% AV Level Silver Plan","87.95%","0.879467844963074","No","Yes","No","100%",,"$250","$40","$1,220","$1,510","$250","$700","$120","$1,070","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%20250-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140012","Tradition $3,000 HDHP","38166WI014",,"WIN003","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140012-01","Tradition $3,000 HDHP","Standard Silver On Exchange Plan",,"0.704241394996643","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%203000-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140021","Tradition $3,000 - Copay HDHP","38166WI014",,"WIN003","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140021-00","Tradition $3,000 - Copay HDHP","Standard Silver Off Exchange Plan",,"0.687713086605072","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%203000-copay-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170004-06","Classic $250 - 10% (B)","94% AV Level Silver Plan","94.18%","0.941839277744293","No","Yes","No","100%",,"$250","$20","$230","$500","$250","$230","$20","$500","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%20250-10-b.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170006-00","Classic $6,000 HDHP","Standard Bronze Off Exchange Plan",,"0.611644566059113","Yes","Yes","No","100%",,"$6,000","$40","$0","$6,040","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400713_Classic_6000HDHP_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140021","Tradition $3,000 - Copay HDHP","38166WI014",,"WIN003","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140021-01","Tradition $3,000 - Copay HDHP","Standard Silver On Exchange Plan",,"0.687713086605072","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%203000-copay-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140022","Tradition $3,500 HDHP","38166WI014",,"WIN003","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140022-00","Tradition $3,500 HDHP","Standard Silver Off Exchange Plan",,"0.682242512702942","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%203500-copay-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170006-01","Classic $6,000 HDHP","Standard Bronze On Exchange Plan",,"0.611644566059113","Yes","Yes","No","100%",,"$6,000","$40","$0","$6,040","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%206000-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170007-01","Classic $5,500 HDHP","Standard Bronze On Exchange Plan",,"0.617677092552185","Yes","Yes","No","100%",,"$5,500","$40","$0","$5,540","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%205500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170007-02","Classic $5,500 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-5500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160001","Reliance $500 - 10%","38166WI016",,"WIN004","WIS004","WIF007","Existing","EPO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160001-01","Reliance $500 - 10%","Standard Platinum On Exchange Plan",,"0.905921518802643","No","Yes","No","100%",,"$500","$20","$480","$0","$500","$480","$20","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%20500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180001","Select $1,500 - 20%","38166WI018",,"WIN002","WIS002","WIF012","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180001-01","Select $1,500 - 20%","Standard Gold On Exchange Plan",,"0.781687796115875","No","Yes","No","100%",,"$1,500","$1,030","$970","$3,500","$850","$930","$0","$1,780","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%201500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180001","Select $1,500 - 20%","38166WI018",,"WIN002","WIS002","WIF012","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180001-02","Select $1,500 - 20%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-1500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160014","Reliance $750","38166WI016",,"WIN004","WIS004","WIF007","Existing","EPO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160014-00","Reliance $750","Standard Platinum Off Exchange Plan",,"0.917586207389832","No","Yes","No","100%",,"$750","$40","$0","$0","$750","$570","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%20750.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160014","Reliance $750","38166WI016",,"WIN004","WIS004","WIF007","Existing","EPO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160014-01","Reliance $750","Standard Platinum On Exchange Plan",,"0.917586207389832","No","Yes","No","100%",,"$750","$40","$0","$0","$750","$570","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%20750.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180001","Select $1,500 - 20%","38166WI018",,"WIN002","WIS002","WIF012","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180001-03","Select $1,500 - 20%","Limited Cost Sharing Plan Variation",,"0.781687796115875","No","Yes","No","100%",,"$1,500","$1,030","$970","$3,500","$850","$930","$0","$1,780","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select 1500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0140013","Tradition $6,000 - 20% HDHP","38166WI014",,"WIN003","WIS003","WIF011","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0140013-01","Tradition $6,000 - 20% HDHP","Standard Bronze On Exchange Plan",,"0.618660032749176","Yes","Yes","No","100%",,"$6,000","$40","$260","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Tradition/Tradition%206000-20-HDHP.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170007-03","Classic $5,500 HDHP","Limited Cost Sharing Plan Variation",,"0.617677092552185","Yes","Yes","No","100%",,"$5,500","$40","$0","$5,540","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic 5500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170008","Classic Protection","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170008-00","Classic Protection","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$650","$0","$650","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400714_ClassicProtection_7150_SBC","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170008","Classic Protection","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170008-01","Classic Protection","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$650","$0","$650","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%20protection.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170009-00","Classic $4,500 - 30%","Standard Silver Off Exchange Plan",,"0.699693977832794","No","Yes","No","100%",,"$4,500","$1,900","$0","$6,400","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400716_Classic_4500-30_SBC","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170009-01","Classic $4,500 - 30%","Standard Silver On Exchange Plan",,"0.699693977832794","No","Yes","No","100%",,"$4,500","$1,900","$0","$6,400","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%204500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170009-02","Classic $4,500 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-4500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170009-03","Classic $4,500 - 30%","Limited Cost Sharing Plan Variation",,"0.699693977832794","No","Yes","No","100%",,"$4,500","$1,900","$0","$6,400","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic 4500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170009-04","Classic $3,500","73% AV Level Silver Plan",,"0.733509361743927","No","Yes","No","100%",,"$3,500","$2,200","$0","$5,700","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%203500.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170009-05","Classic $1,750","87% AV Level Silver Plan",,"0.867900371551514","No","Yes","No","100%",,"$1,670","$80","$0","$1,750","$640","$1,110","$0","$1,750","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%201750.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170009-06","Classic $750","94% AV Level Silver Plan",,"0.932883381843567","No","Yes","No","100%",,"$730","$20","$0","$750","$300","$450","$0","$750","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%20750.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170010","Classic $6,500","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170010-02","Classic $6,500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-6500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170010","Classic $6,500","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170010-03","Classic $6,500","Limited Cost Sharing Plan Variation",,"0.598379969596863","Yes","Yes","No","100%",,"$6,340","$120","$0","$6,460","$950","$1,120","$0","$2,070","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic%206500-hdhp.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170011","Classic $7,150","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170011-00","Classic $7,150","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$950","$0","$0","$950","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400722_Classic_7150_SBC","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170011","Classic $7,150","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170011-01","Classic $7,150","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$950","$0","$0","$950","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%207150.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170011","Classic $7,150","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170011-02","Classic $7,150","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-7150-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170011","Classic $7,150","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170011-03","Classic $7,150","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$950","$0","$0","$950","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic 7150.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160029","Reliance $1,500 - 10%","38166WI016",,"WIN004","WIS004","WIF010","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160029-01","Reliance $1,500 - 10%","Standard Gold On Exchange Plan",,"0.788633286952972","No","Yes","No","100%",,"$1,500","$930","$570","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%201500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180002","Select  $3,750 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180002-03","Select  $3,750 HDHP","Limited Cost Sharing Plan Variation",,"0.710583329200745","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select%203750-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170012","Classic $5,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170012-00","Classic $5,500 - 30%","Standard Silver Off Exchange Plan",,"0.680325448513031","No","Yes","No","100%",,"$5,500","$120","$0","$5,620","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$10000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Classic/400720_Classic_5500-30_SBC","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170012","Classic $5,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170012-01","Classic $5,500 - 30%","Standard Silver On Exchange Plan",,"0.680325448513031","No","Yes","No","100%",,"$5,500","$120","$0","$5,620","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$10000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic/Classic%205500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170012","Classic $5,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170012-02","Classic $5,500 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Classic-5500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170012","Classic $5,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170012-03","Classic $5,500 - 30%","Limited Cost Sharing Plan Variation",,"0.680325448513031","No","Yes","No","100%",,"$5,500","$120","$0","$5,620","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$10000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Classic/Classic%205500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170012","Classic $5,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170012-04","Classic $4,000","73% AV Level Silver Plan",,"0.733668923377991","No","Yes","No","100%",,"$3,920","$80","$0","$4,000","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%204000.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170012","Classic $5,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170012-05","Classic $1,600","87% AV Level Silver Plan",,"0.876681864261627","No","Yes","No","100%",,"$1,520","$80","$0","$1,600","$540","$1,060","$0","$1,600","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%201600.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0170012","Classic $5,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0170012-06","Classic $600","94% AV Level Silver Plan",,"0.943933963775635","No","Yes","No","100%",,"$590","$20","$0","$590","$240","$360","$0","$600","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Classic-CSR/Classic%20600.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180001","Select $1,500 - 20%","38166WI018",,"WIN002","WIS002","WIF012","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848316",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180001-00","Select $1,500 - 20%","Standard Gold Off Exchange Plan",,"0.781687796115875","No","Yes","No","100%",,"$1,500","$1,030","$970","$3,500","$850","$930","$0","$1,780","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Select/400701_Select_1500-20_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160001","Reliance $500 - 10%","38166WI016",,"WIN004","WIS004","WIF007","Existing","EPO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160001-00","Reliance $500 - 10%","Standard Platinum Off Exchange Plan",,"0.905921518802643","No","Yes","No","100%",,"$500","$20","$480","$0","$500","$480","$20","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%20500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180002","Select  $3,750 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180002-00","Select  $3,750 HDHP","Standard Silver Off Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off Exchange Select/400707_Select_3750HDHP_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160002","Reliance $1,000 - 20%","38166WI016",,"WIN004","WIS004","WIF005","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160002-00","Reliance $1,000 - 20%","Standard Gold Off Exchange Plan",,"0.803269565105438","No","Yes","No","100%",,"$1,000","$40","$1,240","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%201000-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180003-06","Select $250 - 10% (A)","94% AV Level Silver Plan","94.18%","0.941839277744293","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%20250-10-a.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180004-00","Select $2,000 - 30%","Standard Silver Off Exchange Plan","71.20%","0.711601495742798","No","Yes","No","100%",,"$2,000","$570","$1,300","$3,870","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off Exchange Select/400705_Select_2000-30_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160027","Reliance $2,000 HDHP","38166WI016",,"WIN004","WIS004","WIF006","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160027-00","Reliance $2,000 HDHP","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%202000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160027","Reliance $2,000 HDHP","38166WI016",,"WIN004","WIS004","WIF006","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160027-01","Reliance $2,000 HDHP","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%202000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180004-01","Select $2,000 - 30%","Standard Silver On Exchange Plan","71.20%","0.711601495742798","No","Yes","No","100%",,"$2,000","$570","$1,300","$3,870","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%202000-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180004-04","Select $2000 - 30% $4,790 MOOP","73% AV Level Silver Plan","73.40%","0.734016895294189","No","Yes","No","100%",,"$2,000","$1,700","$1,090","$4,790","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,790","$4790 per person","$9580 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,790","$4790 per person","$9580 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%202000-30-4790.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160002","Reliance $1,000 - 20%","38166WI016",,"WIN004","WIS004","WIF005","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160002-01","Reliance $1,000 - 20%","Standard Gold On Exchange Plan",,"0.803269565105438","No","Yes","No","100%",,"$1,000","$40","$1,240","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%201000-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180002","Select  $3,750 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180002-01","Select  $3,750 HDHP","Standard Silver On Exchange Plan",,"0.710583329200745","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%203750-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180002","Select  $3,750 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180002-02","Select  $3,750 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-3750-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160029","Reliance $1,500 - 10%","38166WI016",,"WIN004","WIS004","WIF010","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160029-00","Reliance $1,500 - 10%","Standard Gold Off Exchange Plan",,"0.788633286952972","No","Yes","No","100%",,"$1,500","$930","$570","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%201500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180002","Select  $3,750 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180002-04","Select  $3,250","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,250","$0","$0","$3,250","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%203250.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160005","Reliance $2,000 - Copay","38166WI016",,"WIN004","WIS004","WIF007","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160005-00","Reliance $2,000 - Copay","Standard Gold Off Exchange Plan",,"0.817467927932739","No","Yes","No","100%",,"$2,000","$40","$0","$0","$540","$720","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%202000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160005","Reliance $2,000 - Copay","38166WI016",,"WIN004","WIS004","WIF007","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160005-01","Reliance $2,000 - Copay","Standard Gold On Exchange Plan",,"0.817467927932739","No","Yes","No","100%",,"$2,000","$40","$0","$0","$540","$720","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%202000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180002","Select  $3,750 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180002-05","Select $1,250","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,250","$0","$0","$1,250","$1,250","$0","$0","$1,250","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select1250.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180004-02","Select $2,000 - 30%","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-2000-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160028","Reliance $2,650 - Copay HDHP","38166WI016",,"WIN004","WIS004","WIF003","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160028-00","Reliance $2,650 - Copay HDHP","Standard Silver Off Exchange Plan",,"0.689679801464081","Yes","Yes","No","100%",,"$2,650","$40","$0","$0","$2,650","$220","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%202650-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160028","Reliance $2,650 - Copay HDHP","38166WI016",,"WIN004","WIS004","WIF003","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160028-01","Reliance $2,650 - Copay HDHP","Standard Silver On Exchange Plan",,"0.689679801464081","Yes","Yes","No","100%",,"$2,650","$40","$0","$0","$2,650","$220","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%202650-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180004-03","Select $2,000 - 30%","Limited Cost Sharing Plan Variation","71.20%","0.711601495742798","No","Yes","No","100%",,"$2,000","$570","$1,300","$3,870","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select 2000-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180002","Select  $3,750 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180002-06","Select $450","94% AV Level Silver Plan",,"0.948019683361053","Yes","Yes","No","100%",,"$450","$0","$0","$450","$450","$0","$0","$450","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%20450.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160011","Reliance $2,500 - 20%","38166WI016",,"WIN004","WIS004","WIF010","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160011-00","Reliance $2,500 - 20%","Standard Silver Off Exchange Plan",,"0.696598410606384","No","Yes","No","100%",,"$2,500","$120","$940","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%202500-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160011","Reliance $2,500 - 20%","38166WI016",,"WIN004","WIS004","WIF010","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160011-01","Reliance $2,500 - 20%","Standard Silver On Exchange Plan",,"0.696598410606384","No","Yes","No","100%",,"$2,500","$120","$940","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%202500-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180003-00","Select $2,500 - 20%","Standard Silver Off Exchange Plan","69.70%","0.699726700782776","No","Yes","No","100%",,"$2,500","$270","$0","$3,540","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off Exchange Select/400704_Select_2500-20_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180003-01","Select $2,500 - 20%","Standard Silver On Exchange Plan","69.70%","0.699726700782776","No","Yes","No","100%",,"$2,500","$270","$0","$3,540","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%202500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160030","Reliance $3,000 - Copay","38166WI016",,"WIN004","WIS004","WIF010","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160030-00","Reliance $3,000 - Copay","Standard Gold Off Exchange Plan",,"0.802570819854736","No","Yes","No","100%",,"$2,920","$80","$0","$0","$540","$1,270","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%203000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160030","Reliance $3,000 - Copay","38166WI016",,"WIN004","WIS004","WIF010","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160030-01","Reliance $3,000 - Copay","Standard Gold On Exchange Plan",,"0.802570819854736","No","Yes","No","100%",,"$2,920","$80","$0","$0","$540","$1,270","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%203000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180003-02","Select $2,500 - 20%","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-2500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180003-03","Select $2,500 - 20%","Limited Cost Sharing Plan Variation","69.70%","0.699726700782776","No","Yes","No","100%",,"$2,500","$270","$0","$3,540","$850","$980","$0","$1,830","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select%202500-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160018","Reliance $4,000","38166WI016",,"WIN004","WIS004","WIF010","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160018-00","Reliance $4,000","Standard Silver Off Exchange Plan",,"0.70470255613327","No","Yes","No","100%",,"$4,000","$120","$0","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%204000.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160018","Reliance $4,000","38166WI016",,"WIN004","WIS004","WIF010","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160018-01","Reliance $4,000","Standard Silver On Exchange Plan",,"0.70470255613327","No","Yes","No","100%",,"$4,000","$120","$0","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%204000.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180003-04","Select $2,000 - 20%","73% AV Level Silver Plan","73.48%","0.734838783740997","No","Yes","No","100%",,"$2,000","$40","$870","$2,910","$850","$850","$0","$1,700","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%202000-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180003-05","Select $750 - 10%","87% AV Level Silver Plan","86.50%","0.864985167980194","No","Yes","No","100%",,"$750","$40","$560","$1,350","$750","$700","$10","$1,460","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%20750-10.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160026","Reliance $1,500 - Copay HDHP","38166WI016",,"WIN004","WIS004","WIF006","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160026-00","Reliance $1,500 - Copay HDHP","Standard Gold Off Exchange Plan",,"0.817554116249084","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$3000 per person","$3000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%201500-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160026","Reliance $1,500 - Copay HDHP","38166WI016",,"WIN004","WIS004","WIF006","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160026-01","Reliance $1,500 - Copay HDHP","Standard Gold On Exchange Plan",,"0.817554116249084","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$3000 per person","$3000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%201500-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160012","Reliance $3,000 HDHP","38166WI016",,"WIN004","WIS004","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160012-00","Reliance $3,000 HDHP","Standard Silver Off Exchange Plan",,"0.704241394996643","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%203000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160012","Reliance $3,000 HDHP","38166WI016",,"WIN004","WIS004","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160012-01","Reliance $3,000 HDHP","Standard Silver On Exchange Plan",,"0.704241394996643","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%203000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180009-01","Select $4,500 - 30%","Standard Silver On Exchange Plan",,"0.699693977832794","No","Yes","No","100%",,"$4,500","$1,900","$0","$6,400","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%204500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150029","Independence $1,500 - 10%","38166WI015",,"WIN005","WIS005","WIF010","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150029-01","Independence $1,500 - 10%","Standard Gold On Exchange Plan",,"0.788633286952972","No","Yes","No","100%",,"$1,500","$930","$570","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","$10,500","$10500 per person","$21000 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$2,250","$2250 per person","$4500 per group","$3,750","$3750 per person","$7500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%201500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150005","Independence $2,000 - Copay","38166WI015",,"WIN005","WIS005","WIF007","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150005-00","Independence $2,000 - Copay","Standard Gold Off Exchange Plan",,"0.817467927932739","No","Yes","No","100%",,"$2,000","$40","$0","$0","$540","$720","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","$10,500","$10500 per person","$21000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%202000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150005","Independence $2,000 - Copay","38166WI015",,"WIN005","WIS005","WIF007","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150005-01","Independence $2,000 - Copay","Standard Gold On Exchange Plan",,"0.817467927932739","No","Yes","No","100%",,"$2,000","$40","$0","$0","$540","$720","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","$10,500","$10500 per person","$21000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%202000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150011","Independence $2,500 - 20%","38166WI015",,"WIN005","WIS005","WIF010","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150011-00","Independence $2,500 - 20%","Standard Silver Off Exchange Plan",,"0.696598410606384","No","Yes","No","100%",,"$2,500","$120","$940","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","$23,975","$23975 per person","$47950 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$3,750","$3750 per person","$7500 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%202500-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150011","Independence $2,500 - 20%","38166WI015",,"WIN005","WIS005","WIF010","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150011-01","Independence $2,500 - 20%","Standard Silver On Exchange Plan",,"0.696598410606384","No","Yes","No","100%",,"$2,500","$120","$940","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","$23,975","$23975 per person","$47950 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$3,750","$3750 per person","$7500 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%202500-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180009-02","Select $4,500 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-4500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180009-03","Select $4,500 - 30%","Limited Cost Sharing Plan Variation",,"0.699693977832794","No","Yes","No","100%",,"$4,500","$1,900","$0","$6,400","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select 4500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180009-04","Select $3,500","73% AV Level Silver Plan",,"0.733509361743927","No","Yes","No","100%",,"$3,500","$2,200","$0","$5,700","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%203500.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180009-05","Select $1,750","87% AV Level Silver Plan",,"0.867900371551514","No","Yes","No","100%",,"$1,670","$80","$0","$1,750","$640","$1,110","$0","$1,750","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%201750.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180004-05","Select $250 - 20%","87% AV Level Silver Plan","87.95%","0.879467844963074","No","Yes","No","100%",,"$250","$40","$1,220","$1,510","$250","$700","$120","$1,070","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%20250-20.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180004-06","Select $250 - 10% (B)","94% AV Level Silver Plan","94.18%","0.941839277744293","No","Yes","No","100%",,"$250","$20","$230","$500","$250","$230","$20","$500","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%20250-10-b.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160021","Reliance $3,000 - Copay HDHP","38166WI016",,"WIN004","WIS004","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160021-00","Reliance $3,000 - Copay HDHP","Standard Silver Off Exchange Plan",,"0.687713086605072","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%203000-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160021","Reliance $3,000 - Copay HDHP","38166WI016",,"WIN004","WIS004","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160021-01","Reliance $3,000 - Copay HDHP","Standard Silver On Exchange Plan",,"0.687713086605072","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%203000-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180006-00","Select $6,000 HDHP","Standard Bronze Off Exchange Plan",,"0.611644566059113","Yes","Yes","No","100%",,"$6,000","$40","$0","$6,040","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off Exchange Select/400712_Select_6000HDHP_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180006-01","Select $6,000 HDHP","Standard Bronze On Exchange Plan",,"0.611644566059113","Yes","Yes","No","100%",,"$6,000","$40","$0","$6,040","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%206000-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160022","Reliance $3,500 HDHP","38166WI016",,"WIN004","WIS004","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160022-00","Reliance $3,500 HDHP","Standard Silver Off Exchange Plan",,"0.682242512702942","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%203500-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160022","Reliance $3,500 HDHP","38166WI016",,"WIN004","WIS004","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160022-01","Reliance $3,500 HDHP","Standard Silver On Exchange Plan",,"0.682242512702942","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%203500-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180006-02","Select $6,000 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-6000-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180006-03","Select $6,000 HDHP","Limited Cost Sharing Plan Variation",,"0.611644566059113","Yes","Yes","No","100%",,"$6,000","$40","$0","$6,040","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select 6000-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160023","Reliance $4,000 HDHP","38166WI016",,"WIN004","WIS004","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160023-00","Reliance $4,000 HDHP","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%204000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160023","Reliance $4,000 HDHP","38166WI016",,"WIN004","WIS004","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160023-01","Reliance $4,000 HDHP","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%204000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180007-00","Select $5,500 HDHP","Standard Bronze Off Exchange Plan",,"0.617677092552185","Yes","Yes","No","100%",,"$5,500","$40","$0","$5,540","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off Exchange Select/400711_Select_5500HDHP_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180007-01","Select $5,500 HDHP","Standard Bronze On Exchange Plan",,"0.617677092552185","Yes","Yes","No","100%",,"$5,500","$40","$0","$5,540","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%205500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160013","Reliance $6,000 - 20% HDHP","38166WI016",,"WIN004","WIS004","WIF011","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160013-00","Reliance $6,000 - 20% HDHP","Standard Bronze Off Exchange Plan",,"0.618660032749176","Yes","Yes","No","100%",,"$6,000","$40","$260","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%206000-20-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0160013","Reliance $6,000 - 20% HDHP","38166WI016",,"WIN004","WIS004","WIF011","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995361426258481",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0160013-01","Reliance $6,000 - 20% HDHP","Standard Bronze On Exchange Plan",,"0.618660032749176","Yes","Yes","No","100%",,"$6,000","$40","$260","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/reliance/reliance%206000-20-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180007-02","Select $5,500 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-5500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180007-03","Select $5,500 HDHP","Limited Cost Sharing Plan Variation",,"0.617677092552185","Yes","Yes","No","100%",,"$5,500","$40","$0","$5,540","$3,100","$0","$0","$3,100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select 5500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180008","Select Protection","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180008-00","Select Protection","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$650","$0","$0","$650","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off Exchange Select/400715_SelectProtection_7150_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180008","Select Protection","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180008-01","Select Protection","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$650","$0","$0","$650","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%20Protection.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180009-00","Select $4,500 - 30%","Standard Silver Off Exchange Plan",,"0.699693977832794","No","Yes","No","100%",,"$4,500","$1,900","$0","$6,400","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off Exchange Select/400717_Select_4500-30_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180009-06","Select $750","94% AV Level Silver Plan",,"0.932883381843567","No","Yes","No","100%",,"$730","$20","$0","$730","$300","$450","$0","$750","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%20750.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150029","Independence $1,500 - 10%","38166WI015",,"WIN005","WIS005","WIF010","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150029-00","Independence $1,500 - 10%","Standard Gold Off Exchange Plan",,"0.788633286952972","No","Yes","No","100%",,"$1,500","$930","$570","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","$10,500","$10500 per person","$21000 per group","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$2,250","$2250 per person","$4500 per group","$3,750","$3750 per person","$7500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%201500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-04","Dean Silver Copay Plus 2750X","73% AV Level Silver Plan",,"0.738201200962067","Yes","Yes","No","100%",,"$2,500","$20","$1,400","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2750X04_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180010","Select $6,500","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180010-00","Select $6,500","Standard Bronze Off Exchange Plan",,"0.598379969596863","Yes","Yes","No","100%",,"$6,340","$120","$0","$6,460","$950","$1,120","$0","$2,070","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/86788B1C79894809B2EF1E64E7747B56.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180010","Select $6,500","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180010-01","Select $6,500","Standard Bronze On Exchange Plan",,"0.598379969596863","Yes","Yes","No","100%",,"$6,340","$120","$0","$6,460","$950","$1,120","$0","$2,070","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%206500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180010","Select $6,500","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180010-02","Select $6,500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-6500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180010","Select $6,500","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180010-03","Select $6,500","Limited Cost Sharing Plan Variation",,"0.598379969596863","Yes","Yes","No","100%",,"$6,340","$120","$0","$6,460","$950","$1,120","$0","$2,070","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select 6500-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150012","Independence $3,000 HDHP","38166WI015",,"WIN005","WIS005","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150012-01","Independence $3,000 HDHP","Standard Silver On Exchange Plan",,"0.704241394996643","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%203000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150021","Independence $3,000 - Copay HDHP","38166WI015",,"WIN005","WIS005","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150021-00","Independence $3,000 - Copay HDHP","Standard Silver Off Exchange Plan",,"0.687713086605072","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$11,250","$11250 per person","$22500 per group","$15,750","$15750 per person","$31500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%203000-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150021","Independence $3,000 - Copay HDHP","38166WI015",,"WIN005","WIS005","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150021-01","Independence $3,000 - Copay HDHP","Standard Silver On Exchange Plan",,"0.687713086605072","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$11,250","$11250 per person","$22500 per group","$15,750","$15750 per person","$31500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%203000-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180011","Select $7,150","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180011-00","Select $7,150","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$950","$0","$0","$950","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off%20Exchange%20Select/400723_Select_7150_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180011","Select $7,150","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180011-01","Select $7,150","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$950","$0","$0","$950","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%207150.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180011","Select $7,150","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180011-02","Select $7,150","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-7150-HDHP.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180011","Select $7,150","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180011-03","Select $7,150","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,340","$0","$0","$6,340","$950","$0","$0","$950","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select 7150.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180012","Select $5,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180012-00","Select $5,500 - 30%","Standard Silver Off Exchange Plan",,"0.680325448513031","No","Yes","No","100%",,"$5,500","$120","$0","$5,620","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$10000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Off Exchange Select/400721_Select_5500-30_SBC.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180012","Select $5,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180012-01","Select $5,500 - 30%","Standard Silver On Exchange Plan",,"0.680325448513031","No","Yes","No","100%",,"$5,500","$120","$0","$5,620","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$10000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select/Select%205500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180012","Select $5,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180012-02","Select $5,500 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Individual/Zero/NA-Select-5500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180012","Select $5,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180012-03","Select $5,500 - 30%","Limited Cost Sharing Plan Variation",,"0.680325448513031","No","Yes","No","100%",,"$5,500","$120","$0","$5,620","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$10000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Limited-Select/Select 5500-30.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180012","Select $5,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180012-04","Select $4,000","73% AV Level Silver Plan",,"0.733668923377991","No","Yes","No","100%",,"$3,920","$80","$0","$3,290","$640","$1,350","$0","$1,990","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%204000.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180012","Select $5,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180012-05","Select $1,600","87% AV Level Silver Plan",,"0.876681864261627","No","Yes","No","100%",,"$1,520","$80","$0","$1,600","$540","$1,060","$0","$1,600","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%201600.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","Individual","No","39-1572880","38166WI0180012","Select $5,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.996484645848315",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/qhpformulary","38166WI0180012-06","Select $600","94% AV Level Silver Plan",,"0.943933963775635","No","Yes","No","100%",,"$590","$20","$0","$610","$240","$360","$0","$600","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/SBC1/Select-CSR/Select%20600.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2017-individual-and-family-plans"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150001","Independence $500 - 10%","38166WI015",,"WIN005","WIS005","WIF007","Existing","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150001-00","Independence $500 - 10%","Standard Platinum Off Exchange Plan",,"0.905921518802643","No","Yes","No","100%",,"$500","$20","$480","$0","$500","$480","$20","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,500","$2500 per person","$5000 per group","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"$750","$750 per person","$1500 per group","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%20500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150001","Independence $500 - 10%","38166WI015",,"WIN005","WIS005","WIF007","Existing","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150001-01","Independence $500 - 10%","Standard Platinum On Exchange Plan",,"0.905921518802643","No","Yes","No","100%",,"$500","$20","$480","$0","$500","$480","$20","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,500","$2500 per person","$5000 per group","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"$750","$750 per person","$1500 per group","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%20500-10.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150014","Independence $750","38166WI015",,"WIN005","WIS005","WIF007","Existing","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150014-00","Independence $750","Standard Platinum Off Exchange Plan",,"0.917586207389832","No","Yes","No","100%",,"$750","$40","$0","$0","$750","$570","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","$750","$750 per person","$1500 per group","0.00%",,,,,"$1,125","$1125 per person","$2250 per group","$1,875","$1875 per person","$3750 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%20750.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150014","Independence $750","38166WI015",,"WIN005","WIS005","WIF007","Existing","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150014-01","Independence $750","Standard Platinum On Exchange Plan",,"0.917586207389832","No","Yes","No","100%",,"$750","$40","$0","$0","$750","$570","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","$750","$750 per person","$1500 per group","0.00%",,,,,"$1,125","$1125 per person","$2250 per group","$1,875","$1875 per person","$3750 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%20750.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150002","Independence $1,000 - 20%","38166WI015",,"WIN005","WIS005","WIF005","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150002-00","Independence $1,000 - 20%","Standard Gold Off Exchange Plan",,"0.803269565105438","No","Yes","No","100%",,"$1,000","$40","$1,240","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","$17,500","$17500 per person","$35000 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%201000-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150002","Independence $1,000 - 20%","38166WI015",,"WIN005","WIS005","WIF005","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150002-01","Independence $1,000 - 20%","Standard Gold On Exchange Plan",,"0.803269565105438","No","Yes","No","100%",,"$1,000","$40","$1,240","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","$17,500","$17500 per person","$35000 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%201000-20.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150030","Independence $3,000 - Copay","38166WI015",,"WIN005","WIS005","WIF010","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150030-00","Independence $3,000 - Copay","Standard Gold Off Exchange Plan",,"0.802570819854736","No","Yes","No","100%",,"$2,920","$80","$0","$0","$540","$1,270","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","$10,500","$10500 per person","$21000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%203000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150030","Independence $3,000 - Copay","38166WI015",,"WIN005","WIS005","WIF010","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150030-01","Independence $3,000 - Copay","Standard Gold On Exchange Plan",,"0.802570819854736","No","Yes","No","100%",,"$2,920","$80","$0","$0","$540","$1,270","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","$10,500","$10500 per person","$21000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%203000-copay.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150018","Independence $4,000","38166WI015",,"WIN005","WIS005","WIF010","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150018-00","Independence $4,000","Standard Silver Off Exchange Plan",,"0.70470255613327","No","Yes","No","100%",,"$4,000","$120","$0","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$16,500","$16500 per person","$33000 per group","$23,100","$23100 per person","$46200 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%204000.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150018","Independence $4,000","38166WI015",,"WIN005","WIS005","WIF010","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150018-01","Independence $4,000","Standard Silver On Exchange Plan",,"0.70470255613327","No","Yes","No","100%",,"$4,000","$120","$0","$0","$850","$1,120","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$16,500","$16500 per person","$33000 per group","$23,100","$23100 per person","$46200 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%204000.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150026","Independence $1,500 - Copay HDHP","38166WI015",,"WIN005","WIS005","WIF006","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150026-00","Independence $1,500 - Copay HDHP","Standard Gold Off Exchange Plan",,"0.817554116249084","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$6,250","$12500 per person","$12500 per group","$8,750","$17500 per person","$17500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"$2,250","$4500 per person","$4500 per group","$3,750","$3750 per person","$7500 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%201500-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150026","Independence $1,500 - Copay HDHP","38166WI015",,"WIN005","WIS005","WIF006","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150026-01","Independence $1,500 - Copay HDHP","Standard Gold On Exchange Plan",,"0.817554116249084","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$6,250","$12500 per person","$12500 per group","$8,750","$17500 per person","$17500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"$2,250","$4500 per person","$4500 per group","$3,750","$3750 per person","$7500 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%201500-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150027","Independence $2,000 HDHP","38166WI015",,"WIN005","WIS005","WIF006","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150027-00","Independence $2,000 HDHP","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$5,000","$10000 per person","$10000 per group","$7,000","$14000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$3,000","$6000 per person","$6000 per group","$5,000","$10000 per person","$10000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%202000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150027","Independence $2,000 HDHP","38166WI015",,"WIN005","WIS005","WIF006","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150027-01","Independence $2,000 HDHP","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$5,000","$10000 per person","$10000 per group","$7,000","$14000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$3,000","$6000 per person","$6000 per group","$5,000","$10000 per person","$10000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%202000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150028","Independence $2,650 - Copay HDHP","38166WI015",,"WIN005","WIS005","WIF003","New","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150028-00","Independence $2,650 - Copay HDHP","Standard Silver Off Exchange Plan",,"0.689679801464081","Yes","Yes","No","100%",,"$2,650","$40","$0","$0","$2,650","$220","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","33.00%",,,,,"$3,975","$3975 per person","$7950 per group","$6,625","$6625 per person","$13250 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%202650-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150028","Independence $2,650 - Copay HDHP","38166WI015",,"WIN005","WIS005","WIF003","New","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150028-01","Independence $2,650 - Copay HDHP","Standard Silver On Exchange Plan",,"0.689679801464081","Yes","Yes","No","100%",,"$2,650","$40","$0","$0","$2,650","$220","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","33.00%",,,,,"$3,975","$3975 per person","$7950 per group","$6,625","$6625 per person","$13250 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%202650-copay-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150012","Independence $3,000 HDHP","38166WI015",,"WIN005","WIS005","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150012-00","Independence $3,000 HDHP","Standard Silver Off Exchange Plan",,"0.704241394996643","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","33.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%203000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150022","Independence $3,500 HDHP","38166WI015",,"WIN005","WIS005","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150022-00","Independence $3,500 HDHP","Standard Silver Off Exchange Plan",,"0.682242512702942","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$11,250","$11250 per person","$22500 per group","$15,750","$15750 per person","$31500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","33.00%",,,,,"$5,250","$5250 per person","$10500 per group","$8,750","$8750 per person","$17500 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%203500-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150022","Independence $3,500 HDHP","38166WI015",,"WIN005","WIS005","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150022-01","Independence $3,500 HDHP","Standard Silver On Exchange Plan",,"0.682242512702942","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$11,250","$11250 per person","$22500 per group","$15,750","$15750 per person","$31500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","33.00%",,,,,"$5,250","$5250 per person","$10500 per group","$8,750","$8750 per person","$17500 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%203500-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150023","Independence $4,000 HDHP","38166WI015",,"WIN005","WIS005","WIF006","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150023-00","Independence $4,000 HDHP","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%204000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150023","Independence $4,000 HDHP","38166WI015",,"WIN005","WIS005","WIF006","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150023-01","Independence $4,000 HDHP","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%204000-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150013","Independence $6,000 - 20% HDHP","38166WI015",,"WIN005","WIS005","WIF011","Existing","POS","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150013-00","Independence $6,000 - 20% HDHP","Standard Bronze Off Exchange Plan",,"0.618660032749176","Yes","Yes","No","100%",,"$6,000","$40","$260","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%206000-20-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 3750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-05","Dean Silver Classic 3750X","87% AV Level Silver Plan",,"0.860291004180908","Yes","Yes","No","100%",,"$900","$20","$300","$200","$900","$700","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic3750X05_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-02","Dean Silver Value Copay 5000X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-03","Dean Silver Value Copay 5000X","Limited Cost Sharing Plan Variation",,"0.683491885662079","Yes","Yes","No","100%",,"$5,000","$20","$500","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38166","HIOS","2017-04-26 02:48:20","SHOP (Small Group)","No","39-1572880","38166WI0150013","Independence $6,000 - 20% HDHP","38166WI015",,"WIN005","WIS005","WIF011","Existing","POS","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99536142625848",,,"2017-01-01","2017-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/qhpformulary","38166WI0150013-01","Independence $6,000 - 20% HDHP","Standard Bronze On Exchange Plan",,"0.618660032749176","Yes","Yes","No","100%",,"$6,000","$40","$260","$0","$3,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/SBC1/small%20group/Independence/Independence%206000-20-hdhp.ashx","https://www.securityhealth.org/employer-coverage/2017-shop"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010124-00","Dean Gold Copay Plus 1500X","Standard Gold Off Exchange Plan",,"0.815392851829529","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1500X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010124-01","Dean Gold Copay Plus 1500X","Standard Gold On Exchange Plan",,"0.815392851829529","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1500X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010124-02","Dean Gold Copay Plus 1500X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1500X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010124-03","Dean Gold Copay Plus 1500X","Limited Cost Sharing Plan Variation",,"0.815392851829529","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1500X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-00","Dean Silver Copay Plus 2750X","Standard Silver Off Exchange Plan",,"0.714038908481598","Yes","Yes","No","100%",,"$2,800","$20","$1,400","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2750X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-01","Dean Silver Copay Plus 2750X","Standard Silver On Exchange Plan",,"0.714038908481598","Yes","Yes","No","100%",,"$2,800","$20","$1,400","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2750X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-02","Dean Silver Copay Plus 2750X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2750X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-03","Dean Silver Copay Plus 2750X","Limited Cost Sharing Plan Variation",,"0.714038908481598","Yes","Yes","No","100%",,"$2,800","$20","$1,400","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2750X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-05","Dean Silver Copay Plus 2750X","87% AV Level Silver Plan",,"0.878519415855408","Yes","Yes","No","100%",,"$400","$20","$700","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2750X05_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-06","Dean Silver Copay Plus 2750X","94% AV Level Silver Plan",,"0.947931349277496","Yes","Yes","No","100%",,"$100","$20","$400","$200","$100","$600","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2750X06_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-00","Dean Silver Copay Plus 3500X","Standard Silver Off Exchange Plan",,"0.714859366416931","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-01","Dean Silver Copay Plus 3500X","Standard Silver On Exchange Plan",,"0.714859366416931","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-02","Dean Silver Copay Plus 3500X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-03","Dean Silver Copay Plus 3500X","Limited Cost Sharing Plan Variation",,"0.714859366416931","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-04","Dean Silver Copay Plus 3500X","73% AV Level Silver Plan",,"0.739775776863098","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X04_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-05","Dean Silver Copay Plus 3500X","87% AV Level Silver Plan",,"0.878519415855408","Yes","Yes","No","100%",,"$400","$20","$700","$200","$300","$900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X05_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-06","Dean Silver Copay Plus 3500X","94% AV Level Silver Plan",,"0.947931349277496","Yes","Yes","No","100%",,"$100","$20","$400","$200","$100","$600","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X06_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-00","Dean Silver Classic 2500X","Standard Silver Off Exchange Plan",,"0.70637047290802","Yes","Yes","No","100%",,"$2,500","$20","$1,000","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-01","Dean Silver Classic 2500X","Standard Silver On Exchange Plan",,"0.70637047290802","Yes","Yes","No","100%",,"$2,500","$20","$1,000","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-02","Dean Silver Classic 2500X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-03","Dean Silver Classic 2500X","Limited Cost Sharing Plan Variation",,"0.70637047290802","Yes","Yes","No","100%",,"$2,500","$20","$1,000","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-04","Dean Silver Classic 2500X","73% AV Level Silver Plan",,"0.737612307071686","Yes","Yes","No","100%",,"$2,000","$20","$1,100","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X04_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-05","Dean Silver Classic 2500X","87% AV Level Silver Plan",,"0.87822037935257","Yes","Yes","No","100%",,"$500","$20","$700","$200","$500","$700","$50","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X05_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-06","Dean Silver Classic 2500X","94% AV Level Silver Plan",,"0.949195206165314","Yes","Yes","No","100%",,"$100","$20","$400","$200","$100","$600","$40","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X06_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 3750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-00","Dean Silver Classic 3750X","Standard Silver Off Exchange Plan",,"0.681862831115723","Yes","Yes","No","100%",,"$3,800","$20","$700","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic3750X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 3750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-01","Dean Silver Classic 3750X","Standard Silver On Exchange Plan",,"0.681862831115723","Yes","Yes","No","100%",,"$3,800","$20","$700","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic3750X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 3750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-02","Dean Silver Classic 3750X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic3750X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 3750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-03","Dean Silver Classic 3750X","Limited Cost Sharing Plan Variation",,"0.681862831115723","Yes","Yes","No","100%",,"$3,800","$20","$700","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic3750X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 3750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-04","Dean Silver Classic 3750X","73% AV Level Silver Plan",,"0.720591425895691","Yes","Yes","No","100%",,"$3,500","$20","$400","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic3750X04_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 3750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-06","Dean Silver Classic 3750X","94% AV Level Silver Plan",,"0.930102825164795","Yes","Yes","No","100%",,"$300","$20","$400","$200","$300","$700","$40","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic3750X06_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 2650X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010108-00","Dean Gold Value Copay 2650X","Standard Gold Off Exchange Plan",,"0.817773282527924","Yes","Yes","No","100%",,"$2,700","$0","$0","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay2650X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 2650X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010108-01","Dean Gold Value Copay 2650X","Standard Gold On Exchange Plan",,"0.817773282527924","Yes","Yes","No","100%",,"$2,700","$0","$0","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay2650X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 2650X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010108-02","Dean Gold Value Copay 2650X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay2650X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 2650X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010108-03","Dean Gold Value Copay 2650X","Limited Cost Sharing Plan Variation",,"0.817773282527924","Yes","Yes","No","100%",,"$2,700","$0","$0","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay2650X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-00","Dean Silver Value Copay 5000X","Standard Silver Off Exchange Plan",,"0.683491885662079","Yes","Yes","No","100%",,"$5,000","$20","$500","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-01","Dean Silver Value Copay 5000X","Standard Silver On Exchange Plan",,"0.683491885662079","Yes","Yes","No","100%",,"$5,000","$20","$500","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-04","Dean Silver Value Copay 5000X","73% AV Level Silver Plan",,"0.720568358898163","Yes","Yes","No","100%",,"$3,300","$20","$800","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X04_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-05","Dean Silver Value Copay 5000X","87% AV Level Silver Plan",,"0.860764920711517","Yes","Yes","No","100%",,"$900","$20","$300","$200","$900","$700","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X05_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-06","Dean Silver Value Copay 5000X","94% AV Level Silver Plan",,"0.930989801883698","Yes","Yes","No","100%",,"$100","$20","$400","$200","$100","$700","$40","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X06_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 7150X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010119-00","Dean Bronze Value Copay 7150X","Standard Bronze Off Exchange Plan",,"0.615630924701691","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay7150X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 7150X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010119-01","Dean Bronze Value Copay 7150X","Standard Bronze On Exchange Plan",,"0.615630924701691","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay7150X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 7150X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010119-02","Dean Bronze Value Copay 7150X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay7150X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 7150X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010119-03","Dean Bronze Value Copay 7150X","Limited Cost Sharing Plan Variation",,"0.615630924701691","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay7150X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3000X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-00","Dean Silver HSA-E 3000X","Standard Silver Off Exchange Plan",,"0.689543306827545","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3000X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3000X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-01","Dean Silver HSA-E 3000X","Standard Silver On Exchange Plan",,"0.689543306827545","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3000X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3000X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-02","Dean Silver HSA-E 3000X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3000X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3000X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-03","Dean Silver HSA-E 3000X","Limited Cost Sharing Plan Variation",,"0.689543306827545","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3000X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3000X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-04","Dean Silver HSA-E 3000X","73% AV Level Silver Plan",,"0.727415502071381","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3000X04_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3000X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-05","Dean Silver HSA-E 3000X","87% AV Level Silver Plan",,"0.863061726093292","Yes","Yes","No","100%",,"$1,000","$0","$300","$200","$1,000","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3000X05_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3000X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-06","Dean Silver HSA-E 3000X","94% AV Level Silver Plan",,"0.932823061943054","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3000X06_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010126","Dean Bronze HSA-E 6550X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010126-00","Dean Bronze HSA-E 6550X","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6550X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060002","Platinum 1000","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060002-00","Platinum 1000","Standard Platinum Off Exchange Plan",,"0.911424279212952","No","Yes","No","100%",,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/platinum1000","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050005","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050005-02","Gold 2000/80  w/copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold2000-80-copay-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010126","Dean Bronze HSA-E 6550X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010126-01","Dean Bronze HSA-E 6550X","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6550X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010126","Dean Bronze HSA-E 6550X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010126-02","Dean Bronze HSA-E 6550X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6550X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010126","Dean Bronze HSA-E 6550X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010126-03","Dean Bronze HSA-E 6550X","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6550X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010063","Dean Catastrophic Safety Net","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010063-00","Dean Catastrophic Safety Net","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_CatastrophicSafetyNet00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0010063","Dean Catastrophic Safety Net","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010063-01","Dean Catastrophic Safety Net","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_CatastrophicSafetyNet01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-00","Dean Focus Network Silver Value Copay 5000X","Standard Silver Off Exchange Plan",,"0.683491885662079","Yes","Yes","No","100%",,"$5,000","$20","$500","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-01","Dean Focus Network Silver Value Copay 5000X","Standard Silver On Exchange Plan",,"0.683491885662079","Yes","Yes","No","100%",,"$5,000","$20","$500","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 7150X","38345WI008",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080029-02","Dean Focus Network Bronze Value Copay 7150X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay7150X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 7150X","38345WI008",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080029-03","Dean Focus Network Bronze Value Copay 7150X","Limited Cost Sharing Plan Variation",,"0.615630924701691","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay7150X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-02","Dean Focus Network Silver Value Copay 5000X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-03","Dean Focus Network Silver Value Copay 5000X","Limited Cost Sharing Plan Variation",,"0.683491885662079","Yes","Yes","No","100%",,"$5,000","$20","$500","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-04","Dean Focus Network Silver Value Copay 5000X","73% AV Level Silver Plan",,"0.720568358898163","Yes","Yes","No","100%",,"$3,300","$20","$800","$200","$1,000","$700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X04_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-05","Dean Focus Network Silver Value Copay 5000X","87% AV Level Silver Plan",,"0.860764920711517","Yes","Yes","No","100%",,"$900","$20","$300","$200","$900","$700","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X05_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-06","Dean Focus Network Silver Value Copay 5000X","94% AV Level Silver Plan",,"0.930989801883698","Yes","Yes","No","100%",,"$100","$20","$400","$200","$100","$700","$40","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X06_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 7150X","38345WI008",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080029-00","Dean Focus Network Bronze Value Copay 7150X","Standard Bronze Off Exchange Plan",,"0.615630924701691","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay7150X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 7150X","38345WI008",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080029-01","Dean Focus Network Bronze Value Copay 7150X","Standard Bronze On Exchange Plan",,"0.615630924701691","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay7150X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3000X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-00","Dean Focus Network Silver HSA-E 3000X","Standard Silver Off Exchange Plan",,"0.689543306827545","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3000X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3000X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-01","Dean Focus Network Silver HSA-E 3000X","Standard Silver On Exchange Plan",,"0.689543306827545","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3000X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3000X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-02","Dean Focus Network Silver HSA-E 3000X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3000X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3000X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-03","Dean Focus Network Silver HSA-E 3000X","Limited Cost Sharing Plan Variation",,"0.689543306827545","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3000X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3000X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-04","Dean Focus Network Silver HSA-E 3000X","73% AV Level Silver Plan",,"0.727415502071381","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3000X04_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3000X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-05","Dean Focus Network Silver HSA-E 3000X","87% AV Level Silver Plan",,"0.863061726093292","Yes","Yes","No","100%",,"$1,000","$0","$300","$200","$1,000","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3000X05_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3000X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-06","Dean Focus Network Silver HSA-E 3000X","94% AV Level Silver Plan",,"0.932823061943054","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3000X06_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080033","Dean Focus Network Bronze HSA-E 6550X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080033-00","Dean Focus Network Bronze HSA-E 6550X","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6550X00_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080033","Dean Focus Network Bronze HSA-E 6550X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080033-01","Dean Focus Network Bronze HSA-E 6550X","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6550X01_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080033","Dean Focus Network Bronze HSA-E 6550X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080033-02","Dean Focus Network Bronze HSA-E 6550X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6550X02_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","38345","HIOS","2016-08-20 07:40:33","Individual","No","39-1535024","38345WI0080033","Dean Focus Network Bronze HSA-E 6550X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080033-03","Dean Focus Network Bronze HSA-E 6550X","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,600","$0","$0","$200","$5,100","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6550X03_0117.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060001","Platinum 1000","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060001-00","Platinum 1000","Standard Platinum Off Exchange Plan",,"0.911424279212952","No","Yes","No","100%",,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/platinum1000","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050005","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050005-00","Gold 2000/80  w/copay","Standard Gold Off Exchange Plan",,"0.781350076198578","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold2000-80-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050005","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050005-01","Gold 2000/80  w/copay","Standard Gold On Exchange Plan",,"0.781350076198578","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold2000-80-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060001","Platinum 1000","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060001-01","Platinum 1000","Standard Platinum On Exchange Plan",,"0.911424279212952","No","Yes","No","100%",,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/platinum1000","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050005","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050005-03","Gold 2000/80  w/copay","Limited Cost Sharing Plan Variation",,"0.781350076198578","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold2000-80-copay-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060002","Platinum 1000","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060002-01","Platinum 1000","Standard Platinum On Exchange Plan",,"0.911424279212952","No","Yes","No","100%",,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/platinum1000","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060003","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060003-00","Gold 1000/80 w/copay","Standard Gold Off Exchange Plan",,"0.797369837760925","No","Yes","No","100%",,"$1,900","$100","$1,080","$0","$1,000","$720","$140","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold1000-80-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050006","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050006-00","Gold 2000/80  w/copay","Standard Gold Off Exchange Plan",,"0.781350076198578","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold2000-80-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050006","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050006-01","Gold 2000/80  w/copay","Standard Gold On Exchange Plan",,"0.781350076198578","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold2000-80-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060003","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060003-01","Gold 1000/80 w/copay","Standard Gold On Exchange Plan",,"0.797369837760925","No","Yes","No","100%",,"$1,900","$100","$1,080","$0","$1,000","$720","$140","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold1000-80-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060004","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060004-00","Gold 1000/80 w/copay","Standard Gold Off Exchange Plan",,"0.797369837760925","No","Yes","No","100%",,"$1,900","$100","$1,080","$0","$1,000","$720","$140","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold1000-80-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050006","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050006-02","Gold 2000/80  w/copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$2,900","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold2000-80-copay-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050006","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050006-03","Gold 2000/80  w/copay","Limited Cost Sharing Plan Variation",,"0.781350076198578","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold2000-80-copay-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060004","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060004-01","Gold 1000/80 w/copay","Standard Gold On Exchange Plan",,"0.797369837760925","No","Yes","No","100%",,"$1,900","$100","$1,080","$0","$1,000","$720","$140","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold1000-80-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060013","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060013-00","Silver 2500/80 w/copay","Standard Silver Off Exchange Plan",,"0.704473257064819","No","Yes","No","100%",,"$3,400","$100","$1,170","$0","$1,700","$720","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver2500-80-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050034-00","Silver 4000/80 w/copay","Standard Silver Off Exchange Plan",,"0.682496607303619","No","Yes","No","100%",,"$4,900","$140","$480","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050034-01","Silver 4000/80 w/copay","Standard Silver On Exchange Plan",,"0.682496607303619","No","Yes","No","100%",,"$4,900","$140","$480","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060013","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060013-01","Silver 2500/80 w/copay","Standard Silver On Exchange Plan",,"0.704473257064819","No","Yes","No","100%",,"$3,400","$100","$1,170","$0","$1,700","$720","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver2500-80-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060014","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060014-00","Silver 2500/80 w/copay","Standard Silver Off Exchange Plan",,"0.704473257064819","No","Yes","No","100%",,"$3,400","$100","$1,170","$0","$1,700","$720","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver2500-80-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050034-02","Silver 4000/80 w/copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050034-03","Silver 4000/80 w/copay","Limited Cost Sharing Plan Variation",,"0.682496607303619","No","Yes","No","100%",,"$4,900","$140","$480","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060014","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060014-01","Silver 2500/80 w/copay","Standard Silver On Exchange Plan",,"0.704473257064819","No","Yes","No","100%",,"$3,400","$100","$1,170","$0","$1,700","$720","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver2500-80-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060034","Silver 1500/70 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060034-00","Silver 1500/70 w/copay","Standard Silver Off Exchange Plan",,"0.70339697599411","No","Yes","No","100%",,"$2,400","$140","$1,470","$0","$1,500","$860","$60","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver1500-70-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050034-04","Silver 4000/80 w/copay","73% AV Level Silver Plan",,"0.738794088363647","No","Yes","No","100%",,"$4,650","$100","$530","$0","$1,700","$510","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050034-05","Silver 4000/80 w/copay","87% AV Level Silver Plan",,"0.874703288078308","No","Yes","No","100%",,"$2,150","$70","$180","$0","$1,250","$250","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060034","Silver 1500/70 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060034-01","Silver 1500/70 w/copay","Standard Silver On Exchange Plan",,"0.70339697599411","No","Yes","No","100%",,"$2,400","$140","$1,470","$0","$1,500","$860","$60","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver1500-70-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060035","Silver 1500/70 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060035-00","Silver 1500/70 w/copay","Standard Silver Off Exchange Plan",,"0.70339697599411","No","Yes","No","100%",,"$2,400","$140","$1,470","$0","$1,500","$860","$60","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver1500-70-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050034-06","Silver 4000/80 w/copay","94% AV Level Silver Plan",,"0.940641224384308","No","Yes","No","100%",,"$600","$40","$760","$0","$300","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060035","Silver 1500/70 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060035-01","Silver 1500/70 w/copay","Standard Silver On Exchange Plan",,"0.70339697599411","No","Yes","No","100%",,"$2,400","$140","$1,470","$0","$1,500","$860","$60","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver1500-70-copay","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050035-00","Silver 4000/80 w/copay","Standard Silver Off Exchange Plan",,"0.682496607303619","No","Yes","No","100%",,"$4,900","$140","$480","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050035-01","Silver 4000/80 w/copay","Standard Silver On Exchange Plan",,"0.682496607303619","No","Yes","No","100%",,"$4,900","$140","$480","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050035-02","Silver 4000/80 w/copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050035-03","Silver 4000/80 w/copay","Limited Cost Sharing Plan Variation",,"0.682496607303619","No","Yes","No","100%",,"$4,900","$140","$480","$0","$1,700","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050035-04","Silver 4000/80 w/copay","73% AV Level Silver Plan",,"0.738794088363647","No","Yes","No","100%",,"$4,650","$100","$530","$0","$1,700","$510","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050035-05","Silver 4000/80 w/copay","87% AV Level Silver Plan",,"0.874703288078308","No","Yes","No","100%",,"$2,150","$70","$180","$0","$1,250","$250","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050035-06","Silver 4000/80 w/copay","94% AV Level Silver Plan",,"0.940641224384308","No","Yes","No","100%",,"$600","$40","$760","$0","$300","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-80-copay-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050051-00","Silver 3000/70 w/copay","Standard Silver Off Exchange Plan",,"0.709693789482117","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$675","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050051-01","Silver 3000/70 w/copay","Standard Silver On Exchange Plan",,"0.709693789482117","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$675","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050051-02","Silver 3000/70 w/copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050051-03","Silver 3000/70 w/copay","Limited Cost Sharing Plan Variation",,"0.709693789482117","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$675","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050051-04","Silver 3000/70 w/copay","73% AV Level Silver Plan",,"0.736282348632813","No","Yes","No","100%",,"$2,900","$100","$1,320","$0","$1,700","$675","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050051-05","Silver 3000/70 w/copay","87% AV Level Silver Plan",,"0.872788846492767","No","Yes","No","100%",,"$1,600","$80","$1,140","$0","$800","$460","$180","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050051-06","Silver 3000/70 w/copay","94% AV Level Silver Plan",,"0.949498534202576","No","Yes","No","100%",,"$800","$70","$330","$0","$400","$200","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050050-00","Silver 3000/70 w/copay","Standard Silver Off Exchange Plan",,"0.709693789482117","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$675","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050050-01","Silver 3000/70 w/copay","Standard Silver On Exchange Plan",,"0.709693789482117","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$675","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050050-02","Silver 3000/70 w/copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050050-03","Silver 3000/70 w/copay","Limited Cost Sharing Plan Variation",,"0.709693789482117","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$675","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050050-04","Silver 3000/70 w/copay","73% AV Level Silver Plan",,"0.736282348632813","No","Yes","No","100%",,"$2,900","$100","$1,320","$0","$1,700","$675","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050050-05","Silver 3000/70 w/copay","87% AV Level Silver Plan",,"0.872788846492767","No","Yes","No","100%",,"$1,600","$80","$1,140","$0","$800","$460","$180","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050050-06","Silver 3000/70 w/copay","94% AV Level Silver Plan",,"0.949498534202576","No","Yes","No","100%",,"$800","$70","$330","$0","$400","$200","$0","$0","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver3000-70-copay-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050055","Silver 4000","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050055-00","Silver 4000","Standard Silver Off Exchange Plan",,"0.683416604995728","No","Yes","No","100%",,"$4,900","$200","$0","$0","$1,700","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050055","Silver 4000","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050055-01","Silver 4000","Standard Silver On Exchange Plan",,"0.683416604995728","No","Yes","No","100%",,"$4,900","$200","$0","$0","$1,700","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050055","Silver 4000","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050055-02","Silver 4000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050055","Silver 4000","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050055-03","Silver 4000","Limited Cost Sharing Plan Variation",,"0.683416604995728","No","Yes","No","100%",,"$4,900","$200","$0","$0","$1,700","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050055","Silver 4000","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050055-04","Silver 4000","73% AV Level Silver Plan",,"0.727086544036865","No","Yes","No","100%",,"$4,400","$200","$0","$0","$1,700","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050055","Silver 4000","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050055-05","Silver 4000","87% AV Level Silver Plan",,"0.86046975851059","No","Yes","No","100%",,"$2,150","$105","$0","$0","$1,250","$450","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050055","Silver 4000","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050055-06","Silver 4000","94% AV Level Silver Plan",,"0.945224583148956","No","Yes","No","100%",,"$800","$20","$0","$0","$400","$150","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050054","Silver 4000","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050054-00","Silver 4000","Standard Silver Off Exchange Plan",,"0.683416604995728","No","Yes","No","100%",,"$4,900","$200","$0","$0","$1,700","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050054","Silver 4000","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050054-01","Silver 4000","Standard Silver On Exchange Plan",,"0.683416604995728","No","Yes","No","100%",,"$4,900","$200","$0","$0","$1,700","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050054","Silver 4000","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050054-02","Silver 4000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050054","Silver 4000","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050054-03","Silver 4000","Limited Cost Sharing Plan Variation",,"0.683416604995728","No","Yes","No","100%",,"$4,900","$200","$0","$0","$1,700","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050054","Silver 4000","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050054-04","Silver 4000","73% AV Level Silver Plan",,"0.727086544036865","No","Yes","No","100%",,"$4,400","$200","$0","$0","$1,700","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050054","Silver 4000","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050054-05","Silver 4000","87% AV Level Silver Plan",,"0.86046975851059","No","Yes","No","100%",,"$2,150","$105","$0","$0","$1,250","$450","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050054","Silver 4000","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050054-06","Silver 4000","94% AV Level Silver Plan",,"0.945224583148956","No","Yes","No","100%",,"$800","$20","$0","$0","$400","$150","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver4000-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060017","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060017-00","Silver HDHP 90","Standard Silver Off Exchange Plan",,"0.703092992305756","Yes","Yes","No","100%",,"$3,900","$0","$360","$0","$3,000","$0","$230","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/silverhdhp90","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050003-00","Gold 1000/80","Standard Gold Off Exchange Plan",,"0.781746685504913","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$480","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold1000-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050003-01","Gold 1000/80","Standard Gold On Exchange Plan",,"0.781746685504913","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$480","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold1000-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060017","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060017-01","Silver HDHP 90","Standard Silver On Exchange Plan",,"0.703092992305756","Yes","Yes","No","100%",,"$3,900","$0","$360","$0","$3,000","$0","$230","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/silverhdhp90","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060018","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060018-00","Silver HDHP 90","Standard Silver Off Exchange Plan",,"0.703092992305756","Yes","Yes","No","100%",,"$3,900","$0","$360","$0","$3,000","$0","$230","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/silverhdhp90","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050003-02","Gold 1000/80","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold1000-80-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050003-03","Gold 1000/80","Limited Cost Sharing Plan Variation",,"0.781746685504913","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$480","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold1000-80-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060018","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060018-01","Silver HDHP 90","Standard Silver On Exchange Plan",,"0.703092992305756","Yes","Yes","No","100%",,"$3,900","$0","$360","$0","$3,000","$0","$230","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/silverhdhp90","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060047","Silver HDHP 100","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060047-00","Silver HDHP 100","Standard Silver Off Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/silverhdhp100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050004-00","Gold 1000/80","Standard Gold Off Exchange Plan",,"0.781746685504913","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$480","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold1000-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050004-01","Gold 1000/80","Standard Gold On Exchange Plan",,"0.781746685504913","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$480","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold1000-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060047","Silver HDHP 100","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060047-01","Silver HDHP 100","Standard Silver On Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/silverhdhp100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060046","Silver HDHP 100","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060046-00","Silver HDHP 100","Standard Silver Off Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/silverhdhp100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050004-02","Gold 1000/80","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold1000-80-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050004-03","Gold 1000/80","Limited Cost Sharing Plan Variation",,"0.781746685504913","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$480","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/gold1000-80-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060046","Silver HDHP 100","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060046-01","Silver HDHP 100","Standard Silver On Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/silverhdhp100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060049","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060049-00","Bronze HDHP 80","Standard Bronze Off Exchange Plan",,"0.618253171443939","Yes","Yes","No","100%",,"$6,400","$0","$220","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050031","Silver 2500/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050031-00","Silver 2500/80","Standard Silver Off Exchange Plan",,"0.697323977947235","No","Yes","No","100%",,"$3,400","$140","$780","$0","$2,400","$480","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050031","Silver 2500/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050031-01","Silver 2500/80","Standard Silver On Exchange Plan",,"0.697323977947235","No","Yes","No","100%",,"$3,400","$140","$780","$0","$2,400","$480","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060049","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060049-01","Bronze HDHP 80","Standard Bronze On Exchange Plan",,"0.618253171443939","Yes","Yes","No","100%",,"$6,400","$0","$220","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060048","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060048-00","Bronze HDHP 80","Standard Bronze Off Exchange Plan",,"0.618253171443939","Yes","Yes","No","100%",,"$6,400","$0","$220","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050031","Silver 2500/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050031-02","Silver 2500/80","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050031","Silver 2500/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050031-03","Silver 2500/80","Limited Cost Sharing Plan Variation",,"0.697323977947235","No","Yes","No","100%",,"$3,400","$140","$780","$0","$2,400","$480","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060048","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060048-01","Bronze HDHP 80","Standard Bronze On Exchange Plan",,"0.618253171443939","Yes","Yes","No","100%",,"$6,400","$0","$220","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060011","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060011-00","Bronze HDHP 60","Standard Bronze Off Exchange Plan",,"0.617065250873566","Yes","Yes","No","100%",,"$5,900","$0","$640","$0","$5,000","$0","$120","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp60","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050031","Silver 2500/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050031-04","Silver 2500/80","73% AV Level Silver Plan",,"0.73316365480423","No","Yes","No","100%",,"$2,900","$140","$880","$0","$2,000","$440","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050031","Silver 2500/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050031-05","Silver 2500/80","87% AV Level Silver Plan",,"0.879042506217957","No","Yes","No","100%",,"$1,800","$100","$200","$0","$900","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060011","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060011-01","Bronze HDHP 60","Standard Bronze On Exchange Plan",,"0.617065250873566","Yes","Yes","No","100%",,"$5,900","$0","$640","$0","$5,000","$0","$120","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp60","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060012","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060012-00","Bronze HDHP 60","Standard Bronze Off Exchange Plan",,"0.617065250873566","Yes","Yes","No","100%",,"$5,900","$0","$640","$0","$5,000","$0","$120","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp60","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050031","Silver 2500/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050031-06","Silver 2500/80","94% AV Level Silver Plan",,"0.942219078540802","No","Yes","No","100%",,"$500","$70","$530","$0","$250","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050032","Silver 2500/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050032-00","Silver 2500/80","Standard Silver Off Exchange Plan",,"0.697323977947235","No","Yes","No","100%",,"$3,400","$140","$780","$0","$2,400","$480","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060012","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060012-01","Bronze HDHP 60","Standard Bronze On Exchange Plan",,"0.617065250873566","Yes","Yes","No","100%",,"$5,900","$0","$640","$0","$5,000","$0","$120","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp60","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060051","Bronze HDHP 50","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060051-00","Bronze HDHP 50","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$1,050","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp50","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050032","Silver 2500/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050032-01","Silver 2500/80","Standard Silver On Exchange Plan",,"0.697323977947235","No","Yes","No","100%",,"$3,400","$140","$780","$0","$2,400","$480","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050032","Silver 2500/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050032-02","Silver 2500/80","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060051","Bronze HDHP 50","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060051-01","Bronze HDHP 50","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$1,050","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp50","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060050","Bronze HDHP 50","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060050-00","Bronze HDHP 50","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$1,050","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp50","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050032","Silver 2500/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050032-03","Silver 2500/80","Limited Cost Sharing Plan Variation",,"0.697323977947235","No","Yes","No","100%",,"$3,400","$140","$780","$0","$2,400","$480","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050032","Silver 2500/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050032-04","Silver 2500/80","73% AV Level Silver Plan",,"0.73316365480423","No","Yes","No","100%",,"$2,900","$140","$880","$0","$2,000","$440","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060050","Bronze HDHP 50","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060050-01","Bronze HDHP 50","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$1,050","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthtradition.com/go/sg/bronzehdhp50","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050032","Silver 2500/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050032-05","Silver 2500/80","87% AV Level Silver Plan",,"0.879042506217957","No","Yes","No","100%",,"$1,800","$100","$200","$0","$900","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050032","Silver 2500/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050032-06","Silver 2500/80","94% AV Level Silver Plan",,"0.942219078540802","No","Yes","No","100%",,"$500","$70","$530","$0","$250","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/silver2500-80-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050015-00","Bronze 6000/80","Standard Bronze Off Exchange Plan",,"0.60929149389267","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze6000-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050015-01","Bronze 6000/80","Standard Bronze On Exchange Plan",,"0.60929149389267","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze6000-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050015-02","Bronze 6000/80","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze6000-80-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050015-03","Bronze 6000/80","Limited Cost Sharing Plan Variation",,"0.60929149389267","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze6000-80-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050016-00","Bronze 6000/80","Standard Bronze Off Exchange Plan",,"0.60929149389267","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze6000-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050016-01","Bronze 6000/80","Standard Bronze On Exchange Plan",,"0.60929149389267","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze6000-80","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050016-02","Bronze 6000/80","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze6000-80-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050016-03","Bronze 6000/80","Limited Cost Sharing Plan Variation",,"0.60929149389267","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze6000-80-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050061","Bronze 7150/100 Rx","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050061-00","Bronze 7150/100 Rx","Standard Bronze Off Exchange Plan",,"0.600060641765594","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-rx","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050061","Bronze 7150/100 Rx","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050061-01","Bronze 7150/100 Rx","Standard Bronze On Exchange Plan",,"0.600060641765594","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-rx","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050061","Bronze 7150/100 Rx","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050061-02","Bronze 7150/100 Rx","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-rx-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050061","Bronze 7150/100 Rx","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050061-03","Bronze 7150/100 Rx","Limited Cost Sharing Plan Variation",,"0.600060641765594","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-rx-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050060","Bronze 7150/100 Rx","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050060-00","Bronze 7150/100 Rx","Standard Bronze Off Exchange Plan",,"0.600060641765594","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-rx","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050060","Bronze 7150/100 Rx","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050060-01","Bronze 7150/100 Rx","Standard Bronze On Exchange Plan",,"0.600060641765594","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-rx","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050060","Bronze 7150/100 Rx","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050060-02","Bronze 7150/100 Rx","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-rx-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050060","Bronze 7150/100 Rx","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050060-03","Bronze 7150/100 Rx","Limited Cost Sharing Plan Variation",,"0.600060641765594","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$960","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-rx-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050063","Bronze 7150/100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050063-00","Bronze 7150/100","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronze7150-100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050063","Bronze 7150/100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050063-01","Bronze 7150/100","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronze7150-100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050063","Bronze 7150/100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050063-02","Bronze 7150/100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050063","Bronze 7150/100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050063-03","Bronze 7150/100","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050062","Bronze 7150/100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050062-00","Bronze 7150/100","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronze7150-100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050062","Bronze 7150/100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050062-01","Bronze 7150/100","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronze7150-100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050062","Bronze 7150/100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050062-02","Bronze 7150/100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050062","Bronze 7150/100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050062-03","Bronze 7150/100","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronze7150-100-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060005","Gold 1500/80","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060005-00","Gold 1500/80","Standard Gold Off Exchange Plan",,"0.782734990119934","No","Yes","No","100%",,"$2,400","$100","$980","$0","$1,500","$500","$760","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold1500-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050053-00","Silver HDHP 100","Standard Silver Off Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/silverhdhp100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050053-01","Silver HDHP 100","Standard Silver On Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/silverhdhp100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060005","Gold 1500/80","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060005-01","Gold 1500/80","Standard Gold On Exchange Plan",,"0.782734990119934","No","Yes","No","100%",,"$2,400","$100","$980","$0","$1,500","$500","$760","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold1500-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060006","Gold 1500/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060006-00","Gold 1500/80","Standard Gold Off Exchange Plan",,"0.782734990119934","No","Yes","No","100%",,"$2,400","$100","$980","$0","$1,500","$500","$760","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold1500-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050053-02","Silver HDHP 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050053-03","Silver HDHP 100","Limited Cost Sharing Plan Variation",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060006","Gold 1500/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060006-01","Gold 1500/80","Standard Gold On Exchange Plan",,"0.782734990119934","No","Yes","No","100%",,"$2,400","$100","$980","$0","$1,500","$500","$760","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold1500-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060009","Silver 2000/70","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060009-00","Silver 2000/70","Standard Silver Off Exchange Plan",,"0.71446305513382","No","Yes","No","100%",,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver2000-70","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050053-04","Silver HDHP 100","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$4,400","$0","$0","$0","$3,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050053-05","Silver HDHP 100","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$2,250","$0","$0","$0","$1,350","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060009","Silver 2000/70","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060009-01","Silver 2000/70","Standard Silver On Exchange Plan",,"0.71446305513382","No","Yes","No","100%",,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver2000-70","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060010","Silver 2000/70","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060010-00","Silver 2000/70","Standard Silver Off Exchange Plan",,"0.71446305513382","No","Yes","No","100%",,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver2000-70","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050053-06","Silver HDHP 100","94% AV Level Silver Plan",,"0.932620525360107","Yes","Yes","No","100%",,"$1,200","$0","$0","$0","$600","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050052-00","Silver HDHP 100","Standard Silver Off Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/silverhdhp100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060010","Silver 2000/70","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060010-01","Silver 2000/70","Standard Silver On Exchange Plan",,"0.71446305513382","No","Yes","No","100%",,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/silver2000-70","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050052-01","Silver HDHP 100","Standard Silver On Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/silverhdhp100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060053","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060053-00","Bronze 6000/80","Standard Bronze Off Exchange Plan",,"0.615935623645782","No","Yes","No","100%",,"$6,900","$150","$80","$0","$2,400","$435","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/bronze6000-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060053","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060053-01","Bronze 6000/80","Standard Bronze On Exchange Plan",,"0.615935623645782","No","Yes","No","100%",,"$6,900","$150","$80","$0","$2,400","$435","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/bronze6000-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050052-02","Silver HDHP 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050052-03","Silver HDHP 100","Limited Cost Sharing Plan Variation",,"0.680664837360382","Yes","Yes","No","100%",,"$5,300","$0","$0","$0","$4,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060052","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060052-00","Bronze 6000/80","Standard Bronze Off Exchange Plan",,"0.615935623645782","No","Yes","No","100%",,"$6,900","$150","$80","$0","$2,400","$435","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/bronze6000-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060052","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060052-01","Bronze 6000/80","Standard Bronze On Exchange Plan",,"0.615935623645782","No","Yes","No","100%",,"$6,900","$150","$80","$0","$2,400","$435","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/bronze6000-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050052-04","Silver HDHP 100","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$4,400","$0","$0","$0","$3,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050052-05","Silver HDHP 100","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$2,250","$0","$0","$0","$1,350","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060041","Gold 2500/100","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060041-00","Gold 2500/100","Standard Gold Off Exchange Plan",,"0.781861424446106","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$2,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/gold2500-100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060041","Gold 2500/100","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060041-01","Gold 2500/100","Standard Gold On Exchange Plan",,"0.781861424446106","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$2,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/gold2500-100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050052-06","Silver HDHP 100","94% AV Level Silver Plan",,"0.932620525360107","Yes","Yes","No","100%",,"$1,200","$0","$0","$0","$600","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp100-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050018-00","Bronze HDHP 100","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$7,450","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/bronzehdhp100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060040","Gold 2500/100","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060040-00","Gold 2500/100","Standard Gold Off Exchange Plan",,"0.781861424446106","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$2,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/gold2500-100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060040","Gold 2500/100","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060040-01","Gold 2500/100","Standard Gold On Exchange Plan",,"0.781861424446106","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$2,500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/gold2500-100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050018-01","Bronze HDHP 100","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$7,450","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/bronzehdhp100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050018-02","Bronze HDHP 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/bronzehdhp100-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060045","Silver 3000/80","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060045-00","Silver 3000/80","Standard Silver Off Exchange Plan",,"0.688136160373688","Yes","Yes","No","100%",,"$3,900","$0","$720","$0","$3,000","$0","$460","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/silver3000-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060045","Silver 3000/80","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060045-01","Silver 3000/80","Standard Silver On Exchange Plan",,"0.688136160373688","Yes","Yes","No","100%",,"$3,900","$0","$720","$0","$3,000","$0","$460","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/silver3000-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050018-03","Bronze HDHP 100","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$7,450","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronzehdhp100-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050017-00","Bronze HDHP 100","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$7,450","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/bronzehdhp100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060044","Silver 3000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060044-00","Silver 3000/80","Standard Silver Off Exchange Plan",,"0.688136160373688","Yes","Yes","No","100%",,"$3,900","$0","$720","$0","$3,000","$0","$460","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/silver3000-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060044","Silver 3000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060044-01","Silver 3000/80","Standard Silver On Exchange Plan",,"0.688136160373688","Yes","Yes","No","100%",,"$3,900","$0","$720","$0","$3,000","$0","$460","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/silver3000-80","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050017-01","Bronze HDHP 100","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$7,450","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/bronzehdhp100","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050017-02","Bronze HDHP 100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/bronzehdhp100-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060042","Gold 2000/90","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060042-00","Gold 2000/90","Standard Gold Off Exchange Plan",,"0.790832102298737","No","Yes","No","100%",,"$2,900","$120","$230","$0","$2,000","$350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold2000-90","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060042","Gold 2000/90","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060042-01","Gold 2000/90","Standard Gold On Exchange Plan",,"0.790832102298737","No","Yes","No","100%",,"$2,900","$120","$230","$0","$2,000","$350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold2000-90","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050017-03","Bronze HDHP 100","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$7,450","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronzehdhp100-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060043","Gold 2000/90","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060043-00","Gold 2000/90","Standard Gold Off Exchange Plan",,"0.790832102298737","No","Yes","No","100%",,"$2,900","$120","$230","$0","$2,000","$350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold2000-90","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060043","Gold 2000/90","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060043-01","Gold 2000/90","Standard Gold On Exchange Plan",,"0.790832102298737","No","Yes","No","100%",,"$2,900","$120","$230","$0","$2,000","$350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthtradition.com/go/sg/gold2000-90","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060054","Bronze 7150/100","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060054-00","Bronze 7150/100","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/bronze7150-100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060054","Bronze 7150/100","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060054-01","Bronze 7150/100","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/bronze7150-100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060055","Bronze 7150/100","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060055-00","Bronze 7150/100","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/bronze7150-100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","39-1545987","47342WI0060055","Bronze 7150/100","47342WI006","7720081950","WIN001","WIS003","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9981",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0060055-01","Bronze 7150/100","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthtradition.com/go/sg/bronze7150-100","http://www.healthtradition.com/brochures-for-groups"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050037-00","Silver HDHP 85","Standard Silver Off Exchange Plan",,"0.692833006381989","Yes","Yes","No","100%",,"$3,900","$0","$550","$0","$3,000","$0","$345","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/silverhdhp85","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050037-01","Silver HDHP 85","Standard Silver On Exchange Plan",,"0.692833006381989","Yes","Yes","No","100%",,"$3,900","$0","$550","$0","$3,000","$0","$345","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/silverhdhp85","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050037-02","Silver HDHP 85","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050037-03","Silver HDHP 85","Limited Cost Sharing Plan Variation",,"0.692833006381989","Yes","Yes","No","100%",,"$3,900","$0","$550","$0","$3,000","$0","$345","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050037-04","Silver HDHP 85","73% AV Level Silver Plan",,"0.734621822834015","Yes","Yes","No","100%",,"$3,150","$0","$640","$0","$2,250","$0","$445","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050037-05","Silver HDHP 85","87% AV Level Silver Plan",,"0.86721658706665","Yes","Yes","No","100%",,"$1,800","$0","$300","$0","$900","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050037-06","Silver HDHP 85","94% AV Level Silver Plan",,"0.935998857021332","Yes","Yes","No","100%",,"$500","$0","$900","$0","$250","$0","$450","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050038-00","Silver HDHP 85","Standard Silver Off Exchange Plan",,"0.692833006381989","Yes","Yes","No","100%",,"$3,900","$0","$550","$0","$3,000","$0","$345","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/silverhdhp85","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050038-01","Silver HDHP 85","Standard Silver On Exchange Plan",,"0.692833006381989","Yes","Yes","No","100%",,"$3,900","$0","$550","$0","$3,000","$0","$345","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/silverhdhp85","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050038-02","Silver HDHP 85","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050038-03","Silver HDHP 85","Limited Cost Sharing Plan Variation",,"0.692833006381989","Yes","Yes","No","100%",,"$3,900","$0","$550","$0","$3,000","$0","$345","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050038-04","Silver HDHP 85","73% AV Level Silver Plan",,"0.734621822834015","Yes","Yes","No","100%",,"$3,150","$0","$640","$0","$2,250","$0","$445","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-73","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050038-05","Silver HDHP 85","87% AV Level Silver Plan",,"0.86721658706665","Yes","Yes","No","100%",,"$1,800","$0","$300","$0","$900","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-87","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050038-06","Silver HDHP 85","94% AV Level Silver Plan",,"0.935998857021332","Yes","Yes","No","100%",,"$500","$0","$900","$0","$250","$0","$450","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/silverhdhp85-94","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050059","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050059-00","Bronze HDHP 50","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$950","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/bronzehdhp50","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050059","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050059-01","Bronze HDHP 50","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$950","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/bronzehdhp50","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050059","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050059-02","Bronze HDHP 50","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/bronzehdhp50-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050059","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050059-03","Bronze HDHP 50","Limited Cost Sharing Plan Variation",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$950","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronzehdhp50-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050058","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050058-00","Bronze HDHP 50","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$950","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/bronzehdhp50","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050058","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050058-01","Bronze HDHP 50","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$950","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/go/individual/bronzehdhp50","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050058","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050058-02","Bronze HDHP 50","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/go/individual/bronzehdhp50-zero","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050058","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050058-03","Bronze HDHP 50","Limited Cost Sharing Plan Variation",,"0.619072020053864","Yes","Yes","No","100%",,"$5,400","$0","$950","$0","$4,500","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/bronzehdhp50-limited","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050019","Essential","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050019-00","Essential","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/essential","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050019","Essential","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050019-01","Essential","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/essential","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050020","Essential","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050020-00","Essential","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/essential","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","47342","HIOS","2017-01-21 03:35:28","Individual","No","39-1545987","47342WI0050020","Essential","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9986",,,"2017-01-01","2017-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/wp-content/uploads/2016/12/221HTH133FAV_Nov_111816.pdf","47342WI0050020-01","Essential","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/go/individual/essential","https://www.healthtradition.com/brochures-for-individuals"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010001","Molina Marketplace Gold","52697WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010001-00","Molina Marketplace Gold","Standard Gold Off Exchange Plan",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010001","Molina Marketplace Gold","52697WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010001-01","Molina Marketplace Gold","Standard Gold On Exchange Plan",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010001","Molina Marketplace Gold","52697WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010001-02","Molina Marketplace Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010001","Molina Marketplace Gold","52697WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010001-03","Molina Marketplace Gold LCS","Limited Cost Sharing Plan Variation",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010002","Molina Marketplace Silver","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010002-00","Molina Marketplace Silver 250","Standard Silver Off Exchange Plan",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010002","Molina Marketplace Silver","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010002-01","Molina Marketplace Silver 250","Standard Silver On Exchange Plan",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010002","Molina Marketplace Silver","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010002-02","Molina Marketplace Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010002","Molina Marketplace Silver","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010002-03","Molina Marketplace Silver LCS","Limited Cost Sharing Plan Variation",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010002","Molina Marketplace Silver","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010002-04","Molina Marketplace Silver 200","73% AV Level Silver Plan",,"0.739942610263824","No","Yes","No","100%",,"$2,270","$290","$1,340","$150","$2,270","$400","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,275","$2275 per person","$4550 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,275","$2275 per person","$4550 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010002","Molina Marketplace Silver","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010002-05","Molina Marketplace Silver 150","87% AV Level Silver Plan",,"0.879904866218567","No","Yes","No","100%",,"$500","$180","$890","$150","$500","$320","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010002","Molina Marketplace Silver","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010002-06","Molina Marketplace Silver 100","94% AV Level Silver Plan",,"0.949759483337402","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010003","Molina Marketplace Bronze","52697WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010003-00","Molina Marketplace Bronze","Standard Bronze Off Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010003","Molina Marketplace Bronze","52697WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010003-01","Molina Marketplace Bronze","Standard Bronze On Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010003","Molina Marketplace Bronze","52697WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010003-02","Molina Marketplace Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0010003","Molina Marketplace Bronze","52697WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0010003-03","Molina Marketplace Bronze LCS","Limited Cost Sharing Plan Variation",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030001","Molina Marketplace Options Silver","52697WI003",,"WIN001","WIS001","WIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030001-00","Molina Marketplace Options Silver 250","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030001","Molina Marketplace Options Silver","52697WI003",,"WIN001","WIS001","WIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030001-01","Molina Marketplace Options Silver 250","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030001","Molina Marketplace Options Silver","52697WI003",,"WIN001","WIS001","WIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030001-02","Molina Marketplace Options Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030001","Molina Marketplace Options Silver","52697WI003",,"WIN001","WIS001","WIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030001-03","Molina Marketplace Options Silver LCS","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030001","Molina Marketplace Options Silver","52697WI003",,"WIN001","WIS001","WIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030001-04","Molina Marketplace Options Silver 200","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030001","Molina Marketplace Options Silver","52697WI003",,"WIN001","WIS001","WIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030001-05","Molina Marketplace Options Silver 150","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,010","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030001","Molina Marketplace Options Silver","52697WI003",,"WIN001","WIS001","WIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030001-06","Molina Marketplace Options Silver 100","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030002","Molina Marketplace Options Bronze","52697WI003",,"WIN001","WIS001","WIF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030002-00","Molina Marketplace Options Bronze","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030002","Molina Marketplace Options Bronze","52697WI003",,"WIN001","WIS001","WIF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030002-01","Molina Marketplace Options Bronze","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030002","Molina Marketplace Options Bronze","52697WI003",,"WIN001","WIS001","WIF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030002-02","Molina Marketplace Options Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","52697","HIOS","2016-11-15 02:20:22","Individual","No","20-0813104","52697WI0030002","Molina Marketplace Options Bronze","52697WI003",,"WIN001","WIS001","WIF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/formulary-2017.pdf","52697WI0030002-03","Molina Marketplace Options Bronze LCS","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020001-00","Medica Individual Choice Gold Copay","Standard Gold Off Exchange Plan",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICGCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020001-01","Medica Individual Choice Gold Copay","Standard Gold On Exchange Plan",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICGCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020001-02","Medica Individual Choice Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICGCWIZ&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020001-03","Medica Individual Choice Gold Copay","Limited Cost Sharing Plan Variation",,"0.79637199640274","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICGCWIL&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020019-00","Medica Individual Choice Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICGPCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020019-01","Medica Individual Choice Gold Copay Plus","Standard Gold On Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICGPCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020019-02","Medica Individual Choice Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICGPCWIZ&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020019-03","Medica Individual Choice Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICGPCWIL&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020003-00","Medica Individual Choice Silver Copay","Standard Silver Off Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020003-01","Medica Individual Choice Silver Copay","Standard Silver On Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020003-02","Medica Individual Choice Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSCWIZ&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020003-03","Medica Individual Choice Silver Copay","Limited Cost Sharing Plan Variation",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSCWIL&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020003-04","Medica Individual Choice Silver Copay","73% AV Level Silver Plan",,"0.73963475227356","Yes","Yes","No","100%",,"$2,400","$10","$900","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSCWI73&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020003-05","Medica Individual Choice Silver Copay","87% AV Level Silver Plan",,"0.875553548336029","Yes","Yes","No","100%",,"$400","$10","$1,000","$1,000","$400","$400","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSCWI87&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020003-06","Medica Individual Choice Silver Copay","94% AV Level Silver Plan",,"0.934451282024384","Yes","Yes","No","100%",,"$100","$10","$300","$1,000","$100","$400","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSCWI94&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020009-00","Medica Individual Choice Silver H S A","Standard Silver Off Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSHWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020009-01","Medica Individual Choice Silver H S A","Standard Silver On Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSHWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020009-02","Medica Individual Choice Silver H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSHWIZ&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020009-03","Medica Individual Choice Silver H S A","Limited Cost Sharing Plan Variation",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSHWIL&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020009-04","Medica Individual Choice Silver H S A","73% AV Level Silver Plan",,"0.738642454147339","Yes","Yes","No","100%",,"$1,100","$0","$1,300","$1,000","$1,100","$0","$1,300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$3300 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSHWI73&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020009-05","Medica Individual Choice Silver H S A","87% AV Level Silver Plan",,"0.87436580657959","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSHWI87&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020009-06","Medica Individual Choice Silver H S A","94% AV Level Silver Plan",,"0.941599547863007","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICSHWI94&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020005-00","Medica Individual Choice Bronze Copay","Standard Bronze Off Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICBCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020005-01","Medica Individual Choice Bronze Copay","Standard Bronze On Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICBCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020005-02","Medica Individual Choice Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICBCWIZ&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020005-03","Medica Individual Choice Bronze Copay","Limited Cost Sharing Plan Variation",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICBCWIL&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020011-00","Medica Individual Choice Bronze H S A","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICBHWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020011-01","Medica Individual Choice Bronze H S A","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICBHWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020011-02","Medica Individual Choice Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICBHWIZ&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020011-03","Medica Individual Choice Bronze H S A","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICBHWIL&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020013","Medica Individual Choice Catastrophic","57845WI002",,"WIN002","WIS002","WIF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020013-00","Medica Individual Choice Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICCWI&uid=FFM",
"2017","WI","57845","HIOS","2016-08-23 02:28:31","Individual","No","41-1843804","57845WI0020013","Medica Individual Choice Catastrophic","57845WI002",,"WIN002","WIS002","WIF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","57845WI0020013-01","Medica Individual Choice Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICCWI&uid=FFM",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-00","MercyCare HMO Gold Option A","Standard Gold Off Exchange Plan","79.14%","0.791404962539673","No","Yes","No","100%",,"$1,500","$20","$1,150","$150","$1,500","$810","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-A-58326WI0090001.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-01","MercyCare HMO Gold Option A","Standard Gold On Exchange Plan","79.14%","0.791404962539673","No","Yes","No","100%",,"$1,500","$20","$1,150","$150","$1,500","$810","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-A-58326WI0090001.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-02","MercyCare HMO Gold Option A","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Gold-Opt-A-Zero-Cost-Share-58326WI0090001-02.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-03","MercyCare HMO Gold Option A","Limited Cost Sharing Plan Variation","79.14%","0.791404962539673","No","Yes","No","100%",,"$1,500","$20","$1,150","$150","$1,500","$810","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-A-58326WI0090001.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B Standard","58326WI009",,"WIN001","WIS002","WIF001","New","HMO","Gold","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-00","MercyCare HMO Gold Option B Standard","Standard Gold Off Exchange Plan","79.98%","0.799770832061768","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-B-58326WI0090012.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B Standard","58326WI009",,"WIN001","WIS002","WIF001","New","HMO","Gold","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-01","MercyCare HMO Gold Option B Standard","Standard Gold On Exchange Plan","79.98%","0.799770832061768","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-B-58326WI0090012.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B Standard","58326WI009",,"WIN001","WIS002","WIF001","New","HMO","Gold","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-02","MercyCare HMO Gold Option B Standard","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Gold-Opt-B-Zero-Cost-Share-58326WI0090012-02.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B Standard","58326WI009",,"WIN001","WIS002","WIF001","New","HMO","Gold","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-03","MercyCare HMO Gold Option B Standard","Limited Cost Sharing Plan Variation","79.98%","0.799770832061768","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-B-58326WI0090012.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-00","MercyCare HMO Gold Option C","Standard Gold Off Exchange Plan","81.50%","0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-C-58326WI0090013.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-01","MercyCare HMO Gold Option C","Standard Gold On Exchange Plan","81.50%","0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-C-58326WI0090013.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-02","MercyCare HMO Gold Option C","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Gold-Opt-C-Zero-Cost-Share-58326WI0090013-02.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-03","MercyCare HMO Gold Option C","Limited Cost Sharing Plan Variation","81.50%","0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Gold-Opt-C-58326WI0090013.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-00","MercyCare HMO Silver Option A","Standard Silver Off Exchange Plan","69.35%","0.693548858165741","No","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$60","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-A-58326WI0090002.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-01","MercyCare HMO Silver Option A","Standard Silver On Exchange Plan","69.35%","0.693548858165741","No","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$60","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-A-58326WI0090002.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-02","MercyCare HMO Silver Option A","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Silver-Opt-A-Zero-Cost-Share-58326WI0090002-02.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-03","MercyCare HMO Silver Option A","Limited Cost Sharing Plan Variation","69.35%","0.693548858165741","No","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$60","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-A-58326WI0090002.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-04","MercyCare HMO Silver Option A","73% AV Level Silver Plan","73.98%","0.739771962165833","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$520","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-A-73-CSR-58326WI0090002-04.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-05","MercyCare HMO Silver Option A","87% AV Level Silver Plan","86.37%","0.863732874393463","No","Yes","No","100%",,"$750","$0","$1,250","$150","$750","$970","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-A-87-CSR-58326WI0090002-05.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-06","MercyCare HMO Silver Option A","94% AV Level Silver Plan","94.67%","0.946713387966156","No","Yes","No","100%",,"$0","$20","$0","$150","$0","$750","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-A-94-CSR-58326WI0090002-06.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Standard","58326WI009",,"WIN001","WIS002","WIF006","New","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-00","MercyCare HMO Silver Option B Standard","Standard Silver Off Exchange Plan","70.63%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-B-58326WI0090015.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Standard","58326WI009",,"WIN001","WIS002","WIF006","New","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-01","MercyCare HMO Silver Option B Standard","Standard Silver On Exchange Plan","70.63%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-B-58326WI0090015.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Standard","58326WI009",,"WIN001","WIS002","WIF006","New","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-02","MercyCare HMO Silver Option B Standard","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Silver-Opt-B-Zero-Cost-Share-58326WI0090015-02.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Standard","58326WI009",,"WIN001","WIS002","WIF006","New","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-03","MercyCare HMO Silver Option B Standard","Limited Cost Sharing Plan Variation","70.63%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-B-58326WI0090015.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Standard","58326WI009",,"WIN001","WIS002","WIF006","New","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-04","MercyCare HMO Silver Option B Standard","73% AV Level Silver Plan","73.55%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-B-73-CSR-58326WI0090015-04.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Standard","58326WI009",,"WIN001","WIS002","WIF006","New","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-05","MercyCare HMO Silver Option B Standard","87% AV Level Silver Plan","87.47%","0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-B-87-CSR-58326WI0090015-05.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Standard","58326WI009",,"WIN001","WIS002","WIF006","New","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-06","MercyCare HMO Silver Option B Standard","94% AV Level Silver Plan","94.30%","0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$350","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-B-94-CSR-58326WI0090015-06.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-00","MercyCare HMO Silver Option C","Standard Silver Off Exchange Plan","69.87%","0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-C-58326WI0090016.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-01","MercyCare HMO Silver Option C","Standard Silver On Exchange Plan","69.87%","0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-C-58326WI0090016.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-02","MercyCare HMO Silver Option C","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Silver-Opt-C-Zero-Cost-Share-58326WI0090016-02.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-03","MercyCare HMO Silver Option C","Limited Cost Sharing Plan Variation","69.87%","0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-C-58326WI0090016.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-04","MercyCare HMO Silver Option C","73% AV Level Silver Plan","72.81%","0.72806191444397","Yes","Yes","No","100%",,"$3,400","$0","$0","$150","$2,420","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-C-73-CSR-58326WI0090016-04.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-05","MercyCare HMO Silver Option C","87% AV Level Silver Plan","87.22%","0.872201919555664","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-C-87-CSR-58326WI0090016-05-1.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-06","MercyCare HMO Silver Option C","94% AV Level Silver Plan","94.80%","0.948019683361053","Yes","Yes","No","100%",,"$450","$0","$0","$150","$450","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Silver-Opt-C-94-CSR-58326WI0090016-06.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-00","MercyCare HMO Bronze Option A","Standard Bronze Off Exchange Plan","61.49%","0.614894092082977","Yes","Yes","No","100%",,"$5,000","$0","$680","$150","$2,420","$0","$850","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-A-58326WI0090006.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-01","MercyCare HMO Bronze Option A","Standard Bronze On Exchange Plan","61.49%","0.614894092082977","Yes","Yes","No","100%",,"$5,000","$0","$680","$150","$2,420","$0","$850","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-A-58326WI0090006.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-02","MercyCare HMO Bronze Option A","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Bronze-Opt-A-Zero-Cost-Share-58326WI0090006-02.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-03","MercyCare HMO Bronze Option A","Limited Cost Sharing Plan Variation","61.49%","0.614894092082977","Yes","Yes","No","100%",,"$5,000","$0","$680","$150","$2,420","$0","$850","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-A-58326WI0090006.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-00","MercyCare HMO Bronze Option C","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$2,420","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-C-58326WI0090019.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-01","MercyCare HMO Bronze Option C","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$2,420","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-C-58326WI0090019.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-02","MercyCare HMO Bronze Option C","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Bronze-Opt-C-58326WI0090019.pdf",
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340018","Anthem Bronze Blue Priority WI 30 for HSA","79475WI034",,"WIN001","WIS001","WIF021","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340018-03","Anthem Bronze Blue Priority X WI 30 for HSA","Limited Cost Sharing Plan Variation","61.99%","0.617303371429443","Yes","Yes","Yes","51%","49%","$5,150","$20","$600","$0","$5,150","$0","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","30.00%","$5,150","$5150 per person","$10300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ESP","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority WI 3750","79475WI034",,"WIN001","WIS001","WIF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-00","Anthem Silver Blue Priority WI 3750","Standard Silver Off Exchange Plan","71.87%","0.721971929073334","Yes","Yes","Yes","51%","49%","$3,750","$800","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","10.00%","$3,750","$3750 per person","$7500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESQ","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority WI 3750","79475WI034",,"WIN001","WIS001","WIF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-01","Anthem Silver Blue Priority X WI 3750","Standard Silver On Exchange Plan","71.87%","0.721971929073334","Yes","Yes","Yes","51%","49%","$3,750","$800","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","10.00%","$3,750","$3750 per person","$7500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESR","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority WI 3750","79475WI034",,"WIN001","WIS001","WIF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-02","Anthem Silver Blue Priority X WI 3750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ESS","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-03","MercyCare HMO Bronze Option C","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$2,420","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-C-58326WI0090019.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B Standard","58326WI009",,"WIN001","WIS002","WIF013","New","HMO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-00","MercyCare HMO Bronze Option B Standard","Standard Bronze Off Exchange Plan","61.88%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-B-58326WI0090018.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B Standard","58326WI009",,"WIN001","WIS002","WIF013","New","HMO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-01","MercyCare HMO Bronze Option B Standard","Standard Bronze On Exchange Plan","61.88%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-B-58326WI0090018.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B Standard","58326WI009",,"WIN001","WIS002","WIF013","New","HMO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-02","MercyCare HMO Bronze Option B Standard","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/05/HMO-Bronze-Opt-B-58326WI0090018.pdf",
"2017","WI","58326","HIOS","2016-08-25 02:24:34","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B Standard","58326WI009",,"WIN001","WIS002","WIF013","New","HMO","Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9948",,,"2017-01-01","2017-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-03","MercyCare HMO Bronze Option B Standard","Limited Cost Sharing Plan Variation","61.88%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2015/04/HMO-Bronze-Opt-B-58326WI0090018.pdf",
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority WI 2500","79475WI034",,"WIN001","WIS001","WIF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-02","Anthem Silver Blue Priority X WI 2500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ESY","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority WI 2500","79475WI034",,"WIN001","WIS001","WIF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-03","Anthem Silver Blue Priority X WI 2500","Limited Cost Sharing Plan Variation","71.90%","0.727618455886841","Yes","Yes","Yes","51%","49%","$2,500","$800","$1,100","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESX","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","62011","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","62011WI0040002","EHB High PPO","62011WI004",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","62011WI0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WI","62011","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","62011WI0040001","EHB Low PPO","62011WI004",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","62011WI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WI","62011","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","62011WI0030002","EHB High Passive","62011WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","62011WI0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WI","62011","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","93-0242990","62011WI0030001","EHB Low Passive","62011WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","62011WI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WI","66115","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","66115WI0040002","EHB High PPO","66115WI004",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66115WI0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WI","66115","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","66115WI0040001","EHB Low PPO","66115WI004",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66115WI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WI","66115","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","66115WI0030002","EHB High Passive","66115WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66115WI0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WI","66115","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","47-0098400","66115WI0030001","EHB Low Passive","66115WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66115WI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WI","69380","HIOS","2016-08-12 02:50:28","SHOP (Small Group)","Yes","57-0523959","69380WI0030001","Group Dental Policy","69380WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","69380WI0030001-00","Group Dental Policy","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","69589","HIOS","2016-06-10 03:02:05","Individual","Yes","13-5123390","69589WI0090001","Guardian Essentials for Families and Individuals","69589WI009",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","69589WI0090001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","$80 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","WI","69589","HIOS","2016-06-10 03:02:05","Individual","Yes","13-5123390","69589WI0090001","Guardian Essentials for Families and Individuals","69589WI009",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","69589WI0090001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","$80 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","WI","69589","HIOS","2016-06-10 03:02:05","Individual","Yes","13-5123390","69589WI0070001","Guardian Select for Families and Individuals","69589WI007",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","69589WI0070001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","$80 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","WI","69589","HIOS","2016-06-10 03:02:05","Individual","Yes","13-5123390","69589WI0070001","Guardian Select for Families and Individuals","69589WI007",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","69589WI0070001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","$80 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","WI","69589","HIOS","2016-06-10 03:02:05","Individual","Yes","13-5123390","69589WI0080001","Guardian Basics for Families and Individuals","69589WI008",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","69589WI0080001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","$80 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","WI","69589","HIOS","2016-06-10 03:02:05","Individual","Yes","13-5123390","69589WI0080001","Guardian Basics for Families and Individuals","69589WI008",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","69589WI0080001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","$80 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340014","Anthem Catastrophic Blue Priority WI 7150","79475WI034",,"WIN001","WIS001","WIF019","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340014-00","Anthem Catastrophic Blue Priority WI 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESG","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340014","Anthem Catastrophic Blue Priority WI 7150","79475WI034",,"WIN001","WIS001","WIF019","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340014-01","Anthem Catastrophic Blue Priority X WI 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESH","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority WI 2500","79475WI034",,"WIN001","WIS001","WIF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-00","Anthem Silver Blue Priority WI 2500","Standard Silver Off Exchange Plan","71.90%","0.727618455886841","Yes","Yes","Yes","51%","49%","$2,500","$800","$1,100","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESW","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority WI 2500","79475WI034",,"WIN001","WIS001","WIF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-01","Anthem Silver Blue Priority X WI 2500","Standard Silver On Exchange Plan","71.90%","0.727618455886841","Yes","Yes","Yes","51%","49%","$2,500","$800","$1,100","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESX","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority WI 2500","79475WI034",,"WIN001","WIS001","WIF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-04","Anthem Silver Blue Priority X WI 2500 S04","73% AV Level Silver Plan","73.92%","0.745752930641174","Yes","Yes","Yes","51%","49%","$2,450","$600","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10.00%","$2,450","$2450 per person","$4900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESZ","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority WI 2500","79475WI034",,"WIN001","WIS001","WIF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-05","Anthem Silver Blue Priority X WI 2500 S05","87% AV Level Silver Plan","87.23%","0.872911810874939","Yes","Yes","Yes","51%","49%","$900","$900","$200","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","10.00%","$900","$900 per person","$1800 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ET0","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority WI 2500","79475WI034",,"WIN001","WIS001","WIF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-06","Anthem Silver Blue Priority X WI 2500 S06","94% AV Level Silver Plan","94.92%","0.94833105802536","Yes","Yes","Yes","51%","49%","$200","$300","$300","$0","$200","$500","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ET1","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340017","Anthem Bronze Blue Priority WI 0 for HSA","79475WI034",,"WIN001","WIS001","WIF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340017-00","Anthem Bronze Blue Priority WI 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","51%","49%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ESJ","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340017","Anthem Bronze Blue Priority WI 0 for HSA","79475WI034",,"WIN001","WIS001","WIF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340017-01","Anthem Bronze Blue Priority X WI 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","51%","49%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ESL","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340017","Anthem Bronze Blue Priority WI 0 for HSA","79475WI034",,"WIN001","WIS001","WIF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340017-02","Anthem Bronze Blue Priority X WI 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ESK","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340017","Anthem Bronze Blue Priority WI 0 for HSA","79475WI034",,"WIN001","WIS001","WIF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340017-03","Anthem Bronze Blue Priority X WI 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","51%","49%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ESL","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340018","Anthem Bronze Blue Priority WI 30 for HSA","79475WI034",,"WIN001","WIS001","WIF021","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340018-00","Anthem Bronze Blue Priority WI 30 for HSA","Standard Bronze Off Exchange Plan","61.99%","0.617303371429443","Yes","Yes","Yes","51%","49%","$5,150","$20","$600","$0","$5,150","$0","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","30.00%","$5,150","$5150 per person","$10300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ESM","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340018","Anthem Bronze Blue Priority WI 30 for HSA","79475WI034",,"WIN001","WIS001","WIF021","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340018-01","Anthem Bronze Blue Priority X WI 30 for HSA","Standard Bronze On Exchange Plan","61.99%","0.617303371429443","Yes","Yes","Yes","51%","49%","$5,150","$20","$600","$0","$5,150","$0","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","30.00%","$5,150","$5150 per person","$10300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ESP","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340018","Anthem Bronze Blue Priority WI 30 for HSA","79475WI034",,"WIN001","WIS001","WIF021","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340018-02","Anthem Bronze Blue Priority X WI 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ESN","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority WI 3750","79475WI034",,"WIN001","WIS001","WIF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-03","Anthem Silver Blue Priority X WI 3750","Limited Cost Sharing Plan Variation","71.87%","0.721971929073334","Yes","Yes","Yes","51%","49%","$3,750","$800","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","10.00%","$3,750","$3750 per person","$7500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESR","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority WI 3750","79475WI034",,"WIN001","WIS001","WIF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-04","Anthem Silver Blue Priority X WI 3750 S04","73% AV Level Silver Plan","73.90%","0.743669450283051","Yes","Yes","Yes","51%","49%","$3,100","$800","$800","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","10.00%","$3,100","$3100 per person","$6200 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EST","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority WI 3750","79475WI034",,"WIN001","WIS001","WIF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-05","Anthem Silver Blue Priority X WI 3750 S05","87% AV Level Silver Plan","87.99%","0.880592226982117","Yes","Yes","Yes","51%","49%","$800","$900","$200","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%","$800","$800 per person","$1600 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESU","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority WI 3750","79475WI034",,"WIN001","WIS001","WIF024","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-06","Anthem Silver Blue Priority X WI 3750 S06","94% AV Level Silver Plan","94.80%","0.947219848632813","Yes","Yes","Yes","51%","49%","$200","$300","$300","$0","$200","$600","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESV","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340025","Anthem Bronze Blue Priority WI 40 for HSA","79475WI034",,"WIN001","WIS001","WIF022","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340025-00","Anthem Bronze Blue Priority WI 40 for HSA","Standard Bronze Off Exchange Plan","61.71%","0.615684568881989","Yes","Yes","Yes","51%","49%","$5,500","$0","$700","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ET8","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340025","Anthem Bronze Blue Priority WI 40 for HSA","79475WI034",,"WIN001","WIS001","WIF022","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340025-01","Anthem Bronze Blue Priority X WI 40 for HSA","Standard Bronze On Exchange Plan","61.71%","0.615684568881989","Yes","Yes","Yes","51%","49%","$5,500","$0","$700","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ET9","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340025","Anthem Bronze Blue Priority WI 40 for HSA","79475WI034",,"WIN001","WIS001","WIF022","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340025-02","Anthem Bronze Blue Priority X WI 40 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ETA","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340025","Anthem Bronze Blue Priority WI 40 for HSA","79475WI034",,"WIN001","WIS001","WIF022","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340025-03","Anthem Bronze Blue Priority X WI 40 for HSA","Limited Cost Sharing Plan Variation","61.71%","0.615684568881989","Yes","Yes","Yes","51%","49%","$5,500","$0","$700","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ET9","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340026","Anthem Bronze Blue Priority WI 5450","79475WI034",,"WIN001","WIS001","WIF021","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340026-00","Anthem Bronze Blue Priority WI 5450","Standard Bronze Off Exchange Plan","59.33%","0.595386743545532","Yes","Yes","Yes","51%","49%","$5,450","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETB","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340026","Anthem Bronze Blue Priority WI 5450","79475WI034",,"WIN001","WIS001","WIF021","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340026-01","Anthem Bronze Blue Priority X WI 5450","Standard Bronze On Exchange Plan","59.33%","0.595386743545532","Yes","Yes","Yes","51%","49%","$5,450","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETC","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340026","Anthem Bronze Blue Priority WI 5450","79475WI034",,"WIN001","WIS001","WIF021","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340026-02","Anthem Bronze Blue Priority X WI 5450 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ETD","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340026","Anthem Bronze Blue Priority WI 5450","79475WI034",,"WIN001","WIS001","WIF021","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340026-03","Anthem Bronze Blue Priority X WI 5450","Limited Cost Sharing Plan Variation","59.33%","0.595386743545532","Yes","Yes","Yes","51%","49%","$5,450","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETC","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority WI for HSA","79475WI034",,"WIN001","WIS001","WIF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-00","Anthem Silver Blue Priority WI for HSA","Standard Silver Off Exchange Plan","70.11%","0.705594897270203","Yes","Yes","Yes","51%","49%","$3,000","$800","$900","$0","$3,000","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ET2","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority WI for HSA","79475WI034",,"WIN001","WIS001","WIF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-01","Anthem Silver Blue Priority X WI for HSA","Standard Silver On Exchange Plan","70.11%","0.705594897270203","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ET4","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority WI for HSA","79475WI034",,"WIN001","WIS001","WIF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-02","Anthem Silver Blue Priority X WI AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ET3","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority WI for HSA","79475WI034",,"WIN001","WIS001","WIF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-03","Anthem Silver Blue Priority X WI for HSA","Limited Cost Sharing Plan Variation","70.11%","0.705594897270203","Yes","Yes","Yes","51%","49%","$3,000","$800","$900","$0","$3,000","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ET4","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority WI for HSA","79475WI034",,"WIN001","WIS001","WIF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-04","Anthem Silver Blue Priority X WI for HSA S04","73% AV Level Silver Plan","73.97%","0.741133868694305","Yes","Yes","Yes","51%","49%","$2,700","$800","$200","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2ET5","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority WI for HSA","79475WI034",,"WIN001","WIS001","WIF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-05","Anthem Silver Blue Priority X WI S05","87% AV Level Silver Plan","87.64%","0","Yes","Yes","Yes","51%","49%","$1,200","$0","$0","$0","$1,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","10.00%","$1,200","$1200 per person","$2400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ET6","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority WI for HSA","79475WI034",,"WIN001","WIS001","WIF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-06","Anthem Silver Blue Priority X WI S06","94% AV Level Silver Plan","94.28%","0","Yes","Yes","Yes","51%","49%","$500","$0","$0","$0","$500","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%","$500","$500 per person","$1000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ET7","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority WI 4000","79475WI034",,"WIN001","WIS001","WIF026","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-00","Anthem Silver Blue Priority WI 4000","Standard Silver Off Exchange Plan","69.48%","0.68633109331131","No","Yes","Yes","51%","49%","$4,000","$800","$200","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","25.00%","$4,000","$4000 per person","$8000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ETE","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority WI 4000","79475WI034",,"WIN001","WIS001","WIF026","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-01","Anthem Silver Blue Priority X WI 4000","Standard Silver On Exchange Plan","69.48%","0.686536610126495","No","Yes","Yes","51%","49%","$4,000","$800","$200","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","25.00%","$4,000","$4000 per person","$8000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ETF","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority WI 4000","79475WI034",,"WIN001","WIS001","WIF026","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-02","Anthem Silver Blue Priority X WI 4000 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ETG","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority WI 4000","79475WI034",,"WIN001","WIS001","WIF026","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-03","Anthem Silver Blue Priority X WI 4000","Limited Cost Sharing Plan Variation","69.48%","0.68633109331131","No","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","25.00%","$4,000","$4000 per person","$8000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ETF","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority WI 4000","79475WI034",,"WIN001","WIS001","WIF026","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-04","Anthem Silver Blue Priority X WI 4000 S04","73% AV Level Silver Plan","72.91%","0.721496403217316","No","Yes","Yes","51%","49%","$2,250","$900","$1,500","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ETH","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority WI 4000","79475WI034",,"WIN001","WIS001","WIF026","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-05","Anthem Silver Blue Priority X WI 4000 S05","87% AV Level Silver Plan","87.01%","0.839403688907623","No","Yes","Yes","51%","49%","$750","$600","$400","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ETJ","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority WI 4000","79475WI034",,"WIN001","WIS001","WIF026","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-06","Anthem Silver Blue Priority X WI 4000 S06","94% AV Level Silver Plan","94.64%","0.926255643367767","No","Yes","Yes","51%","49%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ETK","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340030","Anthem Silver Blue Priority WI 5300","79475WI034",,"WIN001","WIS001","WIF027","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340030-00","Anthem Silver Blue Priority WI 5300","Standard Silver Off Exchange Plan","68.01%","0.680969774723053","Yes","Yes","Yes","51%","49%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ES4","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340030","Anthem Silver Blue Priority WI 5300","79475WI034",,"WIN001","WIS001","WIF027","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340030-01","Anthem Silver Blue Priority X WI 5300","Standard Silver On Exchange Plan","68.01%","0.680969774723053","Yes","Yes","Yes","51%","49%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ES5","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340030","Anthem Silver Blue Priority WI 5300","79475WI034",,"WIN001","WIS001","WIF027","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340030-02","Anthem Silver Blue Priority X WI 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ES6","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340030","Anthem Silver Blue Priority WI 5300","79475WI034",,"WIN001","WIS001","WIF027","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340030-03","Anthem Silver Blue Priority X WI 5300","Limited Cost Sharing Plan Variation","68.01%","0.680969774723053","Yes","Yes","Yes","51%","49%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ES5","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340030","Anthem Silver Blue Priority WI 5300","79475WI034",,"WIN001","WIS001","WIF027","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340030-04","Anthem Silver Blue Priority X WI 5300 S04","73% AV Level Silver Plan","72.37%","0.726692855358124","Yes","Yes","Yes","51%","49%","$3,000","$600","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%","$3,000","$3000 per person","$6000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ES7","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340030","Anthem Silver Blue Priority WI 5300","79475WI034",,"WIN001","WIS001","WIF027","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340030-05","Anthem Silver Blue Priority X WI 5300 S05","87% AV Level Silver Plan","86.32%","0.862610042095184","Yes","Yes","Yes","51%","49%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ES8","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340030","Anthem Silver Blue Priority WI 5300","79475WI034",,"WIN001","WIS001","WIF027","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340030-06","Anthem Silver Blue Priority X WI 5300 S06","94% AV Level Silver Plan","93.44%","0.932740390300751","Yes","Yes","Yes","51%","49%","$200","$200","$400","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ES9","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340031","Anthem Silver Blue Priority WI 3200","79475WI034",,"WIN001","WIS001","WIF028","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340031-00","Anthem Silver Blue Priority WI 3200","Standard Silver Off Exchange Plan","68.07%","0.682238876819611","Yes","Yes","Yes","51%","49%","$3,200","$800","$1,600","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","50.00%","$3,200","$3200 per person","$6400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESA","http://editiondigital.net/view/IU65/2017/OFF_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340031","Anthem Silver Blue Priority WI 3200","79475WI034",,"WIN001","WIS001","WIF028","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340031-01","Anthem Silver Blue Priority X WI 3200","Standard Silver On Exchange Plan","68.07%","0.682238876819611","Yes","Yes","Yes","51%","49%","$3,200","$800","$1,600","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","50.00%","$3,200","$3200 per person","$6400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESB","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340031","Anthem Silver Blue Priority WI 3200","79475WI034",,"WIN001","WIS001","WIF028","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340031-02","Anthem Silver Blue Priority X WI 3200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ESC","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340031","Anthem Silver Blue Priority WI 3200","79475WI034",,"WIN001","WIS001","WIF028","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340031-03","Anthem Silver Blue Priority X WI 3200","Limited Cost Sharing Plan Variation","68.07%","0.682238876819611","Yes","Yes","Yes","51%","49%","$3,200","$800","$1,600","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","50.00%","$3,200","$3200 per person","$6400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESB","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340031","Anthem Silver Blue Priority WI 3200","79475WI034",,"WIN001","WIS001","WIF028","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340031-04","Anthem Silver Blue Priority X WI 3200 S04","73% AV Level Silver Plan","72.09%","0.719314217567444","Yes","Yes","Yes","51%","49%","$3,000","$800","$1,300","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESD","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340031","Anthem Silver Blue Priority WI 3200","79475WI034",,"WIN001","WIS001","WIF028","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340031-05","Anthem Silver Blue Priority X WI 3200 S05","87% AV Level Silver Plan","86.01%","0.854623436927795","Yes","Yes","Yes","51%","49%","$950","$300","$400","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","50.00%","$950","$950 per person","$1900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESE","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","HIOS","2017-01-19 02:20:17","Individual","No","39-1462554","79475WI0340031","Anthem Silver Blue Priority WI 3200","79475WI034",,"WIN001","WIS001","WIF028","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340031-06","Anthem Silver Blue Priority X WI 3200 S06","94% AV Level Silver Plan","93.15%","0.922246217727661","Yes","Yes","Yes","51%","49%","$200","$40","$500","$0","$200","$500","$40","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50.00%","$200","$200 per person","$400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ESF","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","39-6094742","79597WI0040001","Delta Dental PPO Plus Premier Family Plan High Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040001-00","Delta Dental PPO Plus Premier Family Plan High Option","Standard High Off Exchange Plan","85.20%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2017/SG_FamilyHighPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2017/SG_FamilyHighPlan.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","Individual","Yes","39-6094742","79597WI0030001","Delta Dental Individual and Family High Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030001-00","Delta Dental Individual and Family High Plan","Standard High Off Exchange Plan","86.70%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,"$35","$35 per person","$105 per group",,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_High_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_High_Plan.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","Individual","Yes","39-6094742","79597WI0030001","Delta Dental Individual and Family High Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030001-01","Delta Dental Individual and Family High Plan","Standard High On Exchange Plan","86.70%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,"$35","$35 per person","$105 per group",,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_High_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_High_Plan.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","39-6094742","79597WI0040001","Delta Dental PPO Plus Premier Family Plan High Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040001-01","Delta Dental PPO Plus Premier Family Plan High Option","Standard High On Exchange Plan","85.20%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2017/SG_FamilyHighPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2017/SG_FamilyHighPlan.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","39-6094742","79597WI0040002","Delta Dental PPO Plus Premier Family Plan Low Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040002-00","Delta Dental PPO Plus Premier Family Plan Low Option","Standard Low Off Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2017/SG_FamilyLowPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2017/SG_FamilyLowPlan.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","Individual","Yes","39-6094742","79597WI0030002","Delta Dental Individual and Family Low Plan Major","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030002-00","Delta Dental Individual and Family Low Plan Major","Standard Low Off Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_Low_Plan_Major.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_Low_Plan_Major.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460003-01","Prestige Silver 0","Standard Silver On Exchange Plan",,"0.691724479198456","Yes","Yes","No","100%",,"$4,900","$30","$0","$150","$860","$1,170","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460003-02","Prestige Silver 0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/17/silver0na0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460003-03","Prestige Silver 0","Limited Cost Sharing Plan Variation",,"0.691724479198456","Yes","Yes","No","100%",,"$4,900","$30","$0","$150","$860","$1,170","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver0nalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460003-04","Prestige Silver 0","73% AV Level Silver Plan",,"0.720663666725159","Yes","Yes","No","100%",,"$4,400","$30","$0","$150","$860","$980","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver073.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","Individual","Yes","39-6094742","79597WI0030002","Delta Dental Individual and Family Low Plan Major","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030002-01","Delta Dental Individual and Family Low Plan Major","Standard Low On Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_Low_Plan_Major.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_Low_Plan_Major.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","39-6094742","79597WI0040002","Delta Dental PPO Plus Premier Family Plan Low Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040002-01","Delta Dental PPO Plus Premier Family Plan Low Option","Standard Low On Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2017/SG_FamilyLowPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2017/SG_FamilyLowPlan.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","39-6094742","79597WI0040003","Delta Dental PPO Plus Premier Family Plan High Option Orthodontics","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.909","Estimated Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040003-00","Delta Dental PPO Plus Premier Family Plan High Option Orthodontics","Standard High Off Exchange Plan","85.20%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","79597","HIOS","2016-07-01 08:12:23","Individual","Yes","39-6094742","79597WI0030003","Delta Dental Individual and Family Low Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030003-00","Delta Dental Individual and Family Low Plan","Standard Low Off Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_Low_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_Low_Plan.pdf"
"2017","WI","79597","HIOS","2016-07-01 08:12:23","Individual","Yes","39-6094742","79597WI0030003","Delta Dental Individual and Family Low Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030003-01","Delta Dental Individual and Family Low Plan","Standard Low On Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_Low_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2017_DDWI_Individual_Low_Plan.pdf"
"2017","WI","81335","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","81335WI0120001","EHB Basic Dental Plan (Low)","81335WI012",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0120001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WI","81335","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","81335WI0140001","Family Basic Dental Plan (Low)","81335WI014",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0140001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49138"
"2017","WI","81335","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","81335WI0140001","Family Basic Dental Plan (Low)","81335WI014",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0140001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49138"
"2017","WI","81335","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","81335WI0150001","Family Enhanced Dental Plan (High)","81335WI015",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0150001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49140"
"2017","WI","81335","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","13-5581829","81335WI0150001","Family Enhanced Dental Plan (High)","81335WI015",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0150001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49140"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460005","Prestige Bronze 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460005-00","Prestige Bronze 20 HDHP","Standard Bronze Off Exchange Plan",,"0.618674695491791","Yes","Yes","No","100%",,"$6,400","$0","$180","$150","$5,020","$0","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/bronze20hdhp.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460005","Prestige Bronze 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460005-01","Prestige Bronze 20 HDHP","Standard Bronze On Exchange Plan",,"0.618674695491791","Yes","Yes","No","100%",,"$6,400","$0","$180","$150","$5,020","$0","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/bronze20hdhp.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460005","Prestige Bronze 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460005-02","Prestige Bronze 20 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/17/bronze20hdhpna0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460005","Prestige Bronze 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460005-03","Prestige Bronze 20 HDHP","Limited Cost Sharing Plan Variation",,"0.618674695491791","Yes","Yes","No","100%",,"$6,400","$0","$180","$150","$5,020","$0","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/bronze20hdhpnalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470005","Prestige Bronze 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470005-00","Prestige Bronze 20 HDHP","Standard Bronze Off Exchange Plan",,"0.618674695491791","Yes","Yes","No","100%",,"$6,400","$0","$180","$150","$5,020","$0","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/bronze20hdhp.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470005","Prestige Bronze 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470005-01","Prestige Bronze 20 HDHP","Standard Bronze On Exchange Plan",,"0.618674695491791","Yes","Yes","No","100%",,"$6,400","$0","$180","$150","$5,020","$0","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/bronze20hdhp.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470005","Prestige Bronze 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470005-02","Prestige Bronze 20 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/17/bronze20hdhpna0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470005","Prestige Bronze 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470005-03","Prestige Bronze 20 HDHP","Limited Cost Sharing Plan Variation",,"0.618674695491791","Yes","Yes","No","100%",,"$6,400","$0","$180","$150","$5,020","$0","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/bronze20hdhpnalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460007-00","Prestige Silver 20 HDHP","Standard Silver Off Exchange Plan",,"0.683625936508179","Yes","Yes","No","100%",,"$3,500","$0","$760","$150","$2,600","$0","$480","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460007-01","Prestige Silver 20 HDHP","Standard Silver On Exchange Plan",,"0.683625936508179","Yes","Yes","No","100%",,"$3,500","$0","$760","$150","$2,600","$0","$480","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460007-02","Prestige Silver 20 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhpna0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460007-03","Prestige Silver 20 HDHP","Limited Cost Sharing Plan Variation",,"0.683625936508179","Yes","Yes","No","100%",,"$3,500","$0","$760","$150","$2,600","$0","$480","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhpnalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460007-04","Prestige Silver 20 HDHP","73% AV Level Silver Plan",,"0.738237082958221","Yes","Yes","No","100%",,"$2,500","$0","$960","$150","$1,600","$0","$670","$40","$1,600","$0","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp73.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460007-05","Prestige Silver 20 HDHP","87% AV Level Silver Plan",,"0.860761642456055","Yes","Yes","No","100%",,"$1,750","$0","$1,110","$150","$875","$0","$675","$40","$875","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$875","$875 per person","$1750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp87.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460007-06","Prestige Silver 20 HDHP","94% AV Level Silver Plan",,"0.931820273399353","Yes","Yes","No","100%",,"$500","$0","$600","$150","$250","$0","$500","$40","$250","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp94.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470007-00","Prestige Silver 20 HDHP","Standard Silver Off Exchange Plan",,"0.683625936508179","Yes","Yes","No","100%",,"$3,500","$0","$760","$150","$2,600","$0","$480","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470007-01","Prestige Silver 20 HDHP","Standard Silver On Exchange Plan",,"0.683625936508179","Yes","Yes","No","100%",,"$3,500","$0","$760","$150","$2,600","$0","$480","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470007-02","Prestige Silver 20 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhpna0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460011-03","Prestige Silver Essential","Limited Cost Sharing Plan Variation",,"0.710758686065674","No","Yes","No","100%",,"$3,400","$20","$1,160","$150","$140","$1,310","$0","$40","$590","$710","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverEnalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460011-04","Prestige Silver Essential","73% AV Level Silver Plan",,"0.737093687057495","No","Yes","No","100%",,"$2,900","$20","$1,310","$150","$140","$1,310","$0","$40","$590","$660","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE73.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460011-05","Prestige Silver Essential","87% AV Level Silver Plan",,"0.86097526550293","No","Yes","No","100%",,"$900","$10","$1,270","$150","$140","$810","$0","$40","$450","$360","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE87.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470007-03","Prestige Silver 20 HDHP","Limited Cost Sharing Plan Variation",,"0.683625936508179","Yes","Yes","No","100%",,"$3,500","$0","$760","$150","$2,600","$0","$480","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhpnalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470007-04","Prestige Silver 20 HDHP","73% AV Level Silver Plan",,"0.738237082958221","Yes","Yes","No","100%",,"$2,500","$0","$960","$150","$1,600","$0","$670","$40","$1,600","$0","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp73.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470007-05","Prestige Silver 20 HDHP","87% AV Level Silver Plan",,"0.860761642456055","Yes","Yes","No","100%",,"$1,750","$0","$1,110","$150","$875","$0","$675","$40","$875","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$875","$875 per person","$1750 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp87.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470007-06","Prestige Silver 20 HDHP","94% AV Level Silver Plan",,"0.931820273399353","Yes","Yes","No","100%",,"$500","$0","$600","$150","$250","$0","$500","$40","$250","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver20hdhp94.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460003-00","Prestige Silver 0","Standard Silver Off Exchange Plan",,"0.691724479198456","Yes","Yes","No","100%",,"$4,900","$30","$0","$150","$860","$1,170","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460003-05","Prestige Silver 0","87% AV Level Silver Plan",,"0.860107779502869","Yes","Yes","No","100%",,"$2,000","$30","$0","$150","$860","$980","$0","$40","$1,100","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver087.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460003-06","Prestige Silver 0","94% AV Level Silver Plan",,"0.930498242378235","Yes","Yes","No","100%",,"$800","$30","$0","$150","$400","$400","$0","$40","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver094.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470003-00","Prestige Silver 0","Standard Silver Off Exchange Plan",,"0.691724479198456","Yes","Yes","No","100%",,"$4,900","$30","$0","$150","$860","$1,170","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470003-01","Prestige Silver 0","Standard Silver On Exchange Plan",,"0.691724479198456","Yes","Yes","No","100%",,"$4,900","$30","$0","$150","$860","$1,170","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470011-02","Prestige Silver Essential","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverEna0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470011-03","Prestige Silver Essential","Limited Cost Sharing Plan Variation",,"0.710758686065674","No","Yes","No","100%",,"$3,400","$20","$1,160","$150","$140","$1,310","$0","$40","$590","$710","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverEnalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470011-04","Prestige Silver Essential","73% AV Level Silver Plan",,"0.737093687057495","No","Yes","No","100%",,"$2,900","$20","$1,310","$150","$140","$1,310","$0","$40","$590","$660","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE73.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470011-05","Prestige Silver Essential","87% AV Level Silver Plan",,"0.86097526550293","No","Yes","No","100%",,"$900","$10","$1,270","$150","$140","$810","$0","$40","$450","$360","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE87.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470003-02","Prestige Silver 0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/17/silver0na0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470003-03","Prestige Silver 0","Limited Cost Sharing Plan Variation",,"0.691724479198456","Yes","Yes","No","100%",,"$4,900","$30","$0","$150","$860","$1,170","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver0nalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470003-04","Prestige Silver 0","73% AV Level Silver Plan",,"0.720663666725159","Yes","Yes","No","100%",,"$4,400","$30","$0","$150","$860","$980","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver073.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470003-05","Prestige Silver 0","87% AV Level Silver Plan",,"0.860107779502869","Yes","Yes","No","100%",,"$2,000","$30","$0","$150","$860","$980","$0","$40","$1,100","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver087.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470003-06","Prestige Silver 0","94% AV Level Silver Plan",,"0.930498242378235","Yes","Yes","No","100%",,"$800","$30","$0","$150","$400","$400","$0","$40","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silver094.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460008","Prestige Bronze Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460008-00","Prestige Bronze Essential","Standard Bronze Off Exchange Plan",,"0.618915140628815","Yes","Yes","No","100%",,"$6,400","$20","$340","$150","$2,000","$630","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeE.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460008","Prestige Bronze Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460008-01","Prestige Bronze Essential","Standard Bronze On Exchange Plan",,"0.618915140628815","Yes","Yes","No","100%",,"$6,400","$20","$340","$150","$2,000","$630","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeE.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460008","Prestige Bronze Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460008-02","Prestige Bronze Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeEna0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460008","Prestige Bronze Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460008-03","Prestige Bronze Essential","Limited Cost Sharing Plan Variation",,"0.618915140628815","Yes","Yes","No","100%",,"$6,400","$20","$340","$150","$2,000","$630","$0","$40","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeEnalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470008","Prestige Bronze Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470008-00","Prestige Bronze Essential","Standard Bronze Off Exchange Plan",,"0.618915140628815","Yes","Yes","No","100%",,"$6,400","$20","$340","$150","$2,000","$630","$0","$40","$1,530","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeE.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470008","Prestige Bronze Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470008-01","Prestige Bronze Essential","Standard Bronze On Exchange Plan",,"0.618915140628815","Yes","Yes","No","100%",,"$6,400","$20","$340","$150","$2,000","$630","$0","$40","$1,530","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeE.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470008","Prestige Bronze Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470008-02","Prestige Bronze Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeEna0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470008","Prestige Bronze Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470008-03","Prestige Bronze Essential","Limited Cost Sharing Plan Variation",,"0.618915140628815","Yes","Yes","No","100%",,"$6,400","$20","$340","$150","$2,000","$630","$0","$40","$1,530","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeEnalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460011-00","Prestige Silver Essential","Standard Silver Off Exchange Plan",,"0.710758686065674","No","Yes","No","100%",,"$3,400","$20","$1,160","$150","$140","$1,310","$0","$40","$590","$710","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460011-01","Prestige Silver Essential","Standard Silver On Exchange Plan",,"0.710758686065674","No","Yes","No","100%",,"$3,400","$20","$1,160","$150","$140","$1,310","$0","$40","$590","$710","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460011-02","Prestige Silver Essential","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverEna0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460011-06","Prestige Silver Essential","94% AV Level Silver Plan",,"0.938257873058319","No","Yes","No","100%",,"$100","$10","$720","$150","$50","$430","$10","$40","$50","$220","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE94.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470011-00","Prestige Silver Essential","Standard Silver Off Exchange Plan",,"0.710758686065674","No","Yes","No","100%",,"$3,400","$20","$1,160","$150","$140","$1,310","$0","$40","$590","$710","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470011-01","Prestige Silver Essential","Standard Silver On Exchange Plan",,"0.710758686065674","No","Yes","No","100%",,"$3,400","$20","$1,160","$150","$140","$1,310","$0","$40","$590","$710","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470011-06","Prestige Silver Essential","94% AV Level Silver Plan",,"0.938257873058319","No","Yes","No","100%",,"$100","$10","$720","$150","$50","$430","$10","$40","$50","$220","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://networkhealth.com/benefits/sbc/17/silverE94.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460013","Prestige Gold Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460013-00","Prestige Gold Essential","Standard Gold Off Exchange Plan",,"0.793728709220886","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$150","$140","$1,570","$0","$40","$500","$360","$110","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldE.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460012","Prestige Gold Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460012-01","Prestige Gold Standard","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$2,150","$20","$1,200","$150","$140","$1,180","$0","$40","$1,250","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldS.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460012","Prestige Gold Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460012-02","Prestige Gold Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldSna0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460012","Prestige Gold Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460012-03","Prestige Gold Standard","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$2,150","$20","$1,200","$150","$140","$1,180","$0","$40","$1,250","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldSnalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470012","Prestige Gold Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470012-00","Prestige Gold Standard","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$2,150","$20","$1,200","$150","$140","$1,180","$0","$40","$1,250","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldS.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470012","Prestige Gold Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470012-01","Prestige Gold Standard","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$2,150","$20","$1,200","$150","$140","$1,180","$0","$40","$1,250","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldS.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470009","Prestige Bronze Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470009-01","Prestige Bronze Standard","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$7,260","$70","$0","$150","$2,000","$1,690","$0","$40","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeS.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470009","Prestige Bronze Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470009-02","Prestige Bronze Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeSna0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470009","Prestige Bronze Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470009-03","Prestige Bronze Standard","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$7,260","$70","$0","$150","$2,000","$1,690","$0","$40","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeSnalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330101","HMO  Platinum 500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330101-00","HMO  Platinum 500 featuring AboutHealth","Standard Platinum Off Exchange Plan","88.08%","0.874236404895782","No","Yes","No","100%",,"$500","$100","$1,100","$10","$100","$1,500","$0","$0","$500","$450","$240","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330101.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330101.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330101","HMO  Platinum 500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330101-01","HMO  Platinum 500 featuring AboutHealth","Standard Platinum On Exchange Plan","88.08%","0.874236404895782","No","Yes","No","100%",,"$500","$100","$1,100","$10","$100","$1,500","$0","$0","$500","$450","$240","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330101.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330102.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330102","HMO  Gold 1000 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330102-00","HMO  Gold 1000 featuring AboutHealth","Standard Gold Off Exchange Plan","80.79%","0.80173921585083","No","Yes","No","100%",,"$1,000","$100","$1,700","$10","$100","$2,100","$0","$0","$1,000","$450","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330102.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330104.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470012","Prestige Gold Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470012-02","Prestige Gold Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldSna0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460013","Prestige Gold Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460013-01","Prestige Gold Essential","Standard Gold On Exchange Plan",,"0.793728709220886","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$150","$140","$1,570","$0","$40","$500","$360","$110","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldE.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460013","Prestige Gold Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460013-02","Prestige Gold Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldEna0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460013","Prestige Gold Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0460013-03","Prestige Gold Essential","Limited Cost Sharing Plan Variation",,"0.793728709220886","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$150","$140","$1,570","$0","$40","$500","$360","$110","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldEnalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470013","Prestige Gold Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470013-00","Prestige Gold Essential","Standard Gold Off Exchange Plan",,"0.793728709220886","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$150","$140","$1,570","$0","$40","$500","$360","$110","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldE.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470013","Prestige Gold Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470013-01","Prestige Gold Essential","Standard Gold On Exchange Plan",,"0.793728709220886","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$150","$140","$1,570","$0","$40","$500","$360","$110","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldE.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470013","Prestige Gold Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470013-02","Prestige Gold Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldEna0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470013","Prestige Gold Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist6Tier.pdf","81413WI0470013-03","Prestige Gold Essential","Limited Cost Sharing Plan Variation",,"0.793728709220886","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$150","$140","$1,570","$0","$40","$500","$360","$110","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldEnalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460010","Prestige Silver Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460010-00","Prestige Silver Standard","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$30","$570","$150","$140","$1,690","$0","$40","$1,630","$130","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460010","Prestige Silver Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460010-01","Prestige Silver Standard","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$30","$570","$150","$140","$1,690","$0","$40","$1,630","$130","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460010","Prestige Silver Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460010-02","Prestige Silver Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverSna0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460010","Prestige Silver Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460010-03","Prestige Silver Standard","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$30","$570","$150","$140","$1,690","$0","$40","$1,630","$130","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverSnalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460010","Prestige Silver Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460010-04","Prestige Silver Standard","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,900","$20","$670","$150","$140","$1,510","$0","$40","$1,630","$130","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS73.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460010","Prestige Silver Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460010-05","Prestige Silver Standard","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$1,400","$10","$1,170","$150","$140","$760","$0","$40","$700","$200","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS87.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460010","Prestige Silver Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460010-06","Prestige Silver Standard","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$500","$10","$340","$150","$140","$340","$0","$40","$250","$120","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS94.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470010","Prestige Silver Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470010-00","Prestige Silver Standard","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$30","$570","$150","$140","$1,690","$0","$40","$1,630","$130","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470010","Prestige Silver Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470010-01","Prestige Silver Standard","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$30","$570","$150","$140","$1,690","$0","$40","$1,630","$130","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470010","Prestige Silver Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470010-02","Prestige Silver Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverSna0.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470010","Prestige Silver Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470010-03","Prestige Silver Standard","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$4,400","$30","$570","$150","$140","$1,690","$0","$40","$1,630","$130","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverSnalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470010","Prestige Silver Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470010-04","Prestige Silver Standard","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,900","$20","$670","$150","$140","$1,510","$0","$40","$1,630","$130","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS73.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470010","Prestige Silver Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470010-05","Prestige Silver Standard","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$1,400","$10","$1,170","$150","$140","$760","$0","$40","$700","$200","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS87.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470010","Prestige Silver Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470010-06","Prestige Silver Standard","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$500","$10","$340","$150","$140","$340","$0","$40","$250","$120","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/silverS94.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460012","Prestige Gold Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460012-00","Prestige Gold Standard","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$2,150","$20","$1,200","$150","$140","$1,180","$0","$40","$1,250","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldS.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470012","Prestige Gold Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470012-03","Prestige Gold Standard","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$2,150","$20","$1,200","$150","$140","$1,180","$0","$40","$1,250","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/goldSnalim.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460009","Prestige Bronze Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460009-00","Prestige Bronze Standard","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$7,260","$70","$0","$150","$2,000","$1,690","$0","$40","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeS.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460009","Prestige Bronze Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460009-01","Prestige Bronze Standard","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$7,260","$70","$0","$150","$2,000","$1,690","$0","$40","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeS.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460009","Prestige Bronze Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460009-02","Prestige Bronze Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeSna0.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0460009","Prestige Bronze Standard","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0460009-03","Prestige Bronze Standard","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$7,260","$70","$0","$150","$2,000","$1,690","$0","$40","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeSnalim.pdf","http://www.networkhealth.com/plans/17individualbrochurenewi.pdf"
"2017","WI","81413","HIOS","2017-01-24 02:20:16","Individual","No","39-1442058","81413WI0470009","Prestige Bronze Standard","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Miscellaneous/individualdruglist4Tier.pdf","81413WI0470009-00","Prestige Bronze Standard","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$7,260","$70","$0","$150","$2,000","$1,690","$0","$40","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/17/bronzeS.pdf","http://www.networkhealth.com/plans/17individualbrochuresewi.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330102","HMO  Gold 1000 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330102-01","HMO  Gold 1000 featuring AboutHealth","Standard Gold On Exchange Plan","80.79%","0.80173921585083","No","Yes","No","100%",,"$1,000","$100","$1,700","$10","$100","$2,100","$0","$0","$1,000","$450","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330102.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330103.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330104","HMO  Gold 1500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330104-00","HMO  Gold 1500 featuring AboutHealth","Standard Gold Off Exchange Plan","78.33%","0.777629435062408","No","Yes","No","100%",,"$1,500","$100","$800","$10","$100","$2,100","$0","$0","$1,300","$450","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330104.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330125.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330104","HMO  Gold 1500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330104-01","HMO  Gold 1500 featuring AboutHealth","Standard Gold On Exchange Plan","78.33%","0.777629435062408","No","Yes","No","100%",,"$1,500","$100","$800","$10","$100","$2,100","$0","$0","$1,300","$450","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330104.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330126.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330103","HMO  Gold 2000-0 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330103-00","HMO  Gold 2000-0 featuring AboutHealth","Standard Gold Off Exchange Plan","80.56%","0.800062775611877","No","Yes","No","100%",,"$2,000","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330103.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330134.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330103","HMO  Gold 2000-0 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330103-01","HMO  Gold 2000-0 featuring AboutHealth","Standard Gold On Exchange Plan","80.56%","0.800062775611877","No","Yes","No","100%",,"$2,000","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330103.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330135.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330125","HMO  Gold 2000-20 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330125-00","HMO  Gold 2000-20 featuring AboutHealth","Standard Gold Off Exchange Plan","78.11%","0.774882793426514","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,100","$0","$0","$1,300","$450","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330125.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330106.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330125","HMO  Gold 2000-20 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330125-01","HMO  Gold 2000-20 featuring AboutHealth","Standard Gold On Exchange Plan","78.11%","0.774882793426514","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,100","$0","$0","$1,300","$450","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330125.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330107.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330126","HMO  Gold 2500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330126-00","HMO  Gold 2500 featuring AboutHealth","Standard Gold Off Exchange Plan","78.48%","0.779307901859283","No","Yes","No","100%",,"$2,500","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330126.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330128.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330126","HMO  Gold 2500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330126-01","HMO  Gold 2500 featuring AboutHealth","Standard Gold On Exchange Plan","78.48%","0.779307901859283","No","Yes","No","100%",,"$2,500","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330126.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350101.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330134","HMO  Silver 2500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330134-00","HMO  Silver 2500 featuring AboutHealth","Standard Silver Off Exchange Plan","71.94%","0.71318382024765","No","Yes","No","100%",,"$2,500","$100","$1,400","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330134.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350102.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330134","HMO  Silver 2500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330134-01","HMO  Silver 2500 featuring AboutHealth","Standard Silver On Exchange Plan","71.94%","0.71318382024765","No","Yes","No","100%",,"$2,500","$100","$1,400","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330134.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350104.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330135","HMO  Silver 3000-0 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330135-00","HMO  Silver 3000-0 featuring AboutHealth","Standard Silver Off Exchange Plan","71.87%","0.7132967710495","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,500","$0","$0","$1,300","$530","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330135.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350103.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330135","HMO  Silver 3000-0 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330135-01","HMO  Silver 3000-0 featuring AboutHealth","Standard Silver On Exchange Plan","71.87%","0.7132967710495","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,500","$0","$0","$1,300","$530","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330135.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350125.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330106","HMO  Silver 3000-20 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330106-00","HMO  Silver 3000-20 featuring AboutHealth","Standard Silver Off Exchange Plan","70.84%","0.702183783054352","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330106.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350126.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330106","HMO  Silver 3000-20 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330106-01","HMO  Silver 3000-20 featuring AboutHealth","Standard Silver On Exchange Plan","70.84%","0.702183783054352","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330106.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350134.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330107","HMO  Silver 3500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330107-00","HMO  Silver 3500 featuring AboutHealth","Standard Silver Off Exchange Plan","70.00%","0.694205701351166","No","Yes","No","100%",,"$3,500","$100","$600","$10","$100","$2,500","$0","$0","$1,300","$580","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330107.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350135.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330107","HMO  Silver 3500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330107-01","HMO  Silver 3500 featuring AboutHealth","Standard Silver On Exchange Plan","70.00%","0.694205701351166","No","Yes","No","100%",,"$3,500","$100","$600","$10","$100","$2,500","$0","$0","$1,300","$580","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330107.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350106.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330128","HMO  Silver 4500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330128-00","HMO  Silver 4500 featuring AboutHealth","Standard Silver Off Exchange Plan","68.49%","0.678553342819214","No","Yes","No","100%",,"$4,500","$100","$1,000","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330128.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350107.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330128","HMO  Silver 4500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330128-01","HMO  Silver 4500 featuring AboutHealth","Standard Silver On Exchange Plan","68.49%","0.678553342819214","No","Yes","No","100%",,"$4,500","$100","$1,000","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330128.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350128.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350101","POS  Platinum 500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350101-00","POS  Platinum 500 featuring AboutHealth","Standard Platinum Off Exchange Plan","88.08%","0.874236404895782","No","Yes","No","100%",,"$500","$100","$1,100","$10","$100","$1,500","$0","$0","$500","$450","$240","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350101.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330101.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350104","POS  Gold 1500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350104-00","POS  Gold 1500 featuring AboutHealth","Standard Gold Off Exchange Plan","78.33%","0.777629435062408","No","Yes","No","100%",,"$1,500","$100","$800","$10","$100","$2,100","$0","$0","$1,300","$450","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350104.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330125.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350101","POS  Platinum 500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Platinum","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350101-01","POS  Platinum 500 featuring AboutHealth","Standard Platinum On Exchange Plan","88.08%","0.874236404895782","No","Yes","No","100%",,"$500","$100","$1,100","$10","$100","$1,500","$0","$0","$500","$450","$240","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350101.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330102.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350102","POS  Gold 1000 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350102-00","POS  Gold 1000 featuring AboutHealth","Standard Gold Off Exchange Plan","80.79%","0.80173921585083","No","Yes","No","100%",,"$1,000","$100","$1,700","$10","$100","$2,100","$0","$0","$1,000","$450","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350102.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330104.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350102","POS  Gold 1000 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350102-01","POS  Gold 1000 featuring AboutHealth","Standard Gold On Exchange Plan","80.79%","0.80173921585083","No","Yes","No","100%",,"$1,000","$100","$1,700","$10","$100","$2,100","$0","$0","$1,000","$450","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350102.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330103.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350104","POS  Gold 1500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350104-01","POS  Gold 1500 featuring AboutHealth","Standard Gold On Exchange Plan","78.33%","0.777629435062408","No","Yes","No","100%",,"$1,500","$100","$800","$10","$100","$2,100","$0","$0","$1,300","$450","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350104.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330126.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350103","POS  Gold 2000-0 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350103-00","POS  Gold 2000-0 featuring AboutHealth","Standard Gold Off Exchange Plan","80.56%","0.800062775611877","No","Yes","No","100%",,"$2,000","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350103.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330134.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350103","POS  Gold 2000-0 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350103-01","POS  Gold 2000-0 featuring AboutHealth","Standard Gold On Exchange Plan","80.56%","0.800062775611877","No","Yes","No","100%",,"$2,000","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350103.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330135.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350128","POS  Silver 4500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350128-01","POS  Silver 4500 featuring AboutHealth","Standard Silver On Exchange Plan","68.49%","0.678553342819214","No","Yes","No","100%",,"$4,500","$100","$1,000","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350128.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350128.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350125","POS  Gold 2000-20 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350125-00","POS  Gold 2000-20 featuring AboutHealth","Standard Gold Off Exchange Plan","78.11%","0.774882793426514","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,100","$0","$0","$1,300","$450","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350125.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330106.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350125","POS  Gold 2000-20 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350125-01","POS  Gold 2000-20 featuring AboutHealth","Standard Gold On Exchange Plan","78.11%","0.774882793426514","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,100","$0","$0","$1,300","$450","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350125.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330107.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350126","POS  Gold 2500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350126-00","POS  Gold 2500 featuring AboutHealth","Standard Gold Off Exchange Plan","78.48%","0.779307901859283","No","Yes","No","100%",,"$2,500","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350126.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330128.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350126","POS  Gold 2500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF001","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350126-01","POS  Gold 2500 featuring AboutHealth","Standard Gold On Exchange Plan","78.48%","0.779307901859283","No","Yes","No","100%",,"$2,500","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350126.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350101.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350134","POS  Silver 2500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350134-00","POS  Silver 2500 featuring AboutHealth","Standard Silver Off Exchange Plan","71.94%","0.71318382024765","No","Yes","No","100%",,"$2,500","$100","$1,400","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350134.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350102.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350134","POS  Silver 2500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350134-01","POS  Silver 2500 featuring AboutHealth","Standard Silver On Exchange Plan","71.94%","0.71318382024765","No","Yes","No","100%",,"$2,500","$100","$1,400","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350134.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350104.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350135","POS  Silver 3000-0 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350135-00","POS  Silver 3000-0 featuring AboutHealth","Standard Silver Off Exchange Plan","71.87%","0.7132967710495","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,500","$0","$0","$1,300","$530","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350135.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350103.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350135","POS  Silver 3000-0 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350135-01","POS  Silver 3000-0 featuring AboutHealth","Standard Silver On Exchange Plan","71.87%","0.7132967710495","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,500","$0","$0","$1,300","$530","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350135.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350125.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350106","POS  Silver 3000-20 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350106-00","POS  Silver 3000-20 featuring AboutHealth","Standard Silver Off Exchange Plan","70.84%","0.702183783054352","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350106.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350126.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350106","POS  Silver 3000-20 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350106-01","POS  Silver 3000-20 featuring AboutHealth","Standard Silver On Exchange Plan","70.84%","0.702183783054352","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350106.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350134.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350107","POS  Silver 3500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350107-00","POS  Silver 3500 featuring AboutHealth","Standard Silver Off Exchange Plan","70.00%","0.694205701351166","No","Yes","No","100%",,"$3,500","$100","$600","$10","$100","$2,500","$0","$0","$1,300","$580","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350107.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350135.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350107","POS  Silver 3500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350107-01","POS  Silver 3500 featuring AboutHealth","Standard Silver On Exchange Plan","70.00%","0.694205701351166","No","Yes","No","100%",,"$3,500","$100","$600","$10","$100","$2,500","$0","$0","$1,300","$580","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350107.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350106.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350128","POS  Silver 4500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350128-00","POS  Silver 4500 featuring AboutHealth","Standard Silver Off Exchange Plan","68.49%","0.678553342819214","No","Yes","No","100%",,"$4,500","$100","$1,000","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350128.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350107.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330114","HMO HDHP Gold 2000 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330114-00","HMO HDHP Gold 2000 featuring AboutHealth","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$2,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330114.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330114.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330114","HMO HDHP Gold 2000 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330114-01","HMO HDHP Gold 2000 featuring AboutHealth","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$2,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330114.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330115.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330115","HMO HDHP Silver 1500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330115-00","HMO HDHP Silver 1500 featuring AboutHealth","Standard Silver Off Exchange Plan",,"0.706027865409851","Yes","Yes","No","100%",,"$1,500","$0","$2,500","$10","$1,500","$0","$700","$0","$1,500","$0","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330115.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330116.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330115","HMO HDHP Silver 1500 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330115-01","HMO HDHP Silver 1500 featuring AboutHealth","Standard Silver On Exchange Plan",,"0.706027865409851","Yes","Yes","No","100%",,"$1,500","$0","$2,500","$10","$1,500","$0","$700","$0","$1,500","$0","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330115.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330117.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330116","HMO HDHP Silver 2200 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330116-00","HMO HDHP Silver 2200 featuring AboutHealth","Standard Silver Off Exchange Plan",,"0.718495666980743","Yes","Yes","No","100%",,"$2,200","$0","$1,500","$10","$2,200","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330116.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330120.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330116","HMO HDHP Silver 2200 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330116-01","HMO HDHP Silver 2200 featuring AboutHealth","Standard Silver On Exchange Plan",,"0.718495666980743","Yes","Yes","No","100%",,"$2,200","$0","$1,500","$10","$2,200","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330116.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330122.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330117","HMO HDHP Silver 2600 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330117-00","HMO HDHP Silver 2600 featuring AboutHealth","Standard Silver Off Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$1,500","$10","$2,600","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330117.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330123.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330117","HMO HDHP Silver 2600 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330117-01","HMO HDHP Silver 2600 featuring AboutHealth","Standard Silver On Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$1,500","$10","$2,600","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330117.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350114.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330120","HMO HDHP Silver 3600 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330120-00","HMO HDHP Silver 3600 featuring AboutHealth","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$3,600","$10","$3,600","$0","$3,600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330120.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350115.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330120","HMO HDHP Silver 3600 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330120-01","HMO HDHP Silver 3600 featuring AboutHealth","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$3,600","$10","$3,600","$0","$3,600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330120.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350116.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330122","HMO HDHP Bronze 5050 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330122-00","HMO HDHP Bronze 5050 featuring AboutHealth","Standard Bronze Off Exchange Plan",,"0.619839489459991","Yes","Yes","No","100%",,"$5,050","$0","$1,400","$10","$5,050","$0","$600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330122.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350117.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330122","HMO HDHP Bronze 5050 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330122-01","HMO HDHP Bronze 5050 featuring AboutHealth","Standard Bronze On Exchange Plan",,"0.619839489459991","Yes","Yes","No","100%",,"$5,050","$0","$1,400","$10","$5,050","$0","$600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330122.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330120.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330123","HMO HDHP Bronze 6550 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330123-00","HMO HDHP Bronze 6550 featuring AboutHealth","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330123.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350122.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1330123","HMO HDHP Bronze 6550 featuring AboutHealth","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330123-01","HMO HDHP Bronze 6550 featuring AboutHealth","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1330123.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350123.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350114","POS HDHP Gold 2000 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350114-00","POS HDHP Gold 2000 featuring AboutHealth","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$2,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350114.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330114.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350114","POS HDHP Gold 2000 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350114-01","POS HDHP Gold 2000 featuring AboutHealth","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$2,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350114.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330115.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350115","POS HDHP Silver 1500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF008","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350115-00","POS HDHP Silver 1500 featuring AboutHealth","Standard Silver Off Exchange Plan",,"0.706027865409851","Yes","Yes","No","100%",,"$1,500","$0","$2,500","$10","$1,500","$0","$700","$0","$1,500","$0","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350115.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330116.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040005","HMO  Gold 2000-20","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040005-00","HMO  Gold 2000-20","Standard Gold Off Exchange Plan","78.11%","0.774882793426514","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,100","$0","$0","$1,300","$450","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040005.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040005.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-00","HMO Silver 7000","Standard Silver Off Exchange Plan","68.20%","0.676375925540924","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010001-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010001-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-01","HMO Silver 7000","Standard Silver On Exchange Plan","68.20%","0.676375925540924","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010001-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010001-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040005","HMO  Gold 2000-20","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040005-01","HMO  Gold 2000-20","Standard Gold On Exchange Plan","78.11%","0.774882793426514","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,100","$0","$0","$1,300","$450","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040005.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040005.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040006","HMO  Gold 2500","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040006-00","HMO  Gold 2500","Standard Gold Off Exchange Plan","78.48%","0.779307901859283","No","Yes","No","100%",,"$2,500","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040006.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040006.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-02","HMO Silver 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010001-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010001-02.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350115","POS HDHP Silver 1500 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF008","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350115-01","POS HDHP Silver 1500 featuring AboutHealth","Standard Silver On Exchange Plan",,"0.706027865409851","Yes","Yes","No","100%",,"$1,500","$0","$2,500","$10","$1,500","$0","$700","$0","$1,500","$0","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350115.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330117.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350116","POS HDHP Silver 2200 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350116-00","POS HDHP Silver 2200 featuring AboutHealth","Standard Silver Off Exchange Plan",,"0.717877864837646","Yes","Yes","No","100%",,"$2,200","$0","$1,500","$10","$2,200","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"$14,400","$14400 per person","$28800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","20.00%",,,,,"$4,400","per person not applicable","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350116.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330120.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350116","POS HDHP Silver 2200 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350116-01","POS HDHP Silver 2200 featuring AboutHealth","Standard Silver On Exchange Plan",,"0.717877864837646","Yes","Yes","No","100%",,"$2,200","$0","$1,500","$10","$2,200","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"$14,400","$14400 per person","$28800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","20.00%",,,,,"$4,400","per person not applicable","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350116.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330122.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350117","POS HDHP Silver 2600 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350117-00","POS HDHP Silver 2600 featuring AboutHealth","Standard Silver Off Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$1,500","$10","$2,600","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350117.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330123.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350117","POS HDHP Silver 2600 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350117-01","POS HDHP Silver 2600 featuring AboutHealth","Standard Silver On Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$1,500","$10","$2,600","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350117.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350114.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350120","POS HDHP Silver 3600 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350120-00","POS HDHP Silver 3600 featuring AboutHealth","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$3,600","$10","$3,600","$0","$3,600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350120.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350115.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350120","POS HDHP Silver 3600 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350120-01","POS HDHP Silver 3600 featuring AboutHealth","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$3,600","$10","$3,600","$0","$3,600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350120.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350116.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350122","POS HDHP Bronze 5050 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350122-00","POS HDHP Bronze 5050 featuring AboutHealth","Standard Bronze Off Exchange Plan",,"0.619839489459991","Yes","Yes","No","100%",,"$5,050","$0","$1,400","$10","$5,050","$0","$600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,100","$20100 per person","$40200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","30.00%",,,,,"$10,100","$10100 per person","$20200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350122.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350117.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350122","POS HDHP Bronze 5050 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350122-01","POS HDHP Bronze 5050 featuring AboutHealth","Standard Bronze On Exchange Plan",,"0.619839489459991","Yes","Yes","No","100%",,"$5,050","$0","$1,400","$10","$5,050","$0","$600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,100","$20100 per person","$40200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","30.00%",,,,,"$10,100","$10100 per person","$20200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350122.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1330120.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350123","POS HDHP Bronze 6550 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350123-00","POS HDHP Bronze 6550 featuring AboutHealth","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,100","$19100 per person","$38200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350123.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350122.pdf"
"2017","WI","84670","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","20-2660193","84670WI1350123","POS HDHP Bronze 6550 featuring AboutHealth","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350123-01","POS HDHP Bronze 6550 featuring AboutHealth","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,100","$19100 per person","$38200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/sbc_docs/2017/84670WI1350123.pdf","https://secure.wecareforwisconsin.com/documents/Brochure/2017/84670WI1350123.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010006","HMO Bronze 6250","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010006-01","HMO Bronze 6250","Standard Bronze On Exchange Plan",,"0.598284006118774","Yes","Yes","No","100%",,"$6,250","$0","$700","$10","$6,250","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010006-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010006-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010006","HMO Bronze 6250","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010006-02","HMO Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010006-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010006-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040004","HMO  Gold 2000-0","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040004-00","HMO  Gold 2000-0","Standard Gold Off Exchange Plan","80.56%","0.800062775611877","No","Yes","No","100%",,"$2,000","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040004.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040004.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040004","HMO  Gold 2000-0","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040004-01","HMO  Gold 2000-0","Standard Gold On Exchange Plan","80.56%","0.800062775611877","No","Yes","No","100%",,"$2,000","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040004.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040004.pdf"
"2017","WI","86572","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","86572WI0040002","EHB High PPO","86572WI004",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86572WI0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WI","86572","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","86572WI0040001","EHB Low PPO","86572WI004",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86572WI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WI","86572","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","86572WI0030002","EHB High Passive","86572WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86572WI0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WI","86572","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","36-0883760","86572WI0030001","EHB Low Passive","86572WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86572WI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010005","HMO Bronze 7150","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010005-00","HMO Bronze 7150","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$0","$0","$10","$7,100","$50","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010005-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010005-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040001","HMO  Platinum 500","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040001-00","HMO  Platinum 500","Standard Platinum Off Exchange Plan","88.08%","0.874236404895782","No","Yes","No","100%",,"$500","$100","$1,100","$10","$100","$1,500","$0","$0","$500","$450","$240","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040001.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040001.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040001","HMO  Platinum 500","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040001-01","HMO  Platinum 500","Standard Platinum On Exchange Plan","88.08%","0.874236404895782","No","Yes","No","100%",,"$500","$100","$1,100","$10","$100","$1,500","$0","$0","$500","$450","$240","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040001.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040001.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010005","HMO Bronze 7150","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010005-01","HMO Bronze 7150","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$0","$0","$10","$7,100","$50","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010005-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010005-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010005","HMO Bronze 7150","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010005-02","HMO Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010005-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010005-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040002","HMO  Gold 1000","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040002-00","HMO  Gold 1000","Standard Gold Off Exchange Plan","80.79%","0.80173921585083","No","Yes","No","100%",,"$1,000","$100","$1,700","$10","$100","$2,100","$0","$0","$1,000","$450","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040002.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040002.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040002","HMO  Gold 1000","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040002-01","HMO  Gold 1000","Standard Gold On Exchange Plan","80.79%","0.80173921585083","No","Yes","No","100%",,"$1,000","$100","$1,700","$10","$100","$2,100","$0","$0","$1,000","$450","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040002.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040002.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010005","HMO Bronze 7150","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010005-03","HMO Bronze 7150 CSR Limited","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$0","$0","$10","$7,100","$50","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010005-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010005-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010006","HMO Bronze 6250","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010006-00","HMO Bronze 6250","Standard Bronze Off Exchange Plan",,"0.598284006118774","Yes","Yes","No","100%",,"$6,250","$0","$700","$10","$6,250","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010006-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010006-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040003","HMO  Gold 1500","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040003-00","HMO  Gold 1500","Standard Gold Off Exchange Plan","78.33%","0.777629435062408","No","Yes","No","100%",,"$1,500","$100","$800","$10","$100","$2,100","$0","$0","$1,300","$450","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040003.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040003.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040003","HMO  Gold 1500","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040003-01","HMO  Gold 1500","Standard Gold On Exchange Plan","78.33%","0.777629435062408","No","Yes","No","100%",,"$1,500","$100","$800","$10","$100","$2,100","$0","$0","$1,300","$450","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040003.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040003.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010006","HMO Bronze 6250","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010006-03","HMO Bronze 6250 CSR Limited","Limited Cost Sharing Plan Variation",,"0.598284006118774","Yes","Yes","No","100%",,"$6,250","$0","$700","$10","$6,250","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010006-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010006-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-03","HMO Silver 7000 CSR Limited","Limited Cost Sharing Plan Variation","68.20%","0.676375925540924","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010001-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010001-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040006","HMO  Gold 2500","86584WI004",,"WIN001","WIS001","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040006-01","HMO  Gold 2500","Standard Gold On Exchange Plan","78.48%","0.779307901859283","No","Yes","No","100%",,"$2,500","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040006.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040006.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040007","HMO  Silver 2500","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040007-00","HMO  Silver 2500","Standard Silver Off Exchange Plan","71.94%","0.71318382024765","No","Yes","No","100%",,"$2,500","$100","$1,400","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040007.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040007.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-04","HMO Silver 3000 CSR 73","73% AV Level Silver Plan","73.82%","0.732830464839935","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010001-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010001-04.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-05","HMO Silver 400 CSR 87","87% AV Level Silver Plan","87.71%","0.87143886089325","No","Yes","No","100%",,"$400","$100","$0","$10","$1,300","$0","$0","$0","$400","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010001-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010001-05.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040007","HMO  Silver 2500","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040007-01","HMO  Silver 2500","Standard Silver On Exchange Plan","71.94%","0.71318382024765","No","Yes","No","100%",,"$2,500","$100","$1,400","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040007.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040007.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040008","HMO  Silver 3000-0","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040008-00","HMO  Silver 3000-0","Standard Silver Off Exchange Plan","71.87%","0.7132967710495","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,500","$0","$0","$1,300","$530","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040008.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040008.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-06","HMO Silver 0 CSR 94","94% AV Level Silver Plan","94.90%","0.942931771278381","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010001-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010001-06.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-00","HMO Silver 4500","Standard Silver Off Exchange Plan","69.34%","0.686634004116058","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,460","$0","$0","$1,300","$490","$50","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010002-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010002-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040008","HMO  Silver 3000-0","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040008-01","HMO  Silver 3000-0","Standard Silver On Exchange Plan","71.87%","0.7132967710495","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,500","$0","$0","$1,300","$530","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040008.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040008.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040009","HMO  Silver 3000-20","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040009-00","HMO  Silver 3000-20","Standard Silver Off Exchange Plan","70.84%","0.702183783054352","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040009.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040009.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-01","HMO Silver 4500","Standard Silver On Exchange Plan","69.34%","0.686634004116058","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,460","$0","$0","$1,300","$490","$50","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010002-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010002-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-02","HMO Silver 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010002-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010002-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040009","HMO  Silver 3000-20","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040009-01","HMO  Silver 3000-20","Standard Silver On Exchange Plan","70.84%","0.702183783054352","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040009.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040009.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040010","HMO  Silver 3500","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040010-00","HMO  Silver 3500","Standard Silver Off Exchange Plan","70.00%","0.694205701351166","No","Yes","No","100%",,"$3,500","$100","$600","$10","$100","$2,500","$0","$0","$1,300","$580","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040010.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040010.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-03","HMO Silver 4500 CSR Limited","Limited Cost Sharing Plan Variation","69.34%","0.686634004116058","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,460","$0","$0","$1,300","$490","$50","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010002-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010002-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-04","HMO Silver 3000 CSR 73","73% AV Level Silver Plan","73.82%","0.732830464839935","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010002-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010002-04.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040010","HMO  Silver 3500","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040010-01","HMO  Silver 3500","Standard Silver On Exchange Plan","70.00%","0.694205701351166","No","Yes","No","100%",,"$3,500","$100","$600","$10","$100","$2,500","$0","$0","$1,300","$580","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040010.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040010.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040011","HMO  Silver 4500","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040011-00","HMO  Silver 4500","Standard Silver Off Exchange Plan","68.49%","0.678553342819214","No","Yes","No","100%",,"$4,500","$100","$1,000","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040011.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040011.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-05","HMO Silver 400 CSR 87","87% AV Level Silver Plan","87.71%","0.87143886089325","No","Yes","No","100%",,"$400","$100","$0","$10","$100","$1,300","$0","$0","$400","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010002-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010002-05.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-06","HMO Silver 0 CSR 94","94% AV Level Silver Plan","94.90%","0.942931771278381","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010002-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010002-06.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-04","POS Silver 3000 CSR 73","73% AV Level Silver Plan","73.82%","0.732830464839935","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020002-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020002-04.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030008","POS Silver 3000-0","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030008-01","POS Silver 3000-0","Standard Silver On Exchange Plan","71.87%","0.7132967710495","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,500","$0","$0","$1,300","$530","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030008.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030008.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040017","HMO HDHP Bronze 5050","86584WI004",,"WIN001","WIS001","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040017-01","HMO HDHP Bronze 5050","Standard Bronze On Exchange Plan",,"0.619839489459991","Yes","Yes","No","100%",,"$5,050","$0","$1,400","$10","$5,050","$0","$600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040017.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040017.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040018","HMO HDHP Bronze 6550","86584WI004",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040018-00","HMO HDHP Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040018.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040018.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040011","HMO  Silver 4500","86584WI004",,"WIN001","WIS001","WIF002","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040011-01","HMO  Silver 4500","Standard Silver On Exchange Plan","68.49%","0.678553342819214","No","Yes","No","100%",,"$4,500","$100","$1,000","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040011.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040011.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030001","POS Platinum 500","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Platinum","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030001-00","POS Platinum 500","Standard Platinum Off Exchange Plan","88.08%","0.874236404895782","No","Yes","No","100%",,"$500","$100","$1,100","$10","$100","$1,500","$0","$0","$500","$450","$240","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030001.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030001.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010007","HMO Gold 2000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010007-00","HMO Gold 2000","Standard Gold Off Exchange Plan","78.08%","0.774897158145905","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,460","$0","$0","$1,300","$490","$40","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010007-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010007-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010007","HMO Gold 2000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010007-01","HMO Gold 2000","Standard Gold On Exchange Plan","78.08%","0.774897158145905","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,460","$0","$0","$1,300","$490","$40","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010007-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010007-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030001","POS Platinum 500","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Platinum","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030001-01","POS Platinum 500","Standard Platinum On Exchange Plan","88.08%","0.874236404895782","No","Yes","No","100%",,"$500","$100","$1,100","$10","$100","$1,500","$0","$0","$500","$450","$240","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030001.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030001.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030002","POS Gold 1000","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030002-00","POS Gold 1000","Standard Gold Off Exchange Plan","80.79%","0.80173921585083","No","Yes","No","100%",,"$1,000","$100","$1,700","$10","$100","$2,100","$0","$0","$1,000","$450","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030002.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030002.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010007","HMO Gold 2000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010007-02","HMO Gold 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010007-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010007-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010007","HMO Gold 2000","86584WI001",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010007-03","HMO Gold 2000 CSR Limited","Limited Cost Sharing Plan Variation","78.08%","0.774897158145905","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,460","$0","$0","$1,300","$490","$40","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010007-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010007-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030002","POS Gold 1000","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030002-01","POS Gold 1000","Standard Gold On Exchange Plan","80.79%","0.80173921585083","No","Yes","No","100%",,"$1,000","$100","$1,700","$10","$100","$2,100","$0","$0","$1,000","$450","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030002.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030002.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030003","POS Gold 1500","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030003-00","POS Gold 1500","Standard Gold Off Exchange Plan","78.33%","0.777629435062408","No","Yes","No","100%",,"$1,500","$100","$800","$10","$100","$2,100","$0","$0","$1,300","$450","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030003.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030003.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-00","POS Silver 7000","Standard Silver Off Exchange Plan","68.20%","0.676375925540924","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020001-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020001-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-01","POS Silver 7000","Standard Silver On Exchange Plan","68.20%","0.676375925540924","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020001-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020001-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030003","POS Gold 1500","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030003-01","POS Gold 1500","Standard Gold On Exchange Plan","78.33%","0.777629435062408","No","Yes","No","100%",,"$1,500","$100","$800","$10","$100","$2,100","$0","$0","$1,300","$450","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030003.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030003.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030004","POS Gold 2000-0","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030004-00","POS Gold 2000-0","Standard Gold Off Exchange Plan","80.56%","0.800062775611877","No","Yes","No","100%",,"$2,000","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030004.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030004.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-02","POS Silver 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020001-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020001-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-03","POS Silver 7000 CSR Limited","Limited Cost Sharing Plan Variation","68.20%","0.676375925540924","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020001-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020001-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030004","POS Gold 2000-0","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030004-01","POS Gold 2000-0","Standard Gold On Exchange Plan","80.56%","0.800062775611877","No","Yes","No","100%",,"$2,000","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030004.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030004.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030005","POS Gold 2000-20","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030005-00","POS Gold 2000-20","Standard Gold Off Exchange Plan","78.11%","0.774882793426514","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,100","$0","$0","$1,300","$450","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030005.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030005.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-04","POS Silver 3000 CSR 73","73% AV Level Silver Plan","73.82%","0.732830464839935","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,460","$0","$0","$1,300","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020001-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020001-04.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-05","POS Silver 400 CSR 87","87% AV Level Silver Plan","87.71%","0.87143886089325","No","Yes","No","100%",,"$400","$100","$0","$10","$100","$1,300","$0","$0","$400","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020001-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020001-05.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030005","POS Gold 2000-20","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030005-01","POS Gold 2000-20","Standard Gold On Exchange Plan","78.11%","0.774882793426514","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,100","$0","$0","$1,300","$450","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030005.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030005.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030006","POS Gold 2500","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030006-00","POS Gold 2500","Standard Gold Off Exchange Plan","78.48%","0.779307901859283","No","Yes","No","100%",,"$2,500","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030006.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030006.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-06","POS Silver 0 CSR 94","94% AV Level Silver Plan","94.90%","0.942931771278381","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020001-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020001-06.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-00","POS Silver 4500","Standard Silver Off Exchange Plan","69.34%","0.686634004116058","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,460","$0","$0","$1,300","$490","$50","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020002-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020002-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030006","POS Gold 2500","86584WI003",,"WIN001","WIS001","WIF001","New","POS","Gold","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030006-01","POS Gold 2500","Standard Gold On Exchange Plan","78.48%","0.779307901859283","No","Yes","No","100%",,"$2,500","$100","$0","$10","$100","$2,100","$0","$0","$1,300","$450","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030006.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030006.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030007","POS Silver 2500","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030007-00","POS Silver 2500","Standard Silver Off Exchange Plan","71.94%","0.71318382024765","No","Yes","No","100%",,"$2,500","$100","$1,400","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030007.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030007.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-01","POS Silver 4500","Standard Silver On Exchange Plan","69.34%","0.686634004116058","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,460","$0","$0","$1,300","$490","$50","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020002-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020002-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-02","POS Silver 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020002-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020002-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030007","POS Silver 2500","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030007-01","POS Silver 2500","Standard Silver On Exchange Plan","71.94%","0.71318382024765","No","Yes","No","100%",,"$2,500","$100","$1,400","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030007.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030007.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030008","POS Silver 3000-0","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030008-00","POS Silver 3000-0","Standard Silver Off Exchange Plan","71.87%","0.7132967710495","No","Yes","No","100%",,"$3,000","$100","$0","$10","$100","$2,500","$0","$0","$1,300","$530","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030008.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030008.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-03","POS Silver 4500 CSR Limited","Limited Cost Sharing Plan Variation","69.34%","0.686634004116058","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,460","$0","$0","$1,300","$490","$50","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020002-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020002-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030009","POS Silver 3000-20","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030009-00","POS Silver 3000-20","Standard Silver Off Exchange Plan","70.84%","0.702183783054352","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030009.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030009.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-05","POS Silver 400 CSR 87","87% AV Level Silver Plan","87.71%","0.87143886089325","No","Yes","No","100%",,"$400","$100","$0","$10","$100","$1,300","$0","$0","$400","$490","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020002-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020002-05.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030017","POS HDHP Bronze 5050","86584WI003",,"WIN001","WIS001","WIF008","New","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030017-01","POS HDHP Bronze 5050","Standard Bronze On Exchange Plan",,"0.619839489459991","Yes","Yes","No","100%",,"$5,050","$0","$1,400","$10","$5,050","$0","$600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,100","$20100 per person","$40200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","30.00%",,,,,"$10,100","$10100 per person","$20200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030017.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030017.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020003","POS HDHP Bronze 5500","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020003-03","POS HDHP Bronze 5500 CSR Limited","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020003-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020003-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-00","POS HDHP Silver 2700","Standard Silver Off Exchange Plan",,"0.680992066860199","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$1,400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020004-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020004-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030018","POS HDHP Bronze 6550","86584WI003",,"WIN001","WIS001","WIF006","New","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030018-00","POS HDHP Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,100","$19100 per person","$38200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030018.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030018.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030018","POS HDHP Bronze 6550","86584WI003",,"WIN001","WIS001","WIF006","New","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030018-01","POS HDHP Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,100","$19100 per person","$38200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030018.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030018.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-01","POS HDHP Silver 2700","Standard Silver On Exchange Plan",,"0.680992066860199","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$1,400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020004-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020004-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF003","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-06","POS Silver 0 CSR 94","94% AV Level Silver Plan","94.90%","0.942931771278381","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0","$400","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020002-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020002-06.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030009","POS Silver 3000-20","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030009-01","POS Silver 3000-20","Standard Silver On Exchange Plan","70.84%","0.702183783054352","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030009.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030009.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030010","POS Silver 3500","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030010-00","POS Silver 3500","Standard Silver Off Exchange Plan","70.00%","0.694205701351166","No","Yes","No","100%",,"$3,500","$100","$600","$10","$100","$2,500","$0","$0","$1,300","$580","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030010.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030010.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030010","POS Silver 3500","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030010-01","POS Silver 3500","Standard Silver On Exchange Plan","70.00%","0.694205701351166","No","Yes","No","100%",,"$3,500","$100","$600","$10","$100","$2,500","$0","$0","$1,300","$580","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030010.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030010.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030011","POS Silver 4500","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030011-00","POS Silver 4500","Standard Silver Off Exchange Plan","68.49%","0.678553342819214","No","Yes","No","100%",,"$4,500","$100","$1,000","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030011.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030011.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030011","POS Silver 4500","86584WI003",,"WIN001","WIS001","WIF002","New","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030011-01","POS Silver 4500","Standard Silver On Exchange Plan","68.49%","0.678553342819214","No","Yes","No","100%",,"$4,500","$100","$1,000","$10","$100","$2,500","$0","$0","$1,300","$580","$40","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030011.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030011.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010009","HMO HDHP Bronze 6550","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010009-00","HMO HDHP Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010009-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010009-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040012","HMO HDHP Gold 2000","86584WI004",,"WIN001","WIS001","WIF006","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040012-00","HMO HDHP Gold 2000","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$2,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040012.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040012.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040012","HMO HDHP Gold 2000","86584WI004",,"WIN001","WIS001","WIF006","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040012-01","HMO HDHP Gold 2000","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$2,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040012.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040012.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010009","HMO HDHP Bronze 6550","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010009-01","HMO HDHP Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010009-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010009-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010009","HMO HDHP Bronze 6550","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010009-02","HMO HDHP Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010009-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010009-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040013","HMO HDHP Silver 1500","86584WI004",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040013-00","HMO HDHP Silver 1500","Standard Silver Off Exchange Plan",,"0.706027865409851","Yes","Yes","No","100%",,"$1,500","$0","$2,500","$10","$1,500","$0","$700","$0","$1,500","$0","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040013.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040013.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040013","HMO HDHP Silver 1500","86584WI004",,"WIN001","WIS001","WIF008","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040013-01","HMO HDHP Silver 1500","Standard Silver On Exchange Plan",,"0.706027865409851","Yes","Yes","No","100%",,"$1,500","$0","$2,500","$10","$1,500","$0","$700","$0","$1,500","$0","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040013.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040013.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010009","HMO HDHP Bronze 6550","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010009-03","HMO HDHP Bronze 6550 CSR Limited","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010009-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010009-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040014","HMO HDHP Silver 2200","86584WI004",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040014-00","HMO HDHP Silver 2200","Standard Silver Off Exchange Plan",,"0.718495666980743","Yes","Yes","No","100%",,"$2,200","$0","$1,500","$10","$2,200","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040014.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040014.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010003","HMO HDHP Bronze 5500","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010003-00","HMO HDHP Bronze 5500","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010003-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010003-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010003","HMO HDHP Bronze 5500","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010003-01","HMO HDHP Bronze 5500","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010003-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010003-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040014","HMO HDHP Silver 2200","86584WI004",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040014-01","HMO HDHP Silver 2200","Standard Silver On Exchange Plan",,"0.718495666980743","Yes","Yes","No","100%",,"$2,200","$0","$1,500","$10","$2,200","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040014.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040014.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040015","HMO HDHP Silver 2600","86584WI004",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040015-00","HMO HDHP Silver 2600","Standard Silver Off Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$1,500","$10","$2,600","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040015.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040015.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010003","HMO HDHP Bronze 5500","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010003-02","HMO HDHP Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010003-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010003-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010003","HMO HDHP Bronze 5500","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010003-03","HMO HDHP Bronze 5500 CSR Limited","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010003-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010003-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040015","HMO HDHP Silver 2600","86584WI004",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040015-01","HMO HDHP Silver 2600","Standard Silver On Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$1,500","$10","$2,600","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040015.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040015.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040016","HMO HDHP Silver 3600","86584WI004",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040016-00","HMO HDHP Silver 3600","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$3,600","$10","$3,600","$0","$3,600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040016.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040016.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-00","HMO HDHP Silver 2700","Standard Silver Off Exchange Plan",,"0.680992066860199","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010004-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010004-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-01","HMO HDHP Silver 2700","Standard Silver On Exchange Plan",,"0.680992066860199","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010004-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010004-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040016","HMO HDHP Silver 3600","86584WI004",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040016-01","HMO HDHP Silver 3600","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$3,600","$10","$3,600","$0","$3,600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040016.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040016.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040017","HMO HDHP Bronze 5050","86584WI004",,"WIN001","WIS001","WIF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040017-00","HMO HDHP Bronze 5050","Standard Bronze Off Exchange Plan",,"0.619839489459991","Yes","Yes","No","100%",,"$5,050","$0","$1,400","$10","$5,050","$0","$600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040017.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040017.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-02","HMO HDHP Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010004-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010004-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-03","HMO HDHP Silver 2700 CSR Limited","Limited Cost Sharing Plan Variation",,"0.680992066860199","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010004-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010004-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-04","HMO HDHP Silver 2000 CSR 73","73% AV Level Silver Plan",,"0.739206552505493","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$10","$2,000","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010004-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010004-04.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-05","HMO HDHP Silver 1350 CSR 87","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$1,350","$0","$0","$10","$1,350","$0","$0","$0","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010004-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010004-05.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0040018","HMO HDHP Bronze 6550","86584WI004",,"WIN001","WIS001","WIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","No","Limited to emergency care only","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0040018-01","HMO HDHP Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0040018.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0040018.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030012","POS HDHP Gold 2000","86584WI003",,"WIN001","WIS001","WIF006","New","POS","Gold","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030012-00","POS HDHP Gold 2000","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$2,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030012.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030012.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-06","HMO HDHP Silver 450 CSR 94","94% AV Level Silver Plan",,"0.948019683361053","Yes","Yes","No","100%",,"$450","$0","$0","$10","$450","$0","$0","$0","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010004-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010004-06.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030012","POS HDHP Gold 2000","86584WI003",,"WIN001","WIS001","WIF006","New","POS","Gold","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030012-01","POS HDHP Gold 2000","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$2,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030012.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030012.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-00","HMO HDHP Silver 4000","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$4,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010010-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010010-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-01","HMO HDHP Silver 4000","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$4,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010010-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010010-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030013","POS HDHP Silver 1500","86584WI003",,"WIN001","WIS001","WIF008","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030013-00","POS HDHP Silver 1500","Standard Silver Off Exchange Plan",,"0.706027865409851","Yes","Yes","No","100%",,"$1,500","$0","$2,500","$10","$1,500","$0","$700","$0","$1,500","$0","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030013.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030013.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030013","POS HDHP Silver 1500","86584WI003",,"WIN001","WIS001","WIF008","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030013-01","POS HDHP Silver 1500","Standard Silver On Exchange Plan",,"0.706027865409851","Yes","Yes","No","100%",,"$1,500","$0","$2,500","$10","$1,500","$0","$700","$0","$1,500","$0","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030013.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030013.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-02","HMO HDHP Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010010-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010010-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-03","HMO HDHP Silver 4000 CSR Limited","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$4,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010010-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010010-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030014","POS HDHP Silver 2200","86584WI003",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030014-00","POS HDHP Silver 2200","Standard Silver Off Exchange Plan",,"0.718495666980743","Yes","Yes","No","100%",,"$2,200","$0","$1,500","$10","$2,200","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,400","$14400 per person","$28800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","20.00%",,,,,"$4,400","per person not applicable","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030014.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030014.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030014","POS HDHP Silver 2200","86584WI003",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030014-01","POS HDHP Silver 2200","Standard Silver On Exchange Plan",,"0.718495666980743","Yes","Yes","No","100%",,"$2,200","$0","$1,500","$10","$2,200","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,400","$14400 per person","$28800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","20.00%",,,,,"$4,400","per person not applicable","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030014.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030014.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-04","HMO HDHP Silver 3250 CSR 73","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,250","$0","$0","$10","$3,250","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010010-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010010-04.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-05","HMO HDHP Silver 1350 CSR 87","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$1,350","$0","$0","$10","$1,350","$0","$0","$0","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010010-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010010-05.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030015","POS HDHP Silver 2600","86584WI003",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030015-00","POS HDHP Silver 2600","Standard Silver Off Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$1,500","$10","$2,600","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030015.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030015.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030015","POS HDHP Silver 2600","86584WI003",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030015-01","POS HDHP Silver 2600","Standard Silver On Exchange Plan",,"0.685077726840973","Yes","Yes","No","100%",,"$2,600","$0","$1,500","$10","$2,600","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030015.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030015.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-06","HMO HDHP Silver 450 CSR 94","94% AV Level Silver Plan",,"0.948019683361053","Yes","Yes","No","100%",,"$450","$0","$0","$10","$450","$0","$0","$0","$450","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010010-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010010-06.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020003","POS HDHP Bronze 5500","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020003-00","POS HDHP Bronze 5500","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020003-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020003-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030016","POS HDHP Silver 3600","86584WI003",,"WIN001","WIS001","WIF006","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030016-00","POS HDHP Silver 3600","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$3,600","$10","$3,600","$0","$3,600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030016.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030016.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030016","POS HDHP Silver 3600","86584WI003",,"WIN001","WIS001","WIF006","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030016-01","POS HDHP Silver 3600","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$3,600","$10","$3,600","$0","$3,600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030016.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030016.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020003","POS HDHP Bronze 5500","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020003-01","POS HDHP Bronze 5500","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020003-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020003-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020003","POS HDHP Bronze 5500","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020003-02","POS HDHP Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020003-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020003-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","SHOP (Small Group)","No","36-4832569","86584WI0030017","POS HDHP Bronze 5050","86584WI003",,"WIN001","WIS001","WIF008","New","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01",,"No","Limited to emergency care only","Yes","Services paid at the non-participating provider level","No",,"https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0030017-00","POS HDHP Bronze 5050","Standard Bronze Off Exchange Plan",,"0.619839489459991","Yes","Yes","No","100%",,"$5,050","$0","$1,400","$10","$5,050","$0","$600","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,100","$20100 per person","$40200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","30.00%",,,,,"$10,100","$10100 per person","$20200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0030017.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0030017.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-02","POS HDHP Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020004-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020004-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-03","POS HDHP Silver 2700 CSR Limited","Limited Cost Sharing Plan Variation",,"0.680992066860199","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020004-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020004-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-04","POS HDHP Silver 2000 CSR 73","73% AV Level Silver Plan",,"0.739206552505493","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$10","$2,000","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020004-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020004-04.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-05","POS HDHP Silver 1350 CSR 87","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$1,350","$0","$0","$10","$1,350","$0","$0","$0","$1,350","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020004-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020004-05.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF007","New","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-06","POS HDHP Silver 450 CSR 94","94% AV Level Silver Plan",,"0.948019683361053","Yes","Yes","No","100%",,"$450","$0","$0","$10","$450","$0","$0","$0","$450","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0020004-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0020004-06.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010008","HMO Catastrophic 7150","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010008-00","HMO Catastrophic 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$10","$7,100","$50","$0","$0","$1,700","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010008-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010008-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010008","HMO Catastrophic 7150","86584WI001",,"WIN001","WIS001","WIF006","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010008-01","HMO Catastrophic 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$10","$7,100","$50","$0","$0","$1,700","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010008-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010008-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010011","HMO STANDARD Bronze 6650","86584WI001",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010011-00","HMO STANDARD Bronze 6650","Standard Bronze Off Exchange Plan",,"0.618814051151276","Yes","Yes","No","100%",,"$6,650","$200","$300","$10","$100","$2,400","$100","$0","$1,500","$270","$90","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010011-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010011-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010011","HMO STANDARD Bronze 6650","86584WI001",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010011-01","HMO STANDARD Bronze 6650","Standard Bronze On Exchange Plan",,"0.618814051151276","Yes","Yes","No","100%",,"$6,650","$200","$300","$10","$100","$2,400","$100","$0","$1,500","$270","$90","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010011-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010011-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010011","HMO STANDARD Bronze 6650","86584WI001",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010011-02","HMO STANDARD Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010011-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010011-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010011","HMO STANDARD Bronze 6650","86584WI001",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010011-03","HMO STANDARD Bronze 6650 CSR Limited","Limited Cost Sharing Plan Variation",,"0.618814051151276","Yes","Yes","No","100%",,"$6,650","$200","$300","$10","$100","$2,400","$100","$0","$1,500","$270","$90","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010011-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010011-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010012","HMO STANDARD Silver 3500","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-00","HMO STANDARD Silver 3500","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$1,200","$10","$100","$2,600","$0","$0","$1,300","$650","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010012-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010012-00.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010012","HMO STANDARD Silver 3500","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-01","HMO STANDARD Silver 3500","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$1,200","$10","$100","$2,600","$0","$0","$1,300","$650","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010012-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010012-01.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010012","HMO STANDARD Silver 3500","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-02","HMO STANDARD Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010012-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010012-02.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010012","HMO STANDARD Silver 3500","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-03","HMO STANDARD Silver 3500 CSR Limited","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$1,200","$10","$100","$2,600","$0","$0","$1,300","$650","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010012-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010012-03.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010012","HMO STANDARD Silver 3500","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-04","HMO STANDARD Silver 3000 CSR 73","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,500","$0","$0","$1,300","$550","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010012-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010012-04.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010012","HMO STANDARD Silver 3500","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-05","HMO STANDARD Silver 700 CSR 87","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$10","$100","$1,400","$0","$0","$700","$240","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010012-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010012-05.pdf"
"2017","WI","86584","HIOS","2017-01-21 03:35:28","Individual","No","36-4832569","86584WI0010012","HMO STANDARD Silver 3500","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/premium-payments/","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-06","HMO STANDARD Silver 250 CSR 94","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$1,000","$10","$100","$500","$0","$0","$250","$150","$240","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2017/86584WI0010012-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2017/86584WI0010012-06.pdf"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010020","Envision Aurora Bellin PPO - Gold 1000/90","87416WI001",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010020-00","Envision Aurora Bellin PPO - Gold 1000/90","Standard Gold Off Exchange Plan",,"0.808952152729034","Yes","Yes","No","100%",,"$1,000","$20","$510","$150","$1,000","$610","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold1000-90.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/gold1000-90"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020015","Envision Aurora Bellin PPO - Gold 600/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020015-00","Envision Aurora Bellin PPO - Gold 600/80","Standard Gold Off Exchange Plan",,"0.797857284545898","Yes","Yes","No","100%",,"$600","$20","$1,010","$150","$600","$710","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold600-80G.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020015","Envision Aurora Bellin PPO - Gold 600/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020015-01","Envision Aurora Bellin PPO - Gold 600/80","Standard Gold On Exchange Plan",,"0.797857284545898","Yes","Yes","No","100%",,"$600","$20","$1,010","$150","$600","$710","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold600-80G.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010020","Envision Aurora Bellin PPO - Gold 1000/90","87416WI001",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010020-01","Envision Aurora Bellin PPO - Gold 1000/90","Standard Gold On Exchange Plan",,"0.808952152729034","Yes","Yes","No","100%",,"$1,000","$20","$510","$150","$1,000","$610","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold1000-90.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/gold1000-90"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010020","Envision Aurora Bellin PPO - Gold 1000/90","87416WI001",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010020-02","Envision Aurora Bellin PPO - Gold 1000/90","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold1000-90NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/gold1000-90lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020016","Envision Aurora Bellin PPO - Gold 1000/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020016-00","Envision Aurora Bellin PPO - Gold 1000/80","Standard Gold Off Exchange Plan",,"0.815096080303192","Yes","Yes","No","100%",,"$1,000","$20","$1,010","$150","$1,000","$610","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold1000-80.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold1000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020016","Envision Aurora Bellin PPO - Gold 1000/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020016-01","Envision Aurora Bellin PPO - Gold 1000/80","Standard Gold On Exchange Plan",,"0.815096080303192","Yes","Yes","No","100%",,"$1,000","$20","$1,010","$150","$1,000","$610","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold1000-80.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold1000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010020","Envision Aurora Bellin PPO - Gold 1000/90","87416WI001",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010020-03","Envision Aurora Bellin PPO - Gold 1000/90","Limited Cost Sharing Plan Variation",,"0.808952152729034","Yes","Yes","No","100%",,"$1,000","$20","$510","$150","$1,000","$610","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold1000-90LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/gold1000-90lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3800/80","87416WI001",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010021-00","Envision Aurora Bellin PPO - Silver 3800/80","Standard Silver Off Exchange Plan",,"0.700740575790405","Yes","Yes","No","100%",,"$3,800","$20","$690","$150","$3,800","$390","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","20.00%",,,,,"$11,400","$11400 per person","$22800 per group","$15,200","$15200 per person","$30400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3800-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3800-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020034","Envision Aurora Bellin PPO - Gold 2700/100","87416WI002",,"WIN002","WIS001","WIF014","New","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020034-00","Envision Aurora Bellin PPO - Gold 2700/100","Standard Gold Off Exchange Plan",,"0.816211462020874","Yes","Yes","No","100%",,"$2,700","$0","$0","$150","$2,700","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group",,,,"$10,800","$10800 per person","$21600 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","0.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold2700-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold2700-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020034","Envision Aurora Bellin PPO - Gold 2700/100","87416WI002",,"WIN002","WIS001","WIF014","New","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020034-01","Envision Aurora Bellin PPO - Gold 2700/100","Standard Gold On Exchange Plan",,"0.816211462020874","Yes","Yes","No","100%",,"$2,700","$0","$0","$150","$2,700","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group",,,,"$10,800","$10800 per person","$21600 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","0.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold2700-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold2700-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3800/80","87416WI001",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010021-01","Envision Aurora Bellin PPO - Silver 3800/80","Standard Silver On Exchange Plan",,"0.700740575790405","Yes","Yes","No","100%",,"$3,800","$20","$690","$150","$3,800","$390","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","20.00%",,,,,"$11,400","$11400 per person","$22800 per group","$15,200","$15200 per person","$30400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3800-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3800-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3800/80","87416WI001",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010021-02","Envision Aurora Bellin PPO - Silver 3800/80","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3800-80NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3800-80ncs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010056","Envision Aurora Bellin PPO - Silver 3500/80","87416WI001",,"WIN002","WIS001","WIF008","New","PPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010056-06","Envision Aurora Bellin PPO - Silver 250/80 Standard CSR","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$1,000","$150","$250","$170","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,250","$11250 per person","$22500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,250","$5250 per person","$10500 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0Ded-Copay0CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0ded-copay0csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010057","Envision Aurora Bellin PPO - Silver 5200/80","87416WI001",,"WIN002","WIS001","WIF010","New","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010057-00","Envision Aurora Bellin PPO - Silver 5200/80","Standard Silver Off Exchange Plan","68.12%","0.681154489517212","No","Yes","No","100%",,"$5,220","$0","$410","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$5,200","$5200 per person","$10400 per group","20.00%",,,,,"$15,600","$15600 per person","$31210 per group","$20,800","$20800 per person","$41610 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver5200-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver5200-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020053","Envision Aurora Bellin PPO - Silver 3600/80","87416WI002",,"WIN002","WIS001","WIF011","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020053-00","Envision Aurora Bellin PPO - Silver 3600/80","Standard Silver Off Exchange Plan",,"0.708425402641296","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3600-80.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver3600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020053","Envision Aurora Bellin PPO - Silver 3600/80","87416WI002",,"WIN002","WIS001","WIF011","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020053-01","Envision Aurora Bellin PPO - Silver 3600/80","Standard Silver On Exchange Plan",,"0.708425402641296","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3600-80.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver3600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3800/80","87416WI001",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010021-03","Envision Aurora Bellin PPO - Silver 3800/80","Limited Cost Sharing Plan Variation",,"0.700740575790405","Yes","Yes","No","100%",,"$3,800","$20","$690","$150","$3,800","$390","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","20.00%",,,,,"$11,400","$11400 per person","$22800 per group","$15,200","$15200 per person","$30400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3800-80LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3800-80lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3800/80","87416WI001",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010021-04","Envision Aurora Bellin PPO - Silver 2550/80/Copay35 CSR","73% AV Level Silver Plan",,"0.738036632537842","Yes","Yes","No","100%",,"$2,550","$20","$940","$150","$2,550","$620","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$17,100","$17100 per person","$34200 per group","$22,800","$22800 per person","$45600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,550","$2550 per person","$5100 per group","20.00%",,,,,"$7,650","$7650 per person","$15200 per group","$10,200","$10200 per person","$20300 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2550-80-Copay35CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2550-80-Copay35csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020017","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI002",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020017-00","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","Standard Silver Off Exchange Plan",,"0.717815399169922","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2400-80-Copay35.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2400-80-copay35"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020017","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI002",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020017-01","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","Standard Silver On Exchange Plan",,"0.717815399169922","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2400-80-Copay35.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2400-80-copay35"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3800/80","87416WI001",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010021-05","Envision Aurora Bellin PPO - Silver 0/80/Copay30 CSR","87% AV Level Silver Plan",,"0.879281401634216","Yes","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$700","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0-80-Copay30CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0-80-copay30csr/"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3800/80","87416WI001",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010021-06","Envision Aurora Bellin PPO - Silver 0/80/Copay5 CSR","94% AV Level Silver Plan",,"0.946533679962158","Yes","Yes","No","100%",,"$0","$0","$650","$150","$0","$400","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,650","$5650 per person","$11300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0-80-Copay5CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0-80-copay5csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020008","Empower PPO - Gold 600/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020008-00","Empower PPO - Gold 600/80","Standard Gold Off Exchange Plan",,"0.797857284545898","Yes","Yes","No","100%",,"$600","$20","$1,010","$150","$600","$710","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold600-80G-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020008","Empower PPO - Gold 600/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020008-01","Empower PPO - Gold 600/80","Standard Gold On Exchange Plan",,"0.797857284545898","Yes","Yes","No","100%",,"$600","$20","$1,010","$150","$600","$710","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold600-80G-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010022-00","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","Standard Silver Off Exchange Plan",,"0.713409781455994","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$740","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$7,500","$7500 per person","$15000 per group","$10,000","$10000 per person","$20000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2500-80-Copay35.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2500-80-copay35"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010022-01","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","Standard Silver On Exchange Plan",,"0.713409781455994","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$740","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$7,500","$7500 per person","$15000 per group","$10,000","$10000 per person","$20000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2500-80-Copay35.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2500-80-copay35"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020009","Empower PPO - Gold 1000/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020009-00","Empower PPO - Gold 1000/80","Standard Gold Off Exchange Plan",,"0.815096080303192","Yes","Yes","No","100%",,"$1,000","$20","$1,010","$150","$1,000","$610","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold1000-80-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold1000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020009","Empower PPO - Gold 1000/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020009-01","Empower PPO - Gold 1000/80","Standard Gold On Exchange Plan",,"0.815096080303192","Yes","Yes","No","100%",,"$1,000","$20","$1,010","$150","$1,000","$610","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold1000-80-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold1000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010022-02","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2500-80-Copay35NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2500-80-copay35ncs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010022-03","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","Limited Cost Sharing Plan Variation",,"0.713409781455994","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$740","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$7,500","$7500 per person","$15000 per group","$10,000","$10000 per person","$20000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2500-80-Copay35LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2500-80-copay35lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020037","Empower PPO - Gold 2700/100","87416WI002",,"WIN001","WIS001","WIF014","New","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020037-00","Empower PPO - Gold 2700/100","Standard Gold Off Exchange Plan",,"0.816211462020874","Yes","Yes","No","100%",,"$2,700","$0","$0","$150","$2,700","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group",,,,"$10,800","$10800 per person","$21600 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","0.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold2700-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold2700-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020037","Empower PPO - Gold 2700/100","87416WI002",,"WIN001","WIS001","WIF014","New","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020037-01","Empower PPO - Gold 2700/100","Standard Gold On Exchange Plan",,"0.816211462020874","Yes","Yes","No","100%",,"$2,700","$0","$0","$150","$2,700","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group",,,,"$10,800","$10800 per person","$21600 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","0.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Gold2700-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/gold2700-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010022-04","Envision Aurora Bellin PPO - Silver 2500/Copay30 CSR","73% AV Level Silver Plan",,"0.737617194652557","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$600","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$17,100","$17100 per person","$34200 per group","$22,800","$22800 per person","$45600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$7,500","$7500 per person","$15000 per group","$10,000","$10000 per person","$20000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2500-Copay30CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2500-copay30csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010022-05","Envision Aurora Bellin PPO - Silver 0/Copay25 CSR","87% AV Level Silver Plan",,"0.878930032253265","Yes","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$650","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0-Copay25CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0-copay25csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020033","Empower PPO - Silver 3600/80","87416WI002",,"WIN001","WIS001","WIF011","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020033-00","Empower PPO - Silver 3600/80","Standard Silver Off Exchange Plan",,"0.708425402641296","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3600-80-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver3600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020033","Empower PPO - Silver 3600/80","87416WI002",,"WIN001","WIS001","WIF011","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020033-01","Empower PPO - Silver 3600/80","Standard Silver On Exchange Plan",,"0.708425402641296","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3600-80-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver3600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2500/80/Copay35","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010022-06","Envision Aurora Bellin PPO - Silver 0/Copay5 CSR","94% AV Level Silver Plan",,"0.948858737945557","Yes","Yes","No","100%",,"$0","$0","$650","$150","$0","$750","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,650","$5650 per person","$11300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0-Copay5CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0-copay5csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010056","Envision Aurora Bellin PPO - Silver 3500/80","87416WI001",,"WIN002","WIS001","WIF008","New","PPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010056-00","Envision Aurora Bellin PPO - Silver 3500/80","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$26800 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3500-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3500-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020010","Empower PPO - Silver 2400/80/Copay35","87416WI002",,"WIN001","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020010-00","Empower PPO - Silver 2400/80/Copay35","Standard Silver Off Exchange Plan",,"0.717815399169922","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2400-80-Copay35-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2400-80-copay35"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020010","Empower PPO - Silver 2400/80/Copay35","87416WI002",,"WIN001","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020010-01","Empower PPO - Silver 2400/80/Copay35","Standard Silver On Exchange Plan",,"0.717815399169922","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2400-80-Copay35-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2400-80-copay35"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010056","Envision Aurora Bellin PPO - Silver 3500/80","87416WI001",,"WIN002","WIS001","WIF008","New","PPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010056-01","Envision Aurora Bellin PPO - Silver 3500/80","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3500-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3500-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010056","Envision Aurora Bellin PPO - Silver 3500/80","87416WI001",,"WIN002","WIS001","WIF008","New","PPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010056-02","Envision Aurora Bellin PPO - Silver 3500/80","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3500-80NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3500-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010056","Envision Aurora Bellin PPO - Silver 3500/80","87416WI001",,"WIN002","WIS001","WIF008","New","PPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010056-03","Envision Aurora Bellin PPO - Silver 3500/80","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3500-80LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3500-80lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010056","Envision Aurora Bellin PPO - Silver 3500/80","87416WI001",,"WIN002","WIS001","WIF008","New","PPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010056-04","Envision Aurora Bellin PPO - Silver 3000/80 Standard CSR","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$17,100","$17100 per person","$34200 per group","$22,800","$22800 per person","$45600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3000-80StandardCSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver3000-80standardcsr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010056","Envision Aurora Bellin PPO - Silver 3500/80","87416WI001",,"WIN002","WIS001","WIF008","New","PPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010056-05","Envision Aurora Bellin PPO - Silver 700/80 Standard CSR","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,010","$150","$700","$280","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,700","$5700 per person","$11400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver700-80StandardCSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver700-80standardcsr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010057","Envision Aurora Bellin PPO - Silver 5200/80","87416WI001",,"WIN002","WIS001","WIF010","New","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010057-01","Envision Aurora Bellin PPO - Silver 5200/80","Standard Silver On Exchange Plan","68.12%","0.681154489517212","No","Yes","No","100%",,"$5,220","$0","$410","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$5,200","$5200 per person","$10400 per group","20.00%",,,,,"$15,600","$15600 per person","$31210 per group","$20,800","$20800 per person","$41610 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver5200-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver5200-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010057","Envision Aurora Bellin PPO - Silver 5200/80","87416WI001",,"WIN002","WIS001","WIF010","New","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010057-02","Envision Aurora Bellin PPO - Silver 5200/80","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver5200-80NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver5200-80ncs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010057","Envision Aurora Bellin PPO - Silver 5200/80","87416WI001",,"WIN002","WIS001","WIF010","New","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010057-03","Envision Aurora Bellin PPO - Silver 5200/80","Limited Cost Sharing Plan Variation","68.12%","0.681154489517212","No","Yes","No","100%",,"$5,220","$0","$410","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$5,200","$5200 per person","$10400 per group","20.00%",,,,,"$15,600","$15600 per person","$31210 per group","$20,800","$20800 per person","$41610 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver5200-80LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver5200-80lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010057","Envision Aurora Bellin PPO - Silver 5200/80","87416WI001",,"WIN002","WIS001","WIF010","New","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010057-04","Envision Aurora Bellin PPO - Silver $2600/Copay30 CSR","73% AV Level Silver Plan","73.95%","0.739494264125824","No","Yes","No","100%",,"$2,600","$20","$930","$150","$2,600","$360","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$17,100","$17100 per person","$34200 per group","$22,800","$22800 per person","$45600 per group","$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$7,800","$7800 per person","$15600 per group","$10,400","$10400 per person","$20800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2600-Copay30CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2600-copay30csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010057","Envision Aurora Bellin PPO - Silver 5200/80","87416WI001",,"WIN002","WIS001","WIF010","New","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010057-05","Envision Aurora Bellin PPO - Silver $0Ded/Copay25 CSR","87% AV Level Silver Plan","87.94%","0.884591400623322","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$650","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$10,000","$10000 per person","$20000 per group","$12,350","$12350 per person","$24700 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0Ded-Copay25CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0ded-copay25csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010057","Envision Aurora Bellin PPO - Silver 5200/80","87416WI001",,"WIN002","WIS001","WIF010","New","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010057-06","Envision Aurora Bellin PPO - Silver $0Ded/Copay$0 CSR","94% AV Level Silver Plan","94.99%","0.96385669708252","No","Yes","No","100%",,"$0","$0","$700","$150","$0","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$10,000","$10000 per person","$20000 per group","$10,700","$10700 per person","$21400 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0Ded-Copay0CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0ded-copay0csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010023-00","Envision Aurora Bellin PPO - Silver 2400/80","Standard Silver Off Exchange Plan",,"0.688966870307922","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$7,200","$7200 per person","$14000 per group","$9,600","$9600 per person","$18800 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2400-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2400-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020050","Envision Aurora Bellin PPO - HSA Gold 2300/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020050-00","Envision Aurora Bellin PPO - HSA Gold 2300/100","Standard Gold Off Exchange Plan",,"0.794665277004242","Yes","Yes","No","100%",,"$2,300","$0","$0","$150","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$9,200","$18400 per person","$18400 per group","$11,500","$23000 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0.00%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSAGold2300-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsagold2300-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020050","Envision Aurora Bellin PPO - HSA Gold 2300/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020050-01","Envision Aurora Bellin PPO - HSA Gold 2300/100","Standard Gold On Exchange Plan",,"0.794665277004242","Yes","Yes","No","100%",,"$2,300","$0","$0","$150","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$9,200","$18400 per person","$18400 per group","$11,500","$23000 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0.00%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSAGold2300-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsagold2300-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010023-01","Envision Aurora Bellin PPO - Silver 2400/80","Standard Silver On Exchange Plan",,"0.688966870307922","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$7,200","$7200 per person","$14000 per group","$9,600","$9600 per person","$18800 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2400-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2400-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010023-02","Envision Aurora Bellin PPO - Silver 2400/80","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2400-80NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2400-80ncs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020035","Envision Aurora Bellin PPO - HSA Silver 3600/100","87416WI002",,"WIN002","WIS001","WIF001","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020035-00","Envision Aurora Bellin PPO - HSA Silver 3600/100","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3600-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver3600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020035","Envision Aurora Bellin PPO - HSA Silver 3600/100","87416WI002",,"WIN002","WIS001","WIF001","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020035-01","Envision Aurora Bellin PPO - HSA Silver 3600/100","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3600-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver3600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010023-03","Envision Aurora Bellin PPO - Silver 2400/80","Limited Cost Sharing Plan Variation",,"0.688966870307922","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$7,200","$7200 per person","$14000 per group","$9,600","$9600 per person","$18800 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2400-80LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2400-80lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010023-04","Envision Aurora Bellin PPO - Silver 1700/80 CSR","73% AV Level Silver Plan",,"0.734653055667877","Yes","Yes","No","100%",,"$1,700","$0","$1,120","$150","$1,700","$0","$710","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$17,100","$17100 per person","$34200 per group","$22,800","$22800 per person","$45600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%",,,,,"$5,100","$5100 per person","$10200 per group","$6,800","$6800 per person","$13600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver1700-80CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver1700-80csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020018","Envision Aurora Bellin PPO - Silver 2600/80","87416WI002",,"WIN002","WIS001","WIF013","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020018-00","Envision Aurora Bellin PPO - Silver 2600/80","Standard Silver Off Exchange Plan",,"0.695583462715149","Yes","Yes","No","100%",,"$2,600","$20","$930","$150","$2,600","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$25550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2600-80.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020018","Envision Aurora Bellin PPO - Silver 2600/80","87416WI002",,"WIN002","WIS001","WIF013","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020018-01","Envision Aurora Bellin PPO - Silver 2600/80","Standard Silver On Exchange Plan",,"0.695583462715149","Yes","Yes","No","100%",,"$2,600","$20","$930","$150","$2,600","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$25550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2600-80.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010023-05","Envision Aurora Bellin PPO - Silver 200/80 CSR","87% AV Level Silver Plan",,"0.877864420413971","Yes","Yes","No","100%",,"$200","$0","$1,420","$150","$200","$0","$1,010","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,250","$7250 per person","$14500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,700","$2700 per person","$5400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver200-80CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver200-80csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010023-06","Envision Aurora Bellin PPO - Silver 0/80 CSR","94% AV Level Silver Plan",,"0.936284184455872","Yes","Yes","No","100%",,"$0","$0","$830","$150","$0","$0","$830","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$830","$830 per person","$1660 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,830","$5830 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0-80CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0-80csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020019","Envision Aurora Bellin PPO - Silver 2000/80","87416WI002",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020019-00","Envision Aurora Bellin PPO - Silver 2000/80","Standard Silver Off Exchange Plan",,"0.713272213935852","Yes","Yes","No","100%",,"$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2000-80.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020019","Envision Aurora Bellin PPO - Silver 2000/80","87416WI002",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020019-01","Envision Aurora Bellin PPO - Silver 2000/80","Standard Silver On Exchange Plan",,"0.713272213935852","Yes","Yes","No","100%",,"$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2000-80.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 2000/70","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010024-00","Envision Aurora Bellin PPO - Silver 2000/70","Standard Silver Off Exchange Plan",,"0.690965414047241","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$290","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2000-70.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2000-70"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 2000/70","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010024-01","Envision Aurora Bellin PPO - Silver 2000/70","Standard Silver On Exchange Plan",,"0.690965414047241","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$290","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2000-70.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2000-70"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020051","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI002",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020051-00","Envision Aurora Bellin PPO - HSA Silver 3000/80","Standard Silver Off Exchange Plan",,"0.698762774467468","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver3000-80G.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsasilver3000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020051","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI002",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020051-01","Envision Aurora Bellin PPO - HSA Silver 3000/80","Standard Silver On Exchange Plan",,"0.698762774467468","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver3000-80G.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsasilver3000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 2000/70","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010024-02","Envision Aurora Bellin PPO - Silver 2000/70","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2000-70NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2000-70ncs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 2000/70","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010024-03","Envision Aurora Bellin PPO - Silver 2000/70","Limited Cost Sharing Plan Variation",,"0.690965414047241","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$290","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2000-70LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver2000-70lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020052","Envision Aurora Bellin PPO - HSA Bronze 5800/90","87416WI002",,"WIN002","WIS001","WIF012","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020052-00","Envision Aurora Bellin PPO - HSA Bronze 5800/90","Standard Bronze Off Exchange Plan",,"0.619840681552887","Yes","Yes","No","100%",,"$5,800","$0","$160","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","10.00%",,,,,"$11,600","$11600 per person","$23200 per group","$17,400","$17400 per person","$34800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SOB/HSABronze5800-90.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsabronze5800-90"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020052","Envision Aurora Bellin PPO - HSA Bronze 5800/90","87416WI002",,"WIN002","WIS001","WIF012","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020052-01","Envision Aurora Bellin PPO - HSA Bronze 5800/90","Standard Bronze On Exchange Plan",,"0.619840681552887","Yes","Yes","No","100%",,"$5,800","$0","$160","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","10.00%",,,,,"$11,600","$11600 per person","$23200 per group","$17,400","$17400 per person","$34800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze5800-90.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsabronze5800-90"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 2000/70","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010024-04","Envision Aurora Bellin PPO - Silver 1200/10Rx CSR","73% AV Level Silver Plan",,"0.738883554935455","Yes","Yes","No","100%",,"$1,200","$20","$1,820","$150","$1,200","$360","$470","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$17,100","$17100 per person","$34200 per group","$22,800","$22800 per person","$45600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","30.00%",,,,,"$3,600","$3600 per person","$7200 per group","$4,800","$4800 per person","$9600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver1200-10RxCSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver1200-10rxcsr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 2000/70","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010024-05","Envision Aurora Bellin PPO - Silver 175/10Rx CSR","87% AV Level Silver Plan",,"0.879011929035187","Yes","Yes","No","100%",,"$180","$20","$1,420","$150","$180","$400","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,250","$7250 per person","$14500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,675","$2675 per person","$5350 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver175-10RxCSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver175-10rxcsr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020036","Envision Aurora Bellin PPO - HSA Bronze 6400/100","87416WI002",,"WIN002","WIS001","WIF001","New","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020036-00","Envision Aurora Bellin PPO - HSA Bronze 6400/100","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$1,500","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,600","$25600 per person","$51200 per group","$32,000","$32000 per person","$64000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze6400-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsabronze6400-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020036","Envision Aurora Bellin PPO - HSA Bronze 6400/100","87416WI002",,"WIN002","WIS001","WIF001","New","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020036-01","Envision Aurora Bellin PPO - HSA Bronze 6400/100","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$1,500","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,600","$25600 per person","$51200 per group","$32,000","$32000 per person","$64000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze6400-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsabronze6400-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 2000/70","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010024-06","Envision Aurora Bellin PPO - Silver 0/5Rx CSR","94% AV Level Silver Plan",,"0.948881447315216","Yes","Yes","No","100%",,"$0","$0","$600","$150","$0","$150","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,600","$5600 per person","$11200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver0-5RxCSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/silver0-5rxcsr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010050-00","Envision Aurora Bellin PPO - HSA Silver 3000/80","Standard Silver Off Exchange Plan",,"0.680183172225952","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$16,800","$16800 per person","$33600 per group","$22,400","$22400 per person","$44800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver3000-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsasilver3000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020030","Empower PPO - HSA Gold 2300/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020030-00","Empower PPO - HSA Gold 2300/100","Standard Gold Off Exchange Plan",,"0.794665277004242","Yes","Yes","No","100%",,"$2,300","$0","$0","$150","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$9,200","$18400 per person","$18400 per group","$11,500","$23000 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0.00%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSAGold2300-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsagold2300-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020030","Empower PPO - HSA Gold 2300/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020030-01","Empower PPO - HSA Gold 2300/100","Standard Gold On Exchange Plan",,"0.794665277004242","Yes","Yes","No","100%",,"$2,300","$0","$0","$150","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$9,200","$18400 per person","$18400 per group","$11,500","$23000 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0.00%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSAGold2300-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsagold2300-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010050-01","Envision Aurora Bellin PPO - HSA Silver 3000/80","Standard Silver On Exchange Plan",,"0.680183172225952","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$16,800","$16800 per person","$33600 per group","$22,400","$22400 per person","$44800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver3000-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsasilver3000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010050-02","Envision Aurora Bellin PPO - HSA Silver 3000/80","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver3000-80NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsasilver3000-80ncs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020038","Empower PPO - HSA Silver 3600/100","87416WI002",,"WIN001","WIS001","WIF001","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020038-00","Empower PPO - HSA Silver 3600/100","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3600-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver3600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020038","Empower PPO - HSA Silver 3600/100","87416WI002",,"WIN001","WIS001","WIF001","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020038-01","Empower PPO - HSA Silver 3600/100","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver3600-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver3600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010050-03","Envision Aurora Bellin PPO - HSA Silver 3000/80","Limited Cost Sharing Plan Variation",,"0.680183172225952","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$16,800","$16800 per person","$33600 per group","$22,400","$22400 per person","$44800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver3000-80LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsasilver3000-80lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010050-04","Envision Aurora Bellin PPO - HSA Silver 1900/80 CSR","73% AV Level Silver Plan",,"0.732023596763611","Yes","Yes","No","100%",,"$1,900","$0","$1,080","$150","$1,900","$0","$670","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20.00%",,,,,"$5,700","$5700 per person","$11400 per group","$7,600","$7600 per person","$15200 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver1900-80CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsasilver1900-80csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020011","Empower PPO - Silver 2600/80","87416WI002",,"WIN001","WIS001","WIF013","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020011-00","Empower PPO - Silver 2600/80","Standard Silver Off Exchange Plan",,"0.695583462715149","Yes","Yes","No","100%",,"$2,600","$20","$930","$150","$2,600","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$25550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2600-80-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020011","Empower PPO - Silver 2600/80","87416WI002",,"WIN001","WIS001","WIF013","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020011-01","Empower PPO - Silver 2600/80","Standard Silver On Exchange Plan",,"0.695583462715149","Yes","Yes","No","100%",,"$2,600","$20","$930","$150","$2,600","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$25550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2600-80-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2600-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010050-05","Envision Aurora Bellin PPO - HSA Silver 250/80 CSR","87% AV Level Silver Plan",,"0.87397700548172","Yes","Yes","No","100%",,"$250","$0","$1,410","$150","$250","$0","$1,000","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4700 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,250","$7250 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,750","$2750 per person","$5500 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver250-80CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsasilver250-80csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010050-06","Envision Aurora Bellin PPO - HSA Silver 50/80 CSR","94% AV Level Silver Plan",,"0.934796154499054","Yes","Yes","No","100%",,"$50","$0","$750","$150","$50","$0","$750","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,550","$2550 per person","$5100 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver50-80CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsasilver50-80csr"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020012","Empower PPO - Silver 2000/80","87416WI002",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020012-00","Empower PPO - Silver 2000/80","Standard Silver Off Exchange Plan",,"0.713272213935852","Yes","Yes","No","100%",,"$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2000-80-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020012","Empower PPO - Silver 2000/80","87416WI002",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020012-01","Empower PPO - Silver 2000/80","Standard Silver On Exchange Plan",,"0.713272213935852","Yes","Yes","No","100%",,"$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Silver2000-80-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/silver2000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010051","Envision Aurora Bellin PPO - HSA Bronze 6500/100","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010051-00","Envision Aurora Bellin PPO - HSA Bronze 6500/100","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$39,000","$39000 per person","$78000 per group","$45,500","$45500 per person","$91000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$19,500","$19500 per person","$39000 per group","$26,000","$26000 per person","$52000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze6500-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsabronze6500-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010051","Envision Aurora Bellin PPO - HSA Bronze 6500/100","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010051-01","Envision Aurora Bellin PPO - HSA Bronze 6500/100","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$39,000","$39000 per person","$78000 per group","$45,500","$45500 per person","$91000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$19,500","$19500 per person","$39000 per group","$26,000","$26000 per person","$52000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze6500-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsabronze6500-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020031","Empower PPO - HSA Silver 3000/80","87416WI002",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020031-00","Empower PPO - HSA Silver 3000/80","Standard Silver Off Exchange Plan",,"0.698762774467468","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver3000-80G-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsasilver3000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020031","Empower PPO - HSA Silver 3000/80","87416WI002",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020031-01","Empower PPO - HSA Silver 3000/80","Standard Silver On Exchange Plan",,"0.698762774467468","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSASilver3000-80G-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsasilver3000-80"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010051","Envision Aurora Bellin PPO - HSA Bronze 6500/100","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010051-02","Envision Aurora Bellin PPO - HSA Bronze 6500/100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze6500-100NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsabronze6500-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010051","Envision Aurora Bellin PPO - HSA Bronze 6500/100","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010051-03","Envision Aurora Bellin PPO - HSA Bronze 6500/100","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$39,000","$39000 per person","$78000 per group","$45,500","$45500 per person","$91000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$19,500","$19500 per person","$39000 per group","$26,000","$26000 per person","$52000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze6500-100LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/hsabronze6500-100lcs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020032","Empower PPO - HSA Bronze 5800/90","87416WI002",,"WIN001","WIS001","WIF012","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020032-00","Empower PPO - HSA Bronze 5800/90","Standard Bronze Off Exchange Plan",,"0.619840681552887","Yes","Yes","No","100%",,"$5,800","$0","$160","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","10.00%",,,,,"$11,600","$11600 per person","$23200 per group","$17,400","$17400 per person","$34800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze5800-90-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsabronze5800-90"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020032","Empower PPO - HSA Bronze 5800/90","87416WI002",,"WIN001","WIS001","WIF012","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020032-01","Empower PPO - HSA Bronze 5800/90","Standard Bronze On Exchange Plan",,"0.619840681552887","Yes","Yes","No","100%",,"$5,800","$0","$160","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","10.00%",,,,,"$11,600","$11600 per person","$23200 per group","$17,400","$17400 per person","$34800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze5800-90-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsabronze5800-90"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020039","Empower PPO - HSA Bronze 6400/100","87416WI002",,"WIN001","WIS001","WIF001","New","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020039-00","Empower PPO - HSA Bronze 6400/100","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$1,500","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,600","$25600 per person","$51200 per group","$32,000","$32000 per person","$64000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze6400-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsabronze6400-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020039","Empower PPO - HSA Bronze 6400/100","87416WI002",,"WIN001","WIS001","WIF001","New","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020039-01","Empower PPO - HSA Bronze 6400/100","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$1,500","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,600","$25600 per person","$51200 per group","$32,000","$32000 per person","$64000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/HSABronze6400-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/hsabronze6400-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020021","Envision Aurora Bellin PPO - Bronze 7000/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020021-00","Envision Aurora Bellin PPO - Bronze 7000/100","Standard Bronze Off Exchange Plan",,"0.619867742061615","Yes","Yes","No","100%",,"$7,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Bronze7000-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/bronze7000-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010026","Envision Aurora Bellin PPO - Catastrophic 7150/100","87416WI001",,"WIN002","WIS001","WIF010","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010026-00","Envision Aurora Bellin PPO - Catastrophic 7150/100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$42,900","$42900 per person","$85800 per group","$50,050","$50050 per person","$100100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Catastrophic7150-100.pdf","http://www.commongroundhealthcare.org/our-plans/2016-individuals-families/catastrophic7150-100/"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010026","Envision Aurora Bellin PPO - Catastrophic 7150/100","87416WI001",,"WIN002","WIS001","WIF010","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010026-01","Envision Aurora Bellin PPO - Catastrophic 7150/100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$42,900","$42900 per person","$85800 per group","$50,050","$50050 per person","$100100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Catastrophic7150-100.pdf","http://www.commongroundhealthcare.org/our-plans/2016-individuals-families/catastrophic7150-100/"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020021","Envision Aurora Bellin PPO - Bronze 7000/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020021-01","Envision Aurora Bellin PPO - Bronze 7000/100","Standard Bronze On Exchange Plan",,"0.619867742061615","Yes","Yes","No","100%",,"$7,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Bronze7000-100.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/bronze7000-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020014","Empower PPO - Bronze 7000/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020014-00","Empower PPO - Bronze 7000/100","Standard Bronze Off Exchange Plan",,"0.619867742061615","Yes","Yes","No","100%",,"$7,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Bronze7000-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/bronze7000-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010027","Envision Aurora Bellin PPO - Bronze 7150/100","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010027-00","Envision Aurora Bellin PPO - Bronze 7150/100","Standard Bronze Off Exchange Plan",,"0.615442454814911","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$42,900","$42900 per person","$85800 per group","$50,050","$50050 per person","$100100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Bronze7150-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/bronze7150-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010027","Envision Aurora Bellin PPO - Bronze 7150/100","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010027-01","Envision Aurora Bellin PPO - Bronze 7150/100","Standard Bronze On Exchange Plan",,"0.615442454814911","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$42,900","$42900 per person","$85800 per group","$50,050","$50050 per person","$100100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Bronze7150-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/bronze7150-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","SHOP (Small Group)","No","45-3309488","87416WI0020014","Empower PPO - Bronze 7000/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0020014-01","Empower PPO - Bronze 7000/100","Standard Bronze On Exchange Plan",,"0.619867742061615","Yes","Yes","No","100%",,"$7,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Bronze7000-100-Empower.pdf","http://www.commongroundhealthcare.org/our-plans/small-businesses/bronze7000-100"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010027","Envision Aurora Bellin PPO - Bronze 7150/100","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010027-02","Envision Aurora Bellin PPO - Bronze 7150/100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Bronze7150-100NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/bronze7150-100ncs"
"2017","WI","87416","HIOS","2017-01-25 02:20:17","Individual","No","45-3309488","87416WI0010027","Envision Aurora Bellin PPO - Bronze 7150/100","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2017-01-01",,"Yes","Emergency Services Only","Yes","Out of Network","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/Formulary.pdf","87416WI0010027-03","Envision Aurora Bellin PPO - Bronze 7150/100","Limited Cost Sharing Plan Variation",,"0.615442454814911","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$42,900","$42900 per person","$85800 per group","$50,050","$50050 per person","$100100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2017/SBC/Bronze7150-100LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/bronze7150-100lcs"
"2017","WI","90028","HIOS","2016-06-24 02:40:05","SHOP (Small Group)","Yes","39-0138065","90028WI0450003","Anthem Dental Family","90028WI045",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0450003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215732.pdf",
"2017","WI","90028","HIOS","2016-06-24 02:40:05","Individual","Yes","39-0138065","90028WI0420005","Anthem Dental Family Value","90028WI042",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0420005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215734.pdf",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050004","Gold $3500 - 0%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050004-02","Gold $3500 - 0%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZG&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070008","Silver $3000 - 0%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070008-00","Silver $3000 - 0%","Standard Silver Off Exchange Plan",,"0.70733255147934","No","Yes","No","100%",,"$5,080","$20","$0","$150","$3,000","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2017&state=WI",
"2017","WI","90028","HIOS","2016-06-24 02:40:05","Individual","Yes","39-0138065","90028WI0480005","Anthem Dental Family Value","90028WI048",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0480005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215734.pdf",
"2017","WI","90028","HIOS","2016-06-24 02:40:05","Individual","Yes","39-0138065","90028WI0420003","Anthem Dental Family","90028WI042",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0420003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215732.pdf",
"2017","WI","90028","HIOS","2016-06-24 02:40:05","SHOP (Small Group)","Yes","39-0138065","90028WI0450004","Anthem Dental Family Enhanced","90028WI045",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0450004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215733.pdf",
"2017","WI","90028","HIOS","2016-06-24 02:40:05","Individual","Yes","39-0138065","90028WI0480003","Anthem Dental Family","90028WI048",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0480003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215732.pdf",
"2017","WI","90028","HIOS","2016-06-24 02:40:05","Individual","Yes","39-0138065","90028WI0420004","Anthem Dental Family Enhanced","90028WI042",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0420004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215733.pdf",
"2017","WI","90028","HIOS","2016-06-24 02:40:05","Individual","Yes","39-0138065","90028WI0480004","Anthem Dental Family Enhanced","90028WI048",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0480004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215733.pdf",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050001","Platinum $1000 - 0%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050001-00","Platinum $1000 - 0%","Standard Platinum Off Exchange Plan",,"0.914452254772186","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070001","Platinum $1000 - 0% $30 OV","91058WI007",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070001-00","Platinum $1000 - 0% $30 OV","Standard Platinum Off Exchange Plan",,"0.918217182159424","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070001","Platinum $1000 - 0% $30 OV","91058WI007",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070001-01","Platinum $1000 - 0% $30 OV","Standard Platinum On Exchange Plan",,"0.918217182159424","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050001","Platinum $1000 - 0%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050001-01","Platinum $1000 - 0%","Standard Platinum On Exchange Plan",,"0.914452254772186","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050001","Platinum $1000 - 0%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050001-02","Platinum $1000 - 0%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZC&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070002","Platinum $500 - 20% $15 OV","91058WI007",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070002-00","Platinum $500 - 20% $15 OV","Standard Platinum Off Exchange Plan",,"0.897733211517334","No","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$340","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070002","Platinum $500 - 20% $15 OV","91058WI007",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070002-01","Platinum $500 - 20% $15 OV","Standard Platinum On Exchange Plan",,"0.897733211517334","No","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$340","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050001","Platinum $1000 - 0%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050001-03","Platinum $1000 - 0%","Limited Cost Sharing Plan Variation",,"0.914452254772186","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZD&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050002","Platinum $500 - 20%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050002-00","Platinum $500 - 20%","Standard Platinum Off Exchange Plan",,"0.916596114635468","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070003","Gold $2500 - 0%","91058WI007",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070003-00","Gold $2500 - 0%","Standard Gold Off Exchange Plan",,"0.797847390174866","No","Yes","No","100%",,"$2,500","$0","$0","$150","$2,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070003","Gold $2500 - 0%","91058WI007",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070003-01","Gold $2500 - 0%","Standard Gold On Exchange Plan",,"0.797847390174866","No","Yes","No","100%",,"$2,500","$0","$0","$150","$2,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050002","Platinum $500 - 20%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050002-01","Platinum $500 - 20%","Standard Platinum On Exchange Plan",,"0.916596114635468","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050002","Platinum $500 - 20%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050002-02","Platinum $500 - 20%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZA&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070004","Gold $2000 - 20% $50 OV","91058WI007",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070004-00","Gold $2000 - 20% $50 OV","Standard Gold Off Exchange Plan",,"0.784634828567505","No","Yes","No","100%",,"$3,500","$0","$0","$150","$2,000","$380","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070004","Gold $2000 - 20% $50 OV","91058WI007",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070004-01","Gold $2000 - 20% $50 OV","Standard Gold On Exchange Plan",,"0.784634828567505","No","Yes","No","100%",,"$3,500","$0","$0","$150","$2,000","$380","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050002","Platinum $500 - 20%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050002-03","Platinum $500 - 20%","Limited Cost Sharing Plan Variation",,"0.916596114635468","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZB&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050003","Gold $1750 - 30%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050003-00","Gold $1750 - 30%","Standard Gold Off Exchange Plan",,"0.814589083194733","No","Yes","No","100%",,"$3,250","$0","$0","$150","$1,750","$290","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070005","Silver $4250 - 20%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070005-00","Silver $4250 - 20%","Standard Silver Off Exchange Plan",,"0.682744443416595","No","Yes","No","100%",,"$5,250","$0","$0","$150","$4,250","$120","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070005","Silver $4250 - 20%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070005-01","Silver $4250 - 20%","Standard Silver On Exchange Plan",,"0.682744443416595","No","Yes","No","100%",,"$5,250","$0","$0","$150","$4,250","$120","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050003","Gold $1750 - 30%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050003-01","Gold $1750 - 30%","Standard Gold On Exchange Plan",,"0.814589083194733","No","Yes","No","100%",,"$3,250","$0","$0","$150","$1,750","$290","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050003","Gold $1750 - 30%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050003-02","Gold $1750 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZE&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070006","Silver $3500- 30% $50 OV","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070006-00","Silver $3500- 30% $50 OV","Standard Silver Off Exchange Plan",,"0.692452907562256","No","Yes","No","100%",,"$5,580","$20","$500","$150","$3,500","$220","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070006","Silver $3500- 30% $50 OV","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070006-01","Silver $3500- 30% $50 OV","Standard Silver On Exchange Plan",,"0.692452907562256","No","Yes","No","100%",,"$5,580","$20","$500","$150","$3,500","$220","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050003","Gold $1750 - 30%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050003-03","Gold $1750 - 30%","Limited Cost Sharing Plan Variation",,"0.814589083194733","No","Yes","No","100%",,"$3,250","$0","$0","$150","$1,750","$290","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZF&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050004","Gold $3500 - 0%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050004-00","Gold $3500 - 0%","Standard Gold Off Exchange Plan",,"0.793259859085083","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070007","Silver $600 - 50%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070007-00","Silver $600 - 50%","Standard Silver Off Exchange Plan",,"0.718833148479462","No","Yes","No","100%",,"$1,200","$20","$2,060","$150","$600","$360","$1,090","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070007","Silver $600 - 50%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070007-01","Silver $600 - 50%","Standard Silver On Exchange Plan",,"0.718833148479462","No","Yes","No","100%",,"$1,200","$20","$2,060","$150","$600","$360","$1,090","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050004","Gold $3500 - 0%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050004-01","Gold $3500 - 0%","Standard Gold On Exchange Plan",,"0.793259859085083","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070008","Silver $3000 - 0%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070008-01","Silver $3000 - 0%","Standard Silver On Exchange Plan",,"0.70733255147934","No","Yes","No","100%",,"$5,080","$20","$0","$150","$3,000","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050004","Gold $3500 - 0%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050004-03","Gold $3500 - 0%","Limited Cost Sharing Plan Variation",,"0.793259859085083","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZH&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-00","Silver $2500 - 50%","Standard Silver Off Exchange Plan",,"0.71814501285553","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-01","Silver $2500 - 50%","Standard Silver On Exchange Plan",,"0.71814501285553","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0080003","Bronze HSA $5250 - 30%","91058WI008",,"WIN001","WIS001","WIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080003-00","Bronze HSA $5250 - 30%","Standard Bronze Off Exchange Plan",,"0.617813110351563","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,250","$0","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$6550 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0080003","Bronze HSA $5250 - 30%","91058WI008",,"WIN001","WIS001","WIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080003-01","Bronze HSA $5250 - 30%","Standard Bronze On Exchange Plan",,"0.617813110351563","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,250","$0","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$6550 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050008","Bronze $3750 - 50%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050008-02","Bronze $3750 - 50%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZQ&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050008","Bronze $3750 - 50%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050008-03","Bronze $3750 - 50%","Limited Cost Sharing Plan Variation",,"0.612308979034424","No","Yes","No","100%",,"$5,830","$20","$710","$150","$3,750","$380","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZR&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-02","Silver $2500 - 50%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZK&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050005","Silver $4000 - 10%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-00","Silver $4000 - 10%","Standard Silver Off Exchange Plan",,"0.695141017436981","No","Yes","No","100%",,"$6,000","$0","$0","$150","$4,000","$180","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070009","Bronze $5500 - 10%","91058WI007",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070009-00","Bronze $5500 - 10%","Standard Bronze Off Exchange Plan",,"0.582977712154388","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070009","Bronze $5500 - 10%","91058WI007",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070009-01","Bronze $5500 - 10%","Standard Bronze On Exchange Plan",,"0.582977712154388","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050005","Silver $4000 - 10%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-01","Silver $4000 - 10%","Standard Silver On Exchange Plan",,"0.695141017436981","No","Yes","No","100%",,"$6,000","$0","$0","$150","$4,000","$180","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050005","Silver $4000 - 10%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-02","Silver $4000 - 10%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZM&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070010","Bronze $7000- 0%","91058WI007",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070010-00","Bronze $7000- 0%","Standard Bronze Off Exchange Plan",,"0.591358125209808","No","Yes","No","100%",,"$7,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0070010","Bronze $7000- 0%","91058WI007",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070010-01","Bronze $7000- 0%","Standard Bronze On Exchange Plan",,"0.591358125209808","No","Yes","No","100%",,"$7,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050005","Silver $4000 - 10%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-03","Silver $4000 - 10%","Limited Cost Sharing Plan Variation",,"0.695141017436981","No","Yes","No","100%",,"$6,000","$0","$0","$150","$4,000","$180","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZN&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050005","Silver $4000 - 10%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-04","Silver $4000 - 10%","73% AV Level Silver Plan",,"0.73552018404007","No","Yes","No","100%",,"$5,250","$0","$0","$150","$3,250","$230","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=9S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0080001","Silver HSA $3000 - 20%","91058WI008",,"WIN001","WIS001","WIF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080001-00","Silver HSA $3000 - 20%","Standard Silver Off Exchange Plan",,"0.698762774467468","Yes","Yes","No","100%",,"$4,500","$0","$0","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6550 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0080001","Silver HSA $3000 - 20%","91058WI008",,"WIN001","WIS001","WIF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080001-01","Silver HSA $3000 - 20%","Standard Silver On Exchange Plan",,"0.698762774467468","Yes","Yes","No","100%",,"$4,500","$0","$0","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6550 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050005","Silver $4000 - 10%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-05","Silver $4000 - 10%","87% AV Level Silver Plan",,"0.873995244503021","No","Yes","No","100%",,"$1,750","$0","$0","$150","$1,250","$260","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050005","Silver $4000 - 10%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-06","Silver $4000 - 10%","94% AV Level Silver Plan",,"0.944267988204956","No","Yes","No","100%",,"$500","$0","$250","$150","$250","$200","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=7S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0080002","Bronze HSA $4400 - 50%","91058WI008",,"WIN001","WIS001","WIF010","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080002-00","Bronze HSA $4400 - 50%","Standard Bronze Off Exchange Plan",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0080002","Bronze HSA $4400 - 50%","91058WI008",,"WIN001","WIS001","WIF010","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080002-01","Bronze HSA $4400 - 50%","Standard Bronze On Exchange Plan",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-03","Silver $2500 - 50%","Limited Cost Sharing Plan Variation",,"0.71814501285553","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZL&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0080004","Bronze HSA $6550  - 0%","91058WI008",,"WIN001","WIS001","WIF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080004-00","Bronze HSA $6550  - 0%","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","SHOP (Small Group)","No","39-1807071","91058WI0080004","Bronze HSA $6550  - 0%","91058WI008",,"WIN001","WIS001","WIF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9943",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080004-01","Bronze HSA $6550  - 0%","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-04","Silver $2500 - 50%","73% AV Level Silver Plan",,"0.739291131496429","No","Yes","No","100%",,"$4,580","$20","$1,070","$150","$2,500","$360","$310","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=6S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-05","Silver $2500 - 50%","87% AV Level Silver Plan",,"0.87041711807251","No","Yes","No","100%",,"$2,000","$0","$0","$150","$1,000","$290","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=5S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-06","Silver $2500 - 50%","94% AV Level Silver Plan",,"0.944267988204956","No","Yes","No","100%",,"$500","$0","$250","$150","$250","$200","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=4S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-00","Silver $2500 - 20%","Standard Silver Off Exchange Plan",,"0.712734818458557","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-01","Silver $2500 - 20%","Standard Silver On Exchange Plan",,"0.712734818458557","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-02","Silver $2500 - 20%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZI&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-03","Silver $2500 - 20%","Limited Cost Sharing Plan Variation",,"0.712734818458557","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZJ&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-04","Silver $2500 - 20%","73% AV Level Silver Plan",,"0.736185729503632","No","Yes","No","100%",,"$4,000","$0","$0","$150","$2,250","$270","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=3S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-05","Silver $2500 - 20%","87% AV Level Silver Plan",,"0.877321481704712","No","Yes","No","100%",,"$1,250","$0","$0","$150","$1,000","$80","$170","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=2S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-06","Silver $2500 - 20%","94% AV Level Silver Plan",,"0.946879625320435","No","Yes","No","100%",,"$500","$0","$0","$150","$250","$100","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=1S&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050008","Bronze $3750 - 50%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050008-00","Bronze $3750 - 50%","Standard Bronze Off Exchange Plan",,"0.612308979034424","No","Yes","No","100%",,"$5,830","$20","$710","$150","$3,750","$380","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050008","Bronze $3750 - 50%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050008-01","Bronze $3750 - 50%","Standard Bronze On Exchange Plan",,"0.612308979034424","No","Yes","No","100%",,"$5,830","$20","$710","$150","$3,750","$380","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050009","Bronze $5000 - 10%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050009-00","Bronze $5000 - 10%","Standard Bronze Off Exchange Plan",,"0.600622475147247","No","Yes","No","100%",,"$7,080","$20","$20","$150","$5,000","$80","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050009","Bronze $5000 - 10%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050009-01","Bronze $5000 - 10%","Standard Bronze On Exchange Plan",,"0.600622475147247","No","Yes","No","100%",,"$7,080","$20","$20","$150","$5,000","$80","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050009","Bronze $5000 - 10%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050009-02","Bronze $5000 - 10%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZO&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050009","Bronze $5000 - 10%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050009-03","Bronze $5000 - 10%","Limited Cost Sharing Plan Variation",,"0.600622475147247","No","Yes","No","100%",,"$7,080","$20","$20","$150","$5,000","$80","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZP&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060001","Silver HSA $4400 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-04","Silver HSA $4400 - 0%","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,250","$0","$0","$150","$3,250","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$5700 per person","$6500 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$5700 per person","$6500 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S3&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060001","Silver HSA $4400 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-05","Silver HSA $4400 - 0%","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S2&eff_date=01/01/2017&state=WI",
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220016","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220016-01","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721110","https://planfinder.ghcscw.com/marketplace/1721110"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210032-01","Select Gold 2000 Deductible HSA w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1712210","https://planfinder.ghcscw.com/marketplace/1712210"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240013","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240013-03","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712205","https://planfinder.ghcscw.com/marketplace/1712205"
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060001","Silver HSA $4400 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-06","Silver HSA $4400 - 0%","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S1&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050010","Bronze $6500 - 10%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050010-00","Bronze $6500 - 10%","Standard Bronze Off Exchange Plan",,"0.581400454044342","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050010","Bronze $6500 - 10%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050010-01","Bronze $6500 - 10%","Standard Bronze On Exchange Plan",,"0.581400454044342","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050010","Bronze $6500 - 10%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050010-02","Bronze $6500 - 10%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZS&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050010","Bronze $6500 - 10%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050010-03","Bronze $6500 - 10%","Limited Cost Sharing Plan Variation",,"0.581400454044342","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZT&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060001","Silver HSA $4400 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-00","Silver HSA $4400 - 0%","Standard Silver Off Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$4,400","$0","$0","$150","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060001","Silver HSA $4400 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-01","Silver HSA $4400 - 0%","Standard Silver On Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$4,400","$0","$0","$150","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060001","Silver HSA $4400 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-02","Silver HSA $4400 - 0%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZU&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060001","Silver HSA $4400 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-03","Silver HSA $4400 - 0%","Limited Cost Sharing Plan Variation",,"0.680664837360382","Yes","Yes","No","100%",,"$4,400","$0","$0","$150","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZV&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-00","Silver HSA $2000 - 50%","Standard Silver Off Exchange Plan",,"0.711491823196411","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-01","Silver HSA $2000 - 50%","Standard Silver On Exchange Plan",,"0.711491823196411","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-02","Silver HSA $2000 - 50%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZY&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-03","Silver HSA $2000 - 50%","Limited Cost Sharing Plan Variation",,"0.711491823196411","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=Z1&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-04","Silver HSA $2000 - 50%","73% AV Level Silver Plan",,"0.738561391830444","Yes","Yes","No","100%",,"$3,000","$0","$500","$150","$1,500","$0","$1,890","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$5700 per person","$7000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S6&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-05","Silver HSA $2000 - 50%","87% AV Level Silver Plan",,"0.879132032394409","Yes","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$0","$950","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2350 per person","$3000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","20.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S5&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-06","Silver HSA $2000 - 50%","94% AV Level Silver Plan",,"0.94882071018219","Yes","Yes","No","100%",,"$500","$0","$0","$150","$250","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S4&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060003","Bronze HSA $4400 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060003-00","Bronze HSA $4400 - 50%","Standard Bronze Off Exchange Plan",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060003","Bronze HSA $4400 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060003-01","Bronze HSA $4400 - 50%","Standard Bronze On Exchange Plan",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060003","Bronze HSA $4400 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060003-02","Bronze HSA $4400 - 50%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YE&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060003","Bronze HSA $4400 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060003-03","Bronze HSA $4400 - 50%","Limited Cost Sharing Plan Variation",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YF&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060004","Bronze HSA $6550 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060004-00","Bronze HSA $6550 - 0%","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060004","Bronze HSA $6550 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060004-01","Bronze HSA $6550 - 0%","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060004","Bronze HSA $6550 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060004-02","Bronze HSA $6550 - 0%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YA&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060004","Bronze HSA $6550 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060004-03","Bronze HSA $6550 - 0%","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YB&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060005","Bronze HSA $5750 - 20%","91058WI006",,"WIN002","WIS001","WIF009","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060005-00","Bronze HSA $5750 - 20%","Standard Bronze Off Exchange Plan",,"0.615649044513702","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$6550 per person","$11500 per group","20.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060005","Bronze HSA $5750 - 20%","91058WI006",,"WIN002","WIS001","WIF009","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060005-01","Bronze HSA $5750 - 20%","Standard Bronze On Exchange Plan",,"0.615649044513702","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$6550 per person","$11500 per group","20.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060005","Bronze HSA $5750 - 20%","91058WI006",,"WIN002","WIS001","WIF009","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060005-02","Bronze HSA $5750 - 20%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YC&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0060005","Bronze HSA $5750 - 20%","91058WI006",,"WIN002","WIS001","WIF009","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060005-03","Bronze HSA $5750 - 20%","Limited Cost Sharing Plan Variation",,"0.615649044513702","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$6550 per person","$11500 per group","20.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YD&eff_date=01/01/2017&state=WI",
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210017","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210017-03","Platinum 500 Ded/1000 MOOP w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711111","https://planfinder.ghcscw.com/marketplace/1711111"
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050014","Catastrophic $7150 - 0%","91058WI005",,"WIN002","WIS001","WIF012","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050014-00","Catastrophic $7150 - 0%","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2017&state=WI",
"2017","WI","91058","HIOS","2016-08-20 07:40:33","Individual","No","39-1807071","91058WI0050014","Catastrophic $7150 - 0%","91058WI005",,"WIN002","WIS001","WIF012","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9972",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050014-01","Catastrophic $7150 - 0%","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2017&state=WI",
"2017","WI","91604","HIOS","2016-07-01 08:12:23","Individual","Yes","39-1263473","91604WI0490001","Humana Dental Smart Choice","91604WI049",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9877","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","91604WI0490001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857179"
"2017","WI","91604","HIOS","2016-07-01 08:12:23","Individual","Yes","39-1263473","91604WI0490001","Humana Dental Smart Choice","91604WI049",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9877","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","91604WI0490001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857179"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210017","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210017-00","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731110","https://planfinder.ghcscw.com/marketplace/1731110"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220016","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220016-00","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741110","https://planfinder.ghcscw.com/marketplace/1741110"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210017","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210017-01","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711110","https://planfinder.ghcscw.com/marketplace/1711110"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210017","Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210017-02","Platinum 500 Ded/1000 MOOP w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711112","https://planfinder.ghcscw.com/marketplace/1711112"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220018","Gold 1000 Deductible w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220018-00","Gold 1000 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741207","https://planfinder.ghcscw.com/marketplace/1741207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220018","Gold 1000 Deductible w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220018-01","Gold 1000 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721207","https://planfinder.ghcscw.com/marketplace/1721207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210019","Gold 1000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210019-00","Gold 1000 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731207","https://planfinder.ghcscw.com/marketplace/1731207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220021","Silver 30 Copay w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220021-00","Silver 30 Copay w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741319","https://planfinder.ghcscw.com/marketplace/1741319"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220028","Select Gold 1000 Deductible w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220028-00","Select Gold 1000 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742207","https://planfinder.ghcscw.com/marketplace/1742207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210039-04","Silver 3500 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.736848592758179","No","Yes","No","100%",,"$3,000","$20","$650","$150","$3,000","$680","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711338","https://planfinder.ghcscw.com/marketplace/1711338"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210039-05","Silver 3500 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.878827512264252","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,200","$280","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711339","https://planfinder.ghcscw.com/marketplace/1711339"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210039-06","Silver 3500 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.944851696491241","No","Yes","No","100%",,"$0","$0","$500","$150","$0","$390","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711340","https://planfinder.ghcscw.com/marketplace/1711340"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210035","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210035-02","Select Silver 4000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712336","https://planfinder.ghcscw.com/marketplace/1712336"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-03","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712305","https://planfinder.ghcscw.com/marketplace/1712305"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220021","Silver 30 Copay w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220021-01","Silver 30 Copay w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721319","https://planfinder.ghcscw.com/marketplace/1721319"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210019","Gold 1000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210019-01","Gold 1000 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711207","https://planfinder.ghcscw.com/marketplace/1711207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210019","Gold 1000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210019-02","Gold 1000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711209","https://planfinder.ghcscw.com/marketplace/1711209"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220022","Silver 2000 Deductible w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220022-00","Silver 2000 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741325","https://planfinder.ghcscw.com/marketplace/1741325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220022","Silver 2000 Deductible w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220022-01","Silver 2000 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721325","https://planfinder.ghcscw.com/marketplace/1721325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210019","Gold 1000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210019-03","Gold 1000 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711208","https://planfinder.ghcscw.com/marketplace/1711208"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210022-00","Silver 30 Copay w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731319","https://planfinder.ghcscw.com/marketplace/1731319"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220036","Silver 3500 Deductible w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220036-00","Silver 3500 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741337","https://planfinder.ghcscw.com/marketplace/1741337"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220036","Silver 3500 Deductible w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220036-01","Silver 3500 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721337","https://planfinder.ghcscw.com/marketplace/1721337"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210022-01","Silver 30 Copay w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711319","https://planfinder.ghcscw.com/marketplace/1711319"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210022-02","Silver 30 Copay w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711324","https://planfinder.ghcscw.com/marketplace/1711324"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220026","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220026-00","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742110","https://planfinder.ghcscw.com/marketplace/1742110"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220026","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220026-01","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722110","https://planfinder.ghcscw.com/marketplace/1722110"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210022-03","Silver 30 Copay w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711323","https://planfinder.ghcscw.com/marketplace/1711323"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210022-04","Silver 30 Copay w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.738732695579529","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711320","https://planfinder.ghcscw.com/marketplace/1711320"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220028","Select Gold 1000 Deductible w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220028-01","Select Gold 1000 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722207","https://planfinder.ghcscw.com/marketplace/1722207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210022-05","Silver 30 Copay w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.868587970733643","No","Yes","No","100%",,"$500","$20","$930","$150","$500","$880","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711321","https://planfinder.ghcscw.com/marketplace/1711321"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210022-06","Silver 30 Copay w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.943445324897766","No","Yes","No","100%",,"$0","$20","$520","$150","$0","$400","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711322","https://planfinder.ghcscw.com/marketplace/1711322"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220031","Select Silver 30 Copay w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220031-00","Select Silver 30 Copay w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742319","https://planfinder.ghcscw.com/marketplace/1742319"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220031","Select Silver 30 Copay w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220031-01","Select Silver 30 Copay w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722319","https://planfinder.ghcscw.com/marketplace/1722319"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-00","Silver 2000 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731325","https://planfinder.ghcscw.com/marketplace/1731325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-01","Silver 2000 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711325","https://planfinder.ghcscw.com/marketplace/1711325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220032","Select Silver 2000 Deductible w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220032-00","Select Silver 2000 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742325","https://planfinder.ghcscw.com/marketplace/1742325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220032","Select Silver 2000 Deductible w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220032-01","Select Silver 2000 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722325","https://planfinder.ghcscw.com/marketplace/1722325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-02","Silver 2000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711330","https://planfinder.ghcscw.com/marketplace/1711330"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-03","Silver 2000 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711329","https://planfinder.ghcscw.com/marketplace/1711329"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220037","Select Silver 3500 Deductible w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220037-00","Select Silver 3500 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742337","https://planfinder.ghcscw.com/marketplace/1742337"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220037","Select Silver 3500 Deductible w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220037-01","Select Silver 3500 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722337","https://planfinder.ghcscw.com/marketplace/1722337"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-04","Silver 2000 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.732699751853943","No","Yes","No","100%",,"$1,750","$20","$680","$150","$1,750","$940","$280","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711326","https://planfinder.ghcscw.com/marketplace/1711326"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-05","Silver 2000 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.876867651939392","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,200","$480","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711327","https://planfinder.ghcscw.com/marketplace/1711327"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-06","Silver 2000 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.94398444890976","No","Yes","No","100%",,"$0","$0","$450","$150","$0","$310","$140","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711328","https://planfinder.ghcscw.com/marketplace/1711328"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210039-00","Silver 3500 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731337","https://planfinder.ghcscw.com/marketplace/1731337"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210039-01","Silver 3500 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711337","https://planfinder.ghcscw.com/marketplace/1711337"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210039-02","Silver 3500 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711342","https://planfinder.ghcscw.com/marketplace/1711342"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210039-03","Silver 3500 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711341","https://planfinder.ghcscw.com/marketplace/1711341"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210041-00","Select Silver 3500 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732337","https://planfinder.ghcscw.com/marketplace/1732337"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210041-01","Select Silver 3500 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712337","https://planfinder.ghcscw.com/marketplace/1712337"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210041-02","Select Silver 3500 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712342","https://planfinder.ghcscw.com/marketplace/1712342"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210041-03","Select Silver 3500 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.703939616680145","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712341","https://planfinder.ghcscw.com/marketplace/1712341"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210041-04","Select Silver 3500 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.736848592758179","No","Yes","No","100%",,"$3,000","$20","$650","$150","$3,000","$680","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712338","https://planfinder.ghcscw.com/marketplace/1712338"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210041-05","Select Silver 3500 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.878827512264252","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,200","$280","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712339","https://planfinder.ghcscw.com/marketplace/1712339"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210041-06","Select Silver 3500 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.944851696491241","No","Yes","No","100%",,"$0","$0","$500","$150","$0","$390","$110","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712340","https://planfinder.ghcscw.com/marketplace/1712340"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210028-00","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732110","https://planfinder.ghcscw.com/marketplace/1732110"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210028-01","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712110","https://planfinder.ghcscw.com/marketplace/1712110"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210028-02","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712112","https://planfinder.ghcscw.com/marketplace/1712112"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210028-03","Select Platinum 500 Ded/1000 MOOP w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.917636096477509","No","Yes","No","100%",,"$500","$0","$500","$150","$500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712111","https://planfinder.ghcscw.com/marketplace/1712111"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210030-00","Select Gold 1000 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732207","https://planfinder.ghcscw.com/marketplace/1732207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210030-01","Select Gold 1000 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712207","https://planfinder.ghcscw.com/marketplace/1712207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210030-02","Select Gold 1000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712209","https://planfinder.ghcscw.com/marketplace/1712209"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210030-03","Select Gold 1000 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712208","https://planfinder.ghcscw.com/marketplace/1712208"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210033-00","Select Silver 30 Copay w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732319","https://planfinder.ghcscw.com/marketplace/1732319"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210033-01","Select Silver 30 Copay w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712319","https://planfinder.ghcscw.com/marketplace/1712319"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210033-02","Select Silver 30 Copay w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712324","https://planfinder.ghcscw.com/marketplace/1712324"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210033-03","Select Silver 30 Copay w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.716679751873016","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712323","https://planfinder.ghcscw.com/marketplace/1712323"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210033-04","Select Silver 30 Copay w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.738732695579529","No","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$950","$160","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712320","https://planfinder.ghcscw.com/marketplace/1712320"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210033-05","Select Silver 30 Copay w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.868587970733643","No","Yes","No","100%",,"$500","$20","$930","$150","$500","$880","$120","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712321","https://planfinder.ghcscw.com/marketplace/1712321"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01",,"No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210033-06","Select Silver 30 Copay w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.943445324897766","No","Yes","No","100%",,"$0","$20","$520","$150","$0","$400","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712322","https://planfinder.ghcscw.com/marketplace/1712322"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-00","Select Silver 2000 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732325","https://planfinder.ghcscw.com/marketplace/1732325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-01","Select Silver 2000 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712325","https://planfinder.ghcscw.com/marketplace/1712325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-02","Select Silver 2000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712330","https://planfinder.ghcscw.com/marketplace/1712330"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-03","Select Silver 2000 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712329","https://planfinder.ghcscw.com/marketplace/1712329"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-04","Select Silver 2000 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.732699751853943","No","Yes","No","100%",,"$1,750","$20","$680","$150","$1,750","$940","$280","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712326","https://planfinder.ghcscw.com/marketplace/1712326"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-05","Select Silver 2000 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.876867651939392","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,200","$480","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712327","https://planfinder.ghcscw.com/marketplace/1712327"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-06","Select Silver 2000 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.94398444890976","No","Yes","No","100%",,"$0","$0","$450","$150","$0","$310","$140","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712328","https://planfinder.ghcscw.com/marketplace/1712328"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210021","Gold 2000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210021-00","Gold 2000 Deductible HSA w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1731210","https://planfinder.ghcscw.com/marketplace/1731210"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220020","Gold 2000 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220020-00","Gold 2000 Deductible HSA w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1741210","https://planfinder.ghcscw.com/marketplace/1741210"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220020","Gold 2000 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220020-01","Gold 2000 Deductible HSA w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1721210","https://planfinder.ghcscw.com/marketplace/1721210"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210021","Gold 2000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210021-01","Gold 2000 Deductible HSA w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1711210","https://planfinder.ghcscw.com/marketplace/1711210"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210021","Gold 2000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210021-02","Gold 2000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1711212","https://planfinder.ghcscw.com/marketplace/1711212"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220023","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220023-00","Silver 4000 Deductible HSA w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1741331","https://planfinder.ghcscw.com/marketplace/1741331"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220023","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220023-01","Silver 4000 Deductible HSA w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1721331","https://planfinder.ghcscw.com/marketplace/1721331"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210021","Gold 2000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210021-03","Gold 2000 Deductible HSA w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1711211","https://planfinder.ghcscw.com/marketplace/1711211"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210024","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210024-00","Silver 4000 Deductible HSA w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1731331","https://planfinder.ghcscw.com/marketplace/1731331"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220038","Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220038-00","Bronze 6550 Deductible HSA w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1741404","https://planfinder.ghcscw.com/marketplace/1741404"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220038","Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220038-01","Bronze 6550 Deductible HSA w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1721404","https://planfinder.ghcscw.com/marketplace/1721404"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210024","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210024-01","Silver 4000 Deductible HSA w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1711331","https://planfinder.ghcscw.com/marketplace/1711331"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210024","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210024-02","Silver 4000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1711336","https://planfinder.ghcscw.com/marketplace/1711336"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220030","Select Gold 2000 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220030-00","Select Gold 2000 Deductible HSA w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1742210","https://planfinder.ghcscw.com/marketplace/1742210"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220030","Select Gold 2000 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220030-01","Select Gold 2000 Deductible HSA w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1722210","https://planfinder.ghcscw.com/marketplace/1722210"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210024","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210024-03","Silver 4000 Deductible HSA w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1711335","https://planfinder.ghcscw.com/marketplace/1711335"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210024","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210024-04","Silver 4000 Deductible HSA w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1711332","https://planfinder.ghcscw.com/marketplace/1711332"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220033","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220033-00","Select Silver 4000 Deductible HSA w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1742331","https://planfinder.ghcscw.com/marketplace/1742331"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220033","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220033-01","Select Silver 4000 Deductible HSA w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1722331","https://planfinder.ghcscw.com/marketplace/1722331"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210024","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210024-05","Silver 4000 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1711333","https://planfinder.ghcscw.com/marketplace/1711333"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210024","Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210024-06","Silver 4000 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1711334","https://planfinder.ghcscw.com/marketplace/1711334"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220039","Select Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220039-00","Select Bronze 6550 Deductible HSA w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1742404","https://planfinder.ghcscw.com/marketplace/1742404"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220039","Select Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220039-01","Select Bronze 6550 Deductible HSA w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1722404","https://planfinder.ghcscw.com/marketplace/1722404"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210044","Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210044-00","Bronze 6550 Deductible HSA w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1731404","https://planfinder.ghcscw.com/marketplace/1731404"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210044","Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210044-01","Bronze 6550 Deductible HSA w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1711404","https://planfinder.ghcscw.com/marketplace/1711404"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210044","Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210044-02","Bronze 6550 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1711406","https://planfinder.ghcscw.com/marketplace/1711406"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210044","Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210044-03","Bronze 6550 Deductible HSA w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1711405","https://planfinder.ghcscw.com/marketplace/1711405"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210032-00","Select Gold 2000 Deductible HSA w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1732210","https://planfinder.ghcscw.com/marketplace/1732210"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210032-02","Select Gold 2000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712212","https://planfinder.ghcscw.com/marketplace/1712212"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210032-03","Select Gold 2000 Deductible HSA w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1712211","https://planfinder.ghcscw.com/marketplace/1712211"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210035","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210035-00","Select Silver 4000 Deductible HSA w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1732331","https://planfinder.ghcscw.com/marketplace/1732331"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210035","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210035-01","Select Silver 4000 Deductible HSA w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1712331","https://planfinder.ghcscw.com/marketplace/1712331"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210035","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210035-03","Select Silver 4000 Deductible HSA w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1712335","https://planfinder.ghcscw.com/marketplace/1712335"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210035","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210035-04","Select Silver 4000 Deductible HSA w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1712332","https://planfinder.ghcscw.com/marketplace/1712332"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210035","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210035-05","Select Silver 4000 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712333","https://planfinder.ghcscw.com/marketplace/1712333"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210035","Select Silver 4000 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210035-06","Select Silver 4000 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712334","https://planfinder.ghcscw.com/marketplace/1712334"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210045","Select Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210045-00","Select Bronze 6550 Deductible HSA w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1732404","https://planfinder.ghcscw.com/marketplace/1732404"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210045","Select Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210045-01","Select Bronze 6550 Deductible HSA w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1712404","https://planfinder.ghcscw.com/marketplace/1712404"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210045","Select Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210045-02","Select Bronze 6550 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712406","https://planfinder.ghcscw.com/marketplace/1712406"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210045","Select Bronze 6550 Deductible HSA w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210045-03","Select Bronze 6550 Deductible HSA w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1712405","https://planfinder.ghcscw.com/marketplace/1712405"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240001","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240001-00","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731101","https://planfinder.ghcscw.com/marketplace/1731101"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250001","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250001-00","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741101","https://planfinder.ghcscw.com/marketplace/1741101"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250001","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250001-01","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721101","https://planfinder.ghcscw.com/marketplace/1721101"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240001","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240001-01","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711101","https://planfinder.ghcscw.com/marketplace/1711101"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240001","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240001-02","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711103","https://planfinder.ghcscw.com/marketplace/1711103"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250002","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250002-00","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741104","https://planfinder.ghcscw.com/marketplace/1741104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250002","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250002-01","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721104","https://planfinder.ghcscw.com/marketplace/1721104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240001","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240001-03","Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711102","https://planfinder.ghcscw.com/marketplace/1711102"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240002","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240002-00","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731104","https://planfinder.ghcscw.com/marketplace/1731104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250003","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250003-00","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741107","https://planfinder.ghcscw.com/marketplace/1741107"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250003","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250003-01","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721107","https://planfinder.ghcscw.com/marketplace/1721107"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240002","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240002-01","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711104","https://planfinder.ghcscw.com/marketplace/1711104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240002","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240002-02","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711106","https://planfinder.ghcscw.com/marketplace/1711106"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250004","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250004-00","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741201","https://planfinder.ghcscw.com/marketplace/1741201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250004","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250004-01","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721201","https://planfinder.ghcscw.com/marketplace/1721201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240002","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240002-03","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711105","https://planfinder.ghcscw.com/marketplace/1711105"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240003","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240003-00","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731107","https://planfinder.ghcscw.com/marketplace/1731107"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250005","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250005-00","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741204","https://planfinder.ghcscw.com/marketplace/1741204"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250005","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250005-01","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721204","https://planfinder.ghcscw.com/marketplace/1721204"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240003","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240003-01","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711107","https://planfinder.ghcscw.com/marketplace/1711107"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240003","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240003-02","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711109","https://planfinder.ghcscw.com/marketplace/1711109"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250006-00","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741301","https://planfinder.ghcscw.com/marketplace/1741301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250006-01","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721301","https://planfinder.ghcscw.com/marketplace/1721301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240003","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240003-03","Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711108","https://planfinder.ghcscw.com/marketplace/1711108"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240004","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240004-00","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731201","https://planfinder.ghcscw.com/marketplace/1731201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250007-00","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741307","https://planfinder.ghcscw.com/marketplace/1741307"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250007-01","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721307","https://planfinder.ghcscw.com/marketplace/1721307"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240004","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240004-01","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711201","https://planfinder.ghcscw.com/marketplace/1711201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240004","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240004-02","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711203","https://planfinder.ghcscw.com/marketplace/1711203"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250008-00","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741313","https://planfinder.ghcscw.com/marketplace/1741313"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI025",,"WIN001","WIS003","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250008-01","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721313","https://planfinder.ghcscw.com/marketplace/1721313"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240004","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240004-03","Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711202","https://planfinder.ghcscw.com/marketplace/1711202"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240005","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240005-00","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731204","https://planfinder.ghcscw.com/marketplace/1731204"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250009","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250009-00","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742101","https://planfinder.ghcscw.com/marketplace/1742101"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250009","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250009-01","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722101","https://planfinder.ghcscw.com/marketplace/1722101"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240005","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240005-01","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711204","https://planfinder.ghcscw.com/marketplace/1711204"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240005","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240005-02","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711206","https://planfinder.ghcscw.com/marketplace/1711206"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250010","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250010-00","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742104","https://planfinder.ghcscw.com/marketplace/1742104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250010","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250010-01","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722104","https://planfinder.ghcscw.com/marketplace/1722104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240005","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240005-03","Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711205","https://planfinder.ghcscw.com/marketplace/1711205"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-00","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731301","https://planfinder.ghcscw.com/marketplace/1731301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250011","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250011-00","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742107","https://planfinder.ghcscw.com/marketplace/1742107"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250011","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250011-01","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722107","https://planfinder.ghcscw.com/marketplace/1722107"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-01","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711301","https://planfinder.ghcscw.com/marketplace/1711301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-02","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711306","https://planfinder.ghcscw.com/marketplace/1711306"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250012","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250012-00","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742201","https://planfinder.ghcscw.com/marketplace/1742201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250012","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250012-01","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722201","https://planfinder.ghcscw.com/marketplace/1722201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-03","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711305","https://planfinder.ghcscw.com/marketplace/1711305"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-04","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.738874495029449","No","No","No","100%",,"$1,900","$20","$980","$150","$1,900","$1,130","$190","$80","$0","$0","$0","$0","$300","0","0","0","$3,700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711302","https://planfinder.ghcscw.com/marketplace/1711302"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250013","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250013-00","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742204","https://planfinder.ghcscw.com/marketplace/1742204"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250013","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250013-01","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722204","https://planfinder.ghcscw.com/marketplace/1722204"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-05","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.868982791900635","No","No","No","100%",,"$500","$0","$500","$150","$500","$420","$80","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711303","https://planfinder.ghcscw.com/marketplace/1711303"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240006","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-06","Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.948738694190979","No","No","No","100%",,"$0","$0","$250","$150","$0","$180","$70","$80","$0","$0","$0","$0","$300","0","0","0","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711304","https://planfinder.ghcscw.com/marketplace/1711304"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250014-00","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742301","https://planfinder.ghcscw.com/marketplace/1742301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250014-01","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722301","https://planfinder.ghcscw.com/marketplace/1722301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240007-00","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731307","https://planfinder.ghcscw.com/marketplace/1731307"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240007-01","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711307","https://planfinder.ghcscw.com/marketplace/1711307"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250015-00","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742307","https://planfinder.ghcscw.com/marketplace/1742307"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250015-01","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722307","https://planfinder.ghcscw.com/marketplace/1722307"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240007-02","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711312","https://planfinder.ghcscw.com/marketplace/1711312"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240007-03","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711311","https://planfinder.ghcscw.com/marketplace/1711311"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250016-00","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742313","https://planfinder.ghcscw.com/marketplace/1742313"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0250016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI025",,"WIN002","WIS004","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250016-01","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722313","https://planfinder.ghcscw.com/marketplace/1722313"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240007-04","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.73921275138855","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$4,550","$4550 per person","$9100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711308","https://planfinder.ghcscw.com/marketplace/1711308"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240007-05","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.868982791900635","No","No","No","100%",,"$500","$0","$500","$150","$500","$420","$80","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711309","https://planfinder.ghcscw.com/marketplace/1711309"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240007","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240007-06","Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.934265673160553","No","No","No","100%",,"$0","$0","$500","$150","$0","$410","$90","$80","$0","$0","$0","$0","$300","0","0","0","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711310","https://planfinder.ghcscw.com/marketplace/1711310"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240008-00","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731313","https://planfinder.ghcscw.com/marketplace/1731313"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240008-01","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711313","https://planfinder.ghcscw.com/marketplace/1711313"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240008-02","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711318","https://planfinder.ghcscw.com/marketplace/1711318"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240008-03","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711317","https://planfinder.ghcscw.com/marketplace/1711317"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240008-04","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.738420307636261","No","No","No","100%",,"$2,750","$20","$730","$150","$2,750","$870","$130","$80","$0","$0","$0","$0","$300","0","0","0","$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711314","https://planfinder.ghcscw.com/marketplace/1711314"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240008-05","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.865978837013245","No","No","No","100%",,"$500","$0","$500","$150","$500","$420","$80","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711315","https://planfinder.ghcscw.com/marketplace/1711315"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240008","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240008-06","Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.930393517017365","No","No","No","100%",,"$0","$0","$500","$150","$0","$410","$90","$80","$0","$0","$0","$0","$300","0","0","0","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711316","https://planfinder.ghcscw.com/marketplace/1711316"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240009","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240009-00","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732101","https://planfinder.ghcscw.com/marketplace/1732101"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240009","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240009-01","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712101","https://planfinder.ghcscw.com/marketplace/1712101"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240009","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240009-02","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712103","https://planfinder.ghcscw.com/marketplace/1712103"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240009","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240009-03","Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.918796062469482","No","No","No","100%",,"$0","$0","$1,000","$150","$0","$400","$280","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712102","https://planfinder.ghcscw.com/marketplace/1712102"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240010","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240010-00","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732104","https://planfinder.ghcscw.com/marketplace/1732104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240010","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240010-01","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712104","https://planfinder.ghcscw.com/marketplace/1712104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240010","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240010-02","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712106","https://planfinder.ghcscw.com/marketplace/1712106"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240010","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240010-03","Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712105","https://planfinder.ghcscw.com/marketplace/1712105"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240011","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240011-00","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732107","https://planfinder.ghcscw.com/marketplace/1732107"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240011","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240011-01","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712107","https://planfinder.ghcscw.com/marketplace/1712107"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240011","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240011-02","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712109","https://planfinder.ghcscw.com/marketplace/1712109"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240011","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240011-03","Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.880489110946655","No","No","No","100%",,"$500","$20","$930","$150","$500","$380","$240","$80","$0","$0","$0","$0","$300","0","0","0","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712108","https://planfinder.ghcscw.com/marketplace/1712108"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240012","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240012-00","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732201","https://planfinder.ghcscw.com/marketplace/1732201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240012","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240012-01","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712201","https://planfinder.ghcscw.com/marketplace/1712201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240012","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240012-02","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712203","https://planfinder.ghcscw.com/marketplace/1712203"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240012","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240012-03","Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712202","https://planfinder.ghcscw.com/marketplace/1712202"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240013","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240013-00","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732204","https://planfinder.ghcscw.com/marketplace/1732204"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240013","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240013-01","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.784189343452454","No","No","No","100%",,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","$0","$0","$0","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712204","https://planfinder.ghcscw.com/marketplace/1712204"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240013","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240013-02","Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712206","https://planfinder.ghcscw.com/marketplace/1712206"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-00","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732301","https://planfinder.ghcscw.com/marketplace/1732301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-01","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.71621698141098","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712301","https://planfinder.ghcscw.com/marketplace/1712301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-02","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712306","https://planfinder.ghcscw.com/marketplace/1712306"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-04","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.738874495029449","No","No","No","100%",,"$1,900","$20","$980","$150","$1,900","$1,130","$190","$80","$0","$0","$0","$0","$300","0","0","0","$3,700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712302","https://planfinder.ghcscw.com/marketplace/1712302"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-05","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.868982791900635","No","No","No","100%",,"$500","$0","$500","$150","$500","$420","$80","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712303","https://planfinder.ghcscw.com/marketplace/1712303"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240014","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-06","Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.948738694190979","No","No","No","100%",,"$0","$0","$250","$150","$0","$180","$70","$80","$0","$0","$0","$0","$300","0","0","0","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712304","https://planfinder.ghcscw.com/marketplace/1712304"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240015-00","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732307","https://planfinder.ghcscw.com/marketplace/1732307"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240015-01","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712307","https://planfinder.ghcscw.com/marketplace/1712307"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240015-02","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712312","https://planfinder.ghcscw.com/marketplace/1712312"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240015-03","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.716141760349274","No","No","No","100%",,"$4,250","$20","$280","$150","$4,250","$440","$40","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712311","https://planfinder.ghcscw.com/marketplace/1712311"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240015-04","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.73921275138855","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$4,550","$4550 per person","$9100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712308","https://planfinder.ghcscw.com/marketplace/1712308"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240015-05","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.868982791900635","No","No","No","100%",,"$500","$0","$500","$150","$500","$420","$80","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712309","https://planfinder.ghcscw.com/marketplace/1712309"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240015","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240015-06","Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.934265673160553","No","No","No","100%",,"$0","$0","$500","$150","$0","$410","$90","$80","$0","$0","$0","$0","$300","0","0","0","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712310","https://planfinder.ghcscw.com/marketplace/1712310"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240016-00","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732313","https://planfinder.ghcscw.com/marketplace/1732313"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240016-01","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712313","https://planfinder.ghcscw.com/marketplace/1712313"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240016-02","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712318","https://planfinder.ghcscw.com/marketplace/1712318"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240016-03","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.709517121315002","No","No","No","100%",,"$5,000","$20","$50","$150","$5,000","$110","$30","$80","$0","$0","$0","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712317","https://planfinder.ghcscw.com/marketplace/1712317"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240016-04","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.738420307636261","No","No","No","100%",,"$2,750","$20","$730","$150","$2,750","$870","$130","$80","$0","$0","$0","$0","$300","0","0","0","$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712314","https://planfinder.ghcscw.com/marketplace/1712314"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240016-05","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.865978837013245","No","No","No","100%",,"$500","$0","$500","$150","$500","$420","$80","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712315","https://planfinder.ghcscw.com/marketplace/1712315"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240016","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF006","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240016-06","Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.930393517017365","No","No","No","100%",,"$0","$0","$500","$150","$0","$410","$90","$80","$0","$0","$0","$0","$300","0","0","0","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712316","https://planfinder.ghcscw.com/marketplace/1712316"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240020","Catastrophic 7150 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF008","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240020-00","Catastrophic 7150 Deductible w/ Massage Therapy","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1711001","https://planfinder.ghcscw.com/marketplace/1711001"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220024","Bronze 4000 Deductible w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220024-00","Bronze 4000 Deductible w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1741401","https://planfinder.ghcscw.com/marketplace/1741401"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220024","Bronze 4000 Deductible w/ Massage Therapy","94529WI022",,"WIN001","WIS003","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220024-01","Bronze 4000 Deductible w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1721401","https://planfinder.ghcscw.com/marketplace/1721401"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240020","Catastrophic 7150 Deductible w/ Massage Therapy","94529WI024",,"WIN001","WIS001","WIF008","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240020-01","Catastrophic 7150 Deductible w/ Massage Therapy","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1711001","https://planfinder.ghcscw.com/marketplace/1711001"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240021","Select Catastrophic 7150 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF008","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240021-00","Select Catastrophic 7150 Deductible w/ Massage Therapy","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712001","https://planfinder.ghcscw.com/marketplace/1712001"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220034","Select Bronze 4000 Deductible w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220034-00","Select Bronze 4000 Deductible w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1742401","https://planfinder.ghcscw.com/marketplace/1742401"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0220034","Select Bronze 4000 Deductible w/ Massage Therapy","94529WI022",,"WIN002","WIS004","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220034-01","Select Bronze 4000 Deductible w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1722401","https://planfinder.ghcscw.com/marketplace/1722401"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240021","Select Catastrophic 7150 Deductible w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF008","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240021-01","Select Catastrophic 7150 Deductible w/ Massage Therapy","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712001","https://planfinder.ghcscw.com/marketplace/1712001"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210025-00","Bronze 4000 Deductible w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1731401","https://planfinder.ghcscw.com/marketplace/1731401"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0230001","Gold 1000 Deductible POS w/ Massage Therapy","94529WI023",,"WIN001","WIS006","WIF002","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0230001-00","Gold 1000 Deductible POS w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1744207","https://planfinder.ghcscw.com/marketplace/1744207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0230001","Gold 1000 Deductible POS w/ Massage Therapy","94529WI023",,"WIN001","WIS006","WIF002","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0230001-01","Gold 1000 Deductible POS w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.816974997520447","No","Yes","No","100%",,"$1,000","$20","$830","$150","$1,000","$1,110","$220","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1724207","https://planfinder.ghcscw.com/marketplace/1724207"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210025-01","Bronze 4000 Deductible w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711401","https://planfinder.ghcscw.com/marketplace/1711401"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210025-02","Bronze 4000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711403","https://planfinder.ghcscw.com/marketplace/1711403"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0230002","Silver 2000 Deductible POS w/ Massage Therapy","94529WI023",,"WIN001","WIS006","WIF004","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0230002-00","Silver 2000 Deductible POS w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1744325","https://planfinder.ghcscw.com/marketplace/1744325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0230002","Silver 2000 Deductible POS w/ Massage Therapy","94529WI023",,"WIN001","WIS006","WIF004","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0230002-01","Silver 2000 Deductible POS w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.699874460697174","No","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$870","$310","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1724325","https://planfinder.ghcscw.com/marketplace/1724325"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Deductible w/ Massage Therapy","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210025-03","Bronze 4000 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1711402","https://planfinder.ghcscw.com/marketplace/1711402"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210036-00","Select Bronze 4000 Deductible w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1732401","https://planfinder.ghcscw.com/marketplace/1732401"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210036-01","Select Bronze 4000 Deductible w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712401","https://planfinder.ghcscw.com/marketplace/1712401"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210036-02","Select Bronze 4000 Deductible w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712403","https://planfinder.ghcscw.com/marketplace/1712403"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Deductible w/ Massage Therapy","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210036-03","Select Bronze 4000 Deductible w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.606414556503296","No","Yes","No","100%",,"$4,000","$20","$470","$150","$4,000","$660","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1712402","https://planfinder.ghcscw.com/marketplace/1712402"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240017","Select Gold Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF009","New","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240017-00","Select Gold Standardized Plan w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$20","$780","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1732213","https://planfinder.ghcscw.com/marketplace/1732213"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240017","Select Gold Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF009","New","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240017-01","Select Gold Standardized Plan w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$20","$780","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712213","https://planfinder.ghcscw.com/marketplace/1712213"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240017","Select Gold Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF009","New","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240017-02","Select Gold Standardized Plan w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712215","https://planfinder.ghcscw.com/marketplace/1712215"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240017","Select Gold Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF009","New","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240017-03","Select Gold Standardized Plan w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$20","$780","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712214","https://planfinder.ghcscw.com/marketplace/1712214"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240018","Select Silver Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF010","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-00","Select Silver Standardized Plan w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$330","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1732343","https://planfinder.ghcscw.com/marketplace/1732343"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240018","Select Silver Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF010","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-01","Select Silver Standardized Plan w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$330","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712343","https://planfinder.ghcscw.com/marketplace/1712343"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240018","Select Silver Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF010","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-02","Select Silver Standardized Plan w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712348","https://planfinder.ghcscw.com/marketplace/1712348"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240018","Select Silver Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF010","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-03","Select Silver Standardized Plan w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$330","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712347","https://planfinder.ghcscw.com/marketplace/1712347"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240018","Select Silver Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF010","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-04","Select Silver Standardized Plan w/ Massage Therapy 73%","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$430","$150","$3,000","$320","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712344","https://planfinder.ghcscw.com/marketplace/1712344"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240018","Select Silver Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF010","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-05","Select Silver Standardized Plan w/ Massage Therapy 87%","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$890","$150","$700","$280","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712345","https://planfinder.ghcscw.com/marketplace/1712345"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240018","Select Silver Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF010","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-06","Select Silver Standardized Plan w/ Massage Therapy 94%","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712346","https://planfinder.ghcscw.com/marketplace/1712346"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240019","Select Bronze Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF011","New","HMO","Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240019-00","Select Bronze Standardized Plan w/ Massage Therapy","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1732407","https://planfinder.ghcscw.com/marketplace/1732407"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240019","Select Bronze Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF011","New","HMO","Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240019-01","Select Bronze Standardized Plan w/ Massage Therapy","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712407","https://planfinder.ghcscw.com/marketplace/1712407"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240019","Select Bronze Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF011","New","HMO","Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240019-02","Select Bronze Standardized Plan w/ Massage Therapy Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712409","https://planfinder.ghcscw.com/marketplace/1712409"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","Individual","No","39-1199466","94529WI0240019","Select Bronze Standardized Plan w/ Massage Therapy","94529WI024",,"WIN002","WIS002","WIF011","New","HMO","Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240019-03","Select Bronze Standardized Plan w/ Massage Therapy Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1712408","https://planfinder.ghcscw.com/marketplace/1712408"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0270001","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP POS w/ Massage Therapy","94529WI027",,"WIN001","WIS006","WIF001","New","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270001-00","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP POS w/ Massage Therapy","Standard Platinum Off Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1744104","https://planfinder.ghcscw.com/marketplace/1744104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0270001","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP POS w/ Massage Therapy","94529WI027",,"WIN001","WIS006","WIF001","New","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270001-01","Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP POS w/ Massage Therapy","Standard Platinum On Exchange Plan",,"0.896953701972961","No","No","No","100%",,"$500","$0","$500","$150","$500","$300","$200","$80","$0","$0","$0","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1724104","https://planfinder.ghcscw.com/marketplace/1724104"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0270002","Gold Zero Primary Care Visit Copay 1500 Deductible POS w/ Massage Therapy","94529WI027",,"WIN001","WIS006","WIF003","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270002-00","Gold Zero Primary Care Visit Copay 1500 Deductible POS w/ Massage Therapy","Standard Gold Off Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1744201","https://planfinder.ghcscw.com/marketplace/1744201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0270002","Gold Zero Primary Care Visit Copay 1500 Deductible POS w/ Massage Therapy","94529WI027",,"WIN001","WIS006","WIF003","New","POS","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270002-01","Gold Zero Primary Care Visit Copay 1500 Deductible POS w/ Massage Therapy","Standard Gold On Exchange Plan",,"0.81508857011795","No","No","No","100%",,"$1,500","$0","$700","$150","$1,500","$570","$130","$80","$0","$0","$0","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1724201","https://planfinder.ghcscw.com/marketplace/1724201"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0270003","Silver Zero Primary Care Visit Copay 3500 Deductible POS w/ Massage Therapy","94529WI027",,"WIN001","WIS006","WIF006","New","POS","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270003-00","Silver Zero Primary Care Visit Copay 3500 Deductible POS w/ Massage Therapy","Standard Silver Off Exchange Plan",,"0.719652056694031","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1744301","https://planfinder.ghcscw.com/marketplace/1744301"
"2017","WI","94529","HIOS","2016-11-15 02:20:22","SHOP (Small Group)","No","39-1199466","94529WI0270003","Silver Zero Primary Care Visit Copay 3500 Deductible POS w/ Massage Therapy","94529WI027",,"WIN001","WIS006","WIF006","New","POS","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270003-01","Silver Zero Primary Care Visit Copay 3500 Deductible POS w/ Massage Therapy","Standard Silver On Exchange Plan",,"0.719652056694031","No","No","No","100%",,"$3,500","$20","$500","$150","$3,500","$650","$110","$80","$0","$0","$0","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1724301","https://planfinder.ghcscw.com/marketplace/1724301"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","83-0231011","11269WY0080013","BlueSelect Gold Core with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080013-00","BlueSelect Gold Core with Kid's Dental","Standard Gold Off Exchange Plan","81.52%","0.815167427062988","Yes","Yes","No","100%",,"$1,500","$0","$300","$200","$1,500","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","5%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAGXD","https://www.bcbswy.com/docs/employers/2017/BlueSelect_Small_Group_Gold_Plans.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070001","BlueSelect Gold Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070001-00","BlueSelect Gold Basic with Kid's Dental","Standard Gold Off Exchange Plan","79.79%","0.797861874103546","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070001","BlueSelect Gold Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070001-01","BlueSelect Gold Basic with Kid's Dental","Standard Gold On Exchange Plan","79.79%","0.797861874103546","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","83-0231011","11269WY0080013","BlueSelect Gold Core with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080013-01","BlueSelect Gold Core with Kid's Dental","Standard Gold On Exchange Plan","81.52%","0.815167427062988","Yes","Yes","No","100%",,"$1,500","$0","$300","$200","$1,500","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","5%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAGXD","https://www.bcbswy.com/docs/employers/2017/BlueSelect_Small_Group_Gold_Plans.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","83-0231011","11269WY0080014","BlueSelect Silver Core with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF018","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080014-00","BlueSelect Silver Core with Kid's Dental","Standard Silver Off Exchange Plan","70.89%","0.708850145339966","Yes","Yes","No","100%",,"$1,750","$0","$1,400","$200","$1,750","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,250","$16250 per person","$32500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","25%",,,,,"$4,000","per person not applicable","$5500 per group","$5,750","per person not applicable","$9000 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAGXD","https://www.bcbswy.com/docs/employers/2017/BlueSelect_Small_Group_Silver_Plans.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070001","BlueSelect Gold Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070001-02","BlueSelect Gold Basic with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-03","BlueSelect Silver ValueTwo with Kid's Dental","Limited Cost Sharing Plan Variation","69.61%","0.696081399917603","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-04","BlueSelect Silver ValueTwo with Kid's Dental","73% AV Level Silver Plan","73.47%","0.734715282917023","No","Yes","No","100%",,"$3,000","$10","$0","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$13,200","$13200 per person","$26400 per group","$18,900","$18900 per person","$37800 per group","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-05","BlueSelect Silver ValueTwo with Kid's Dental","87% AV Level Silver Plan","87.01%","0.870096564292908","No","Yes","No","100%",,"$1,250","$10","$0","$200","$1,100","$400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,200","$13200 per person","$26400 per group","$14,700","$14700 per person","$29400 per group","$1,250","$1250 per person","$2500 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$7,250","$7250 per person","$14500 per group","$150","$150 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-02","BlueSelect Silver HealthPlus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-03","BlueSelect Silver HealthPlus","Limited Cost Sharing Plan Variation","70.59%","0.69871973991394","Yes","Yes","No","100%",,"$3,000","$10","$1,100","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$9,900","$9900 per person","$19800 per group","$17,050","$17050 per person","$34100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-04","BlueSelect Silver HealthPlus","73% AV Level Silver Plan","73.84%","0.731846630573273","Yes","Yes","No","100%",,"$2,400","$10","$1,200","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$9,900","$9900 per person","$19800 per group","$15,600","$15600 per person","$31200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,400","$7400 per person","$14800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus73forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-05","BlueSelect Silver HealthPlus","87% AV Level Silver Plan","87.52%","0.872472047805786","Yes","Yes","No","100%",,"$400","$0","$1,600","$200","$400","$300","$200","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$9,900","$9900 per person","$19800 per group","$11,900","$11900 per person","$23800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus87forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-06","BlueSelect Silver HealthPlus","94% AV Level Silver Plan","93.67%","0.936261057853699","Yes","Yes","No","100%",,"$100","$10","$600","$200","$100","$100","$300","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$9,900","$9900 per person","$19800 per group","$10,650","$10650 per person","$21300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus94forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070001","BlueSelect Gold Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070001-03","BlueSelect Gold Basic with Kid's Dental","Limited Cost Sharing Plan Variation","79.79%","0.797861874103546","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","SHOP (Small Group)","No","83-0231011","11269WY0080014","BlueSelect Silver Core with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF018","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080014-01","BlueSelect Silver Core with Kid's Dental","Standard Silver On Exchange Plan","70.89%","0.708850145339966","Yes","Yes","No","100%",,"$1,750","$0","$1,400","$200","$1,750","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,250","$16250 per person","$32500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","25%",,,,,"$4,000","per person not applicable","$5500 per group","$5,750","per person not applicable","$9000 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAGXD","https://www.bcbswy.com/docs/employers/2017/BlueSelect_Small_Group_Silver_Plans.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-00","BlueSelect Silver Basic with Kid's Dental","Standard Silver Off Exchange Plan","71.92%","0.719243347644806","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-01","BlueSelect Silver Basic with Kid's Dental","Standard Silver On Exchange Plan","71.92%","0.719243347644806","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-02","BlueSelect Silver Basic with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-03","BlueSelect Silver Basic with Kid's Dental","Limited Cost Sharing Plan Variation","71.92%","0.719243347644806","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-04","BlueSelect Silver Basic with Kid's Dental","73% AV Level Silver Plan","73.96%","0.739615619182587","Yes","Yes","No","100%",,"$2,275","$10","$1,200","$200","$1,000","$500","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$12,700","$12700 per person","$25400 per group","$18,400","$18400 per person","$36800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,275","$2275 per person","$4550 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,275","$7275 per person","$14550 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-05","BlueSelect Silver Basic with Kid's Dental","87% AV Level Silver Plan","87.07%","0.870730519294739","Yes","Yes","No","100%",,"$400","$10","$1,700","$200","$400","$200","$200","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,950","$14950 per person","$29900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-06","BlueSelect Silver Basic with Kid's Dental","94% AV Level Silver Plan","93.46%","0.934601247310638","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$100","$300","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$12,700","$12700 per person","$25400 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070003","BlueSelect Bronze Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070003-00","BlueSelect Bronze Basic with Kid's Dental","Standard Bronze Off Exchange Plan","61.66%","0.616640985012054","Yes","Yes","No","100%",,"$6,000","$20","$600","$200","$700","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,850","$20850 per person","$41700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$14,000","$14000 per person","$27000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070003","BlueSelect Bronze Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070003-01","BlueSelect Bronze Basic with Kid's Dental","Standard Bronze On Exchange Plan","61.66%","0.616640985012054","Yes","Yes","No","100%",,"$6,000","$20","$600","$200","$700","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,850","$20850 per person","$41700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$14,000","$14000 per person","$27000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070003","BlueSelect Bronze Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070003-02","BlueSelect Bronze Basic with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070003","BlueSelect Bronze Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070003-03","BlueSelect Bronze Basic with Kid's Dental","Limited Cost Sharing Plan Variation","61.66%","0.616640985012054","Yes","Yes","No","100%",,"$6,000","$20","$600","$200","$700","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,850","$20850 per person","$41700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$14,000","$14000 per person","$27000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-00","BlueSelect Bronze Core with Kid's Dental","Standard Bronze Off Exchange Plan","61.91%","0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,400","$200","$4,500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$8000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$10,500","per person not applicable","$20000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-01","BlueSelect Bronze Core with Kid's Dental","Standard Bronze On Exchange Plan","61.91%","0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,400","$200","$4,500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$8000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$10,500","per person not applicable","$20000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-02","BlueSelect Bronze Core with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSA100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-03","BlueSelect Bronze Core with Kid's Dental","Limited Cost Sharing Plan Variation","61.91%","0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,400","$200","$4,500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$8000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$10,500","per person not applicable","$20000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSA300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070012","BlueSelect Gold Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070012-00","BlueSelect Gold Core with Kid's Dental","Standard Gold Off Exchange Plan","81.15%","0.811516880989075","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070012","BlueSelect Gold Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070012-01","BlueSelect Gold Core with Kid's Dental","Standard Gold On Exchange Plan","81.15%","0.811516880989075","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070012","BlueSelect Gold Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070012-02","BlueSelect Gold Core with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSA100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070012","BlueSelect Gold Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070012-03","BlueSelect Gold Core with Kid's Dental","Limited Cost Sharing Plan Variation","81.15%","0.811516880989075","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSA300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-00","BlueSelect Silver Core with Kid's Dental","Standard Silver Off Exchange Plan","71.22%","0.712150514125824","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,250","$16250 per person","$32500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-01","BlueSelect Silver Core with Kid's Dental","Standard Silver On Exchange Plan","71.22%","0.712150514125824","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,250","$16250 per person","$32500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-00","BlueSelect Silver ValueTwo with Kid's Dental","Standard Silver Off Exchange Plan","69.61%","0.696081399917603","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwoIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-02","BlueSelect Silver Core","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-03","BlueSelect Silver Core","Limited Cost Sharing Plan Variation","71.22%","0.712150514125824","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,250","$16250 per person","$32500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-04","BlueSelect Silver Core","73% AV Level Silver Plan","73.38%","0.73384565114975","Yes","Yes","No","100%",,"$1,750","$0","$1,100","$200","$1,750","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$9,700","$9700 per person","$19400 per group","$15,200","$15200 per person","$30400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,250","per person not applicable","$10000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA73forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-05","BlueSelect Silver Core","87% AV Level Silver Plan","87.79%","0.877864420413971","Yes","Yes","No","100%",,"$200","$0","$1,400","$200","$200","$0","$1,000","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$9,700","$9700 per person","$19400 per group","$11,950","$11950 per person","$23900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$4,700","per person not applicable","$6900 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA87forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-03","BlueSelect Silver ValueTwo","Limited Cost Sharing Plan Variation","69.61%","0.696081399917603","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-02","BlueSelect Silver Core with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-03","BlueSelect Silver Core with Kid's Dental","Limited Cost Sharing Plan Variation","71.22%","0.712150514125824","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,250","$16250 per person","$32500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-04","BlueSelect Silver Core with Kid's Dental","73% AV Level Silver Plan","73.38%","0.73384565114975","Yes","Yes","No","100%",,"$1,750","$0","$1,100","$200","$1,750","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$9,700","$9700 per person","$19400 per group","$15,200","$15200 per person","$30400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,250","per person not applicable","$10000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-05","BlueSelect Silver Core with Kid's Dental","87% AV Level Silver Plan","87.79%","0.877864420413971","Yes","Yes","No","100%",,"$200","$0","$1,400","$200","$200","$0","$1,000","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$9,700","$9700 per person","$19400 per group","$11,950","$11950 per person","$23900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$4,700","per person not applicable","$6900 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-06","BlueSelect Silver Core with Kid's Dental","94% AV Level Silver Plan","94.37%","0.943654358386993","Yes","Yes","No","100%",,"$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$9,700","$9700 per person","$19400 per group","$10,300","$10300 per person","$20600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$4,600","per person not applicable","$6700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070020","BlueSelect Bronze Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070020-00","BlueSelect Bronze Classic with Kid'sDental","Standard Bronze Off Exchange Plan","61.38%","0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,550","$16550 per person","$33100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$15,000","$15000 per person","$30000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070020","BlueSelect Bronze Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070020-01","BlueSelect Bronze Classic with Kid'sDental","Standard Bronze On Exchange Plan","61.38%","0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,550","$16550 per person","$33100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$15,000","$15000 per person","$30000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070020","BlueSelect Bronze Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070020-02","BlueSelect Bronze Classic with Kid'sDental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070020","BlueSelect Bronze Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070020-03","BlueSelect Bronze Classic with Kid'sDental","Limited Cost Sharing Plan Variation","61.38%","0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,550","$16550 per person","$33100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$15,000","$15000 per person","$30000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070005","BlueSelect Catastrophic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF005","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070005-00","BlueSelect Catastrophic with Kid's Dental","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$5,100","$200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"$9,350","$9350 per person","$18700 per group","$16,500","$16500 per person","$33000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectCatastrophicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070005","BlueSelect Catastrophic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF005","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070005-01","BlueSelect Catastrophic with Kid's Dental","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$5,100","$200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"$9,350","$9350 per person","$18700 per group","$16,500","$16500 per person","$33000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectCatastrophicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-00","BlueSelect Gold Classic with Kid's Dental","Standard Gold Off Exchange Plan","80.70%","0.807034969329834","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-01","BlueSelect Gold Classic with Kid's Dental","Standard Gold On Exchange Plan","80.70%","0.807034969329834","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-02","BlueSelect Gold Classic with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-03","BlueSelect Gold Classic with Kid's Dental","Limited Cost Sharing Plan Variation","80.70%","0.807034969329834","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-00","BlueSelect Silver Classic with Kid's Dental","Standard Silver Off Exchange Plan","71.65%","0.716492235660553","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-01","BlueSelect Silver Classic with Kid's Dental","Standard Silver On Exchange Plan","71.65%","0.716492235660553","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-02","BlueSelect Silver Classic with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-03","BlueSelect Silver Classic with Kid's Dental","Limited Cost Sharing Plan Variation","71.65%","0.716492235660553","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-04","BlueSelect Silver Classic with Kid's Dental","73% AV Level Silver Plan","73.87%","0.738749384880066","Yes","Yes","No","100%",,"$1,700","$10","$1,900","$200","$1,100","$400","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,150","$14150 per person","$28300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,200","$6200 per person","$9900 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-05","BlueSelect Silver Classic with Kid's Dental","87% AV Level Silver Plan","86.54%","0.865412414073944","Yes","Yes","No","100%",,"$100","$10","$2,100","$200","$100","$100","$400","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$8,750","$8750 per person","$17500 per group","$11,000","$11000 per person","$22000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$4,600","$4600 per person","$6700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-06","BlueSelect Silver Classic with Kid's Dental","94% AV Level Silver Plan","93.37%","0.933725535869598","Yes","Yes","No","100%",,"$50","$0","$600","$200","$50","$90","$400","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$8,750","$8750 per person","$17500 per group","$9,450","$9450 per person","$18900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$4,550","$4550 per person","$6600 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-00","BlueSelect Gold HealthPlus with Kid's Dental","Standard Gold Off Exchange Plan","81.81%","0.814207017421722","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,650","$15650 per person","$31300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-01","BlueSelect Gold HealthPlus with Kid's Dental","Standard Gold On Exchange Plan","81.81%","0.814207017421722","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,650","$15650 per person","$31300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-02","BlueSelect Gold HealthPlus with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-03","BlueSelect Gold HealthPlus with Kid's Dental","Limited Cost Sharing Plan Variation","81.81%","0.814207017421722","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,650","$15650 per person","$31300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-00","BlueSelect Silver HealthPlus with Kid's Dental","Standard Silver Off Exchange Plan","70.59%","0.69871973991394","Yes","Yes","No","100%",,"$3,000","$10","$1,100","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$9,900","$9900 per person","$19800 per group","$17,050","$17050 per person","$34100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-01","BlueSelect Silver HealthPlus with Kid's Dental","Standard Silver On Exchange Plan","70.59%","0.69871973991394","Yes","Yes","No","100%",,"$3,000","$10","$1,100","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$9,900","$9900 per person","$19800 per group","$17,050","$17050 per person","$34100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-02","BlueSelect Silver HealthPlus with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-03","BlueSelect Silver HealthPlus with Kid's Dental","Limited Cost Sharing Plan Variation","70.59%","0.69871973991394","Yes","Yes","No","100%",,"$3,000","$10","$1,100","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$9,900","$9900 per person","$19800 per group","$17,050","$17050 per person","$34100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-04","BlueSelect Silver HealthPlus with Kid's Dental","73% AV Level Silver Plan","73.84%","0.731846630573273","Yes","Yes","No","100%",,"$2,400","$10","$1,200","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$9,900","$9900 per person","$19800 per group","$15,600","$15600 per person","$31200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,400","$7400 per person","$14800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-05","BlueSelect Silver HealthPlus with Kid's Dental","87% AV Level Silver Plan","87.52%","0.872472047805786","Yes","Yes","No","100%",,"$400","$0","$1,600","$200","$400","$300","$200","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$9,900","$9900 per person","$19800 per group","$11,900","$11900 per person","$23800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-06","BlueSelect Silver HealthPlus with Kid's Dental","94% AV Level Silver Plan","93.67%","0.936261057853699","Yes","Yes","No","100%",,"$100","$10","$600","$200","$100","$100","$300","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$9,900","$9900 per person","$19800 per group","$10,650","$10650 per person","$21300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-00","BlueSelect Silver ValueOne with Kid's Dental","Standard Silver Off Exchange Plan","68.11%","0.681130647659302","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,600","$15600 per person","$31200 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOneIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-01","BlueSelect Silver ValueOne with Kid's Dental","Standard Silver On Exchange Plan","68.11%","0.681130647659302","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,600","$15600 per person","$31200 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOneIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-02","BlueSelect Silver ValueOne with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-03","BlueSelect Silver ValueOne with Kid's Dental","Limited Cost Sharing Plan Variation","68.11%","0.681130647659302","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,600","$15600 per person","$31200 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-04","BlueSelect Silver ValueOne with Kid's Dental","73% AV Level Silver Plan","73.77%","0.737667560577393","No","Yes","No","100%",,"$2,750","$20","$700","$200","$1,000","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","$13,500","$13500 per person","$27000 per group","$2,750","$2750 per person","$5500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,250","$9250 per person","$18500 per group","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-05","BlueSelect Silver ValueOne with Kid's Dental","87% AV Level Silver Plan","87.60%","0.875987887382507","No","Yes","No","100%",,"$750","$0","$500","$200","$750","$400","$70","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,250","$11250 per person","$22500 per group","$750","$750 per person","$1500 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$7,250","$7250 per person","$14500 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-06","BlueSelect Silver ValueOne with Kid's Dental","94% AV Level Silver Plan","93.78%","0.937791883945465","No","Yes","No","100%",,"$250","$10","$200","$200","$250","$100","$100","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","$10,500","$10500 per person","$21000 per group","$250","$250 per person","$500 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$6,750","$6750 per person","$13500 per group","$50","$50 per person","$100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-01","BlueSelect Silver ValueTwo with Kid's Dental","Standard Silver On Exchange Plan","69.61%","0.696081399917603","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwoIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-02","BlueSelect Silver ValueTwo with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-06","BlueSelect Silver ValueTwo with Kid's Dental","94% AV Level Silver Plan","94.46%","0.944560170173645","No","Yes","No","100%",,"$200","$0","$0","$200","$200","$100","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$13,200","$13200 per person","$26400 per group","$14,200","$14200 per person","$28400 per group","$200","$200 per person","$400 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$6,200","$6200 per person","$12400 per group","$50","$50 per person","$100 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-00","BlueSelect Bronze Value with Kid's Dental","Standard Bronze Off Exchange Plan","58.91%","0.589140295982361","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,150","$20150 per person","$40300 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-01","BlueSelect Bronze Value with Kid's Dental","Standard Bronze On Exchange Plan","58.91%","0.589140295982361","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,150","$20150 per person","$40300 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIXD","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-02","BlueSelect Bronze Value with Kid's Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-03","BlueSelect Bronze Value with Kid's Dental","Limited Cost Sharing Plan Variation","58.91%","0.589140295982361","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,150","$20150 per person","$40300 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170001","BlueSelect Gold Classic","11269WY017","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170001-00","BlueSelect Gold Classic","Standard Gold Off Exchange Plan","80.70%","0.807034969329834","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170001","BlueSelect Gold Classic","11269WY017","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170001-01","BlueSelect Gold Classic","Standard Gold On Exchange Plan","80.70%","0.807034969329834","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170001","BlueSelect Gold Classic","11269WY017","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170001-02","BlueSelect Gold Classic","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170001","BlueSelect Gold Classic","11269WY017","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170001-03","BlueSelect Gold Classic","Limited Cost Sharing Plan Variation","80.70%","0.807034969329834","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-00","BlueSelect Silver Classic","Standard Silver Off Exchange Plan","71.65%","0.716492235660553","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-01","BlueSelect Silver Classic","Standard Silver On Exchange Plan","71.65%","0.716492235660553","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-02","BlueSelect Silver Classic","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-03","BlueSelect Silver Classic","Limited Cost Sharing Plan Variation","71.65%","0.716492235660553","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-04","BlueSelect Silver Classic","73% AV Level Silver Plan","73.87%","0.738749384880066","Yes","Yes","No","100%",,"$1,700","$10","$1,900","$200","$1,100","$400","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,150","$14150 per person","$28300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,200","$6200 per person","$9900 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic73forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-05","BlueSelect Silver Classic","87% AV Level Silver Plan","86.54%","0.865412414073944","Yes","Yes","No","100%",,"$100","$10","$2,100","$200","$100","$100","$400","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$8,750","$8750 per person","$17500 per group","$11,000","$11000 per person","$22000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$4,600","$4600 per person","$6700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic87forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-06","BlueSelect Silver Classic","94% AV Level Silver Plan","93.37%","0.933725535869598","Yes","Yes","No","100%",,"$50","$0","$600","$200","$50","$90","$400","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$8,750","$8750 per person","$17500 per group","$9,450","$9450 per person","$18900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$4,550","$4550 per person","$6600 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic94forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170003","BlueSelect Gold Core","11269WY017","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170003-00","BlueSelect Gold Core","Standard Gold Off Exchange Plan","81.15%","0.811516880989075","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170003","BlueSelect Gold Core","11269WY017","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170003-01","BlueSelect Gold Core","Standard Gold On Exchange Plan","81.15%","0.811516880989075","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170003","BlueSelect Gold Core","11269WY017","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170003-02","BlueSelect Gold Core","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSA100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170003","BlueSelect Gold Core","11269WY017","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170003-03","BlueSelect Gold Core","Limited Cost Sharing Plan Variation","81.15%","0.811516880989075","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSA300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-00","BlueSelect Silver Core","Standard Silver Off Exchange Plan","71.22%","0.712150514125824","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,250","$16250 per person","$32500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-01","BlueSelect Silver Core","Standard Silver On Exchange Plan","71.22%","0.712150514125824","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,250","$16250 per person","$32500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-06","BlueSelect Silver Core","94% AV Level Silver Plan","94.37%","0.943654358386993","Yes","Yes","No","100%",,"$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$9,700","$9700 per person","$19400 per group","$10,300","$10300 per person","$20600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$4,600","per person not applicable","$6700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA94forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170005","BlueSelect Bronze Classic","11269WY017","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170005-00","BlueSelect Bronze Classic","Standard Bronze Off Exchange Plan","61.38%","0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,550","$16550 per person","$33100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$15,000","$15000 per person","$30000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170005","BlueSelect Bronze Classic","11269WY017","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170005-01","BlueSelect Bronze Classic","Standard Bronze On Exchange Plan","61.38%","0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,550","$16550 per person","$33100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$15,000","$15000 per person","$30000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170005","BlueSelect Bronze Classic","11269WY017","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170005-02","BlueSelect Bronze Classic","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassic100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170005","BlueSelect Bronze Classic","11269WY017","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170005-03","BlueSelect Bronze Classic","Limited Cost Sharing Plan Variation","61.38%","0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,550","$16550 per person","$33100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$15,000","$15000 per person","$30000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassic300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170006","BlueSelect Bronze Core","11269WY017","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170006-00","BlueSelect Bronze Core","Standard Bronze Off Exchange Plan","61.91%","0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,400","$200","$4,500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$8000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$10,500","per person not applicable","$20000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170006","BlueSelect Bronze Core","11269WY017","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170006-01","BlueSelect Bronze Core","Standard Bronze On Exchange Plan","61.91%","0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,400","$200","$4,500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$8000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$10,500","per person not applicable","$20000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170006","BlueSelect Bronze Core","11269WY017","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170006-02","BlueSelect Bronze Core","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSA100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170006","BlueSelect Bronze Core","11269WY017","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170006-03","BlueSelect Bronze Core","Limited Cost Sharing Plan Variation","61.91%","0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,400","$200","$4,500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$8000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$10,500","per person not applicable","$20000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSA300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170007","BlueSelect Gold HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170007-00","BlueSelect Gold HealthPlus","Standard Gold Off Exchange Plan","81.81%","0.814207017421722","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,650","$15650 per person","$31300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170007","BlueSelect Gold HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170007-01","BlueSelect Gold HealthPlus","Standard Gold On Exchange Plan","81.81%","0.814207017421722","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,650","$15650 per person","$31300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170007","BlueSelect Gold HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170007-02","BlueSelect Gold HealthPlus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170007","BlueSelect Gold HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170007-03","BlueSelect Gold HealthPlus","Limited Cost Sharing Plan Variation","81.81%","0.814207017421722","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,650","$15650 per person","$31300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-00","BlueSelect Silver HealthPlus","Standard Silver Off Exchange Plan","70.59%","0.69871973991394","Yes","Yes","No","100%",,"$3,000","$10","$1,100","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$9,900","$9900 per person","$19800 per group","$17,050","$17050 per person","$34100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-01","BlueSelect Silver HealthPlus","Standard Silver On Exchange Plan","70.59%","0.69871973991394","Yes","Yes","No","100%",,"$3,000","$10","$1,100","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$9,900","$9900 per person","$19800 per group","$17,050","$17050 per person","$34100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-00","BlueSelect Silver ValueOne","Standard Silver Off Exchange Plan","68.11%","0.681130647659302","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,600","$15600 per person","$31200 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOneIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-01","BlueSelect Silver ValueOne","Standard Silver On Exchange Plan","68.11%","0.681130647659302","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,600","$15600 per person","$31200 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOneIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-02","BlueSelect Silver ValueOne","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-03","BlueSelect Silver ValueOne","Limited Cost Sharing Plan Variation","68.11%","0.681130647659302","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,600","$15600 per person","$31200 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-04","BlueSelect Silver ValueOne","73% AV Level Silver Plan","73.77%","0.737667560577393","No","Yes","No","100%",,"$2,750","$20","$700","$200","$1,000","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","$13,500","$13500 per person","$27000 per group","$2,750","$2750 per person","$5500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,250","$9250 per person","$18500 per group","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne73forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-05","BlueSelect Silver ValueOne","87% AV Level Silver Plan","87.60%","0.875987887382507","No","Yes","No","100%",,"$750","$0","$500","$200","$750","$400","$70","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,250","$11250 per person","$22500 per group","$750","$750 per person","$1500 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$7,250","$7250 per person","$14500 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne87forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-06","BlueSelect Silver ValueOne","94% AV Level Silver Plan","93.78%","0.937791883945465","No","Yes","No","100%",,"$250","$10","$200","$200","$250","$100","$100","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","$10,500","$10500 per person","$21000 per group","$250","$250 per person","$500 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$6,750","$6750 per person","$13500 per group","$50","$50 per person","$100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne94forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-00","BlueSelect Silver ValueTwo","Standard Silver Off Exchange Plan","69.61%","0.696081399917603","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwoIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-01","BlueSelect Silver ValueTwo","Standard Silver On Exchange Plan","69.61%","0.696081399917603","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwoIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-02","BlueSelect Silver ValueTwo","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-04","BlueSelect Silver ValueTwo","73% AV Level Silver Plan","73.47%","0.734715282917023","No","Yes","No","100%",,"$3,000","$10","$0","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$13,200","$13200 per person","$26400 per group","$18,900","$18900 per person","$37800 per group","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo73forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-05","BlueSelect Silver ValueTwo","87% AV Level Silver Plan","87.01%","0.870096564292908","No","Yes","No","100%",,"$1,250","$10","$0","$200","$1,100","$400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,200","$13200 per person","$26400 per group","$14,700","$14700 per person","$29400 per group","$1,250","$1250 per person","$2500 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$7,250","$7250 per person","$14500 per group","$150","$150 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo87forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-06","BlueSelect Silver ValueTwo","94% AV Level Silver Plan","94.46%","0.944560170173645","No","Yes","No","100%",,"$200","$0","$0","$200","$200","$100","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$13,200","$13200 per person","$26400 per group","$14,200","$14200 per person","$28400 per group","$200","$200 per person","$400 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$6,200","$6200 per person","$12400 per group","$50","$50 per person","$100 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo94forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210002","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF204","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210002-03","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.82%","0.730470657348633","No","Yes","No","100%",,"$3,000","$30","$1,100","$40","$1,600","$1,500","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33005&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210002","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF204","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210002-04","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","73% AV Level Silver Plan","73.94%","0.74869441986084","No","Yes","No","100%",,"$2,700","$30","$1,200","$40","$1,600","$1,500","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32028&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210002","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF204","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210002-05","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","87% AV Level Silver Plan","87.68%","0.873324990272522","No","Yes","No","100%",,"$500","$20","$600","$40","$500","$1,000","$300","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32029&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170010","BlueSelect Bronze Value","11269WY017","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170010-00","BlueSelect Bronze Value","Standard Bronze Off Exchange Plan","58.91%","0.589140295982361","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,150","$20150 per person","$40300 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170010","BlueSelect Bronze Value","11269WY017","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170010-01","BlueSelect Bronze Value","Standard Bronze On Exchange Plan","58.91%","0.589140295982361","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,150","$20150 per person","$40300 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170010","BlueSelect Bronze Value","11269WY017","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170010-02","BlueSelect Bronze Value","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170010","BlueSelect Bronze Value","11269WY017","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170010-03","BlueSelect Bronze Value","Limited Cost Sharing Plan Variation","58.91%","0.589140295982361","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,150","$20150 per person","$40300 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170011","BlueSelect Gold Basic","11269WY017","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170011-00","BlueSelect Gold Basic","Standard Gold Off Exchange Plan","79.79%","0.797861874103546","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170011","BlueSelect Gold Basic","11269WY017","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170011-01","BlueSelect Gold Basic","Standard Gold On Exchange Plan","79.79%","0.797861874103546","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170011","BlueSelect Gold Basic","11269WY017","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170011-02","BlueSelect Gold Basic","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasic100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170011","BlueSelect Gold Basic","11269WY017","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170011-03","BlueSelect Gold Basic","Limited Cost Sharing Plan Variation","79.79%","0.797861874103546","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasic300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-00","BlueSelect Silver Basic","Standard Silver Off Exchange Plan","71.92%","0.719243347644806","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-01","BlueSelect Silver Basic","Standard Silver On Exchange Plan","71.92%","0.719243347644806","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-02","BlueSelect Silver Basic","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-03","BlueSelect Silver Basic","Limited Cost Sharing Plan Variation","71.92%","0.719243347644806","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-04","BlueSelect Silver Basic","73% AV Level Silver Plan","73.96%","0.739615619182587","Yes","Yes","No","100%",,"$2,275","$10","$1,200","$200","$1,000","$500","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$12,700","$12700 per person","$25400 per group","$18,400","$18400 per person","$36800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,275","$2275 per person","$4550 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,275","$7275 per person","$14550 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic73forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver73.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-05","BlueSelect Silver Basic","87% AV Level Silver Plan","87.07%","0.870730519294739","Yes","Yes","No","100%",,"$400","$10","$1,700","$200","$400","$200","$200","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,950","$14950 per person","$29900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic87forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver87.pdf"
"2017","WY","83964","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","83-0209667","83964WY0020004","Delta Dental Small Group High Plan","83964WY002","7609879839","WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB pediatric coverage is not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0020004-00","Delta Dental Small Group High Plan","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d133503.aspx",
"2017","WY","90776","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","90776WY0040002","EHB High PPO","90776WY004",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","90776WY0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WY","90776","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","90776WY0040001","EHB Low PPO","90776WY004",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","90776WY0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610012","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610012-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4R","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610012","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610012-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","80.40%","0.810140609741211","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610013","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610013-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Standard Gold On Exchange Plan","80.40%","0.810140609741211","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610013","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610013-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4R","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610013","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610013-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","80.40%","0.810140609741211","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-06","BlueSelect Silver Basic","94% AV Level Silver Plan","93.46%","0.934601247310638","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$100","$300","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$12,700","$12700 per person","$25400 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic94forIndividuals","https://www.bcbswy.com/docs/coverage/2017/Subsidy_Silver94.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170013","BlueSelect Bronze Basic","11269WY017","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170013-00","BlueSelect Bronze Basic","Standard Bronze Off Exchange Plan","61.66%","0.616640985012054","Yes","Yes","No","100%",,"$6,000","$20","$600","$200","$700","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,850","$20850 per person","$41700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$14,000","$14000 per person","$27000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170013","BlueSelect Bronze Basic","11269WY017","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170013-01","BlueSelect Bronze Basic","Standard Bronze On Exchange Plan","61.66%","0.616640985012054","Yes","Yes","No","100%",,"$6,000","$20","$600","$200","$700","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,850","$20850 per person","$41700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$14,000","$14000 per person","$27000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170013","BlueSelect Bronze Basic","11269WY017","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170013-02","BlueSelect Bronze Basic","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasic100forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170013","BlueSelect Bronze Basic","11269WY017","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170013-03","BlueSelect Bronze Basic","Limited Cost Sharing Plan Variation","61.66%","0.616640985012054","Yes","Yes","No","100%",,"$6,000","$20","$600","$200","$700","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,850","$20850 per person","$41700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$14,000","$14000 per person","$27000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasic300forTribalMembers","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170014","BlueSelect Catastrophic","11269WY017","7154324389","WYN001","WYS001","WYF005","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170014-00","BlueSelect Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$5,100","$200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"$9,350","$9350 per person","$18700 per group","$16,500","$16500 per person","$33000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectCatastrophicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","11269","HIOS","2016-08-24 02:30:21","Individual","No","83-0231011","11269WY0170014","BlueSelect Catastrophic","11269WY017","7154324389","WYN001","WYS001","WYF005","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170014-01","BlueSelect Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$200","$5,100","$200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0%",,,,,"$9,350","$9350 per person","$18700 per group","$16,500","$16500 per person","$33000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectCatastrophicIX","https://www.bcbswy.com/docs/coverage/2017/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2017","WY","14609","HIOS","2016-08-15 07:42:31","SHOP (Small Group)","Yes","57-0523959","14609WY0020001","Group Dental Policy","14609WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditioanl with inside maximum","Yes","traditional with inside maximum","Yes",,"","14609WY0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010007","BESTDental Premium","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Premium_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47731WY0020003","BESTOne Advantage Gold","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47731WY0020003","BESTOne Advantage Gold","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010007","BESTDental Premium","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Premium_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010008","BESTDental Standard - H","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Standard-H_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47731WY0020004","BESTOne Plus Gold","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47731WY0020004","BESTOne Plus Gold","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010008","BESTDental Standard - H","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Standard-H_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010010","BESTDental Choice - H","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Choice-H_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010010","BESTDental Choice - H","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Choice-H_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010009","BESTDental Standard - L","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Premium_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47731WY0020005","BESTOne Plus Silver","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47731WY0020005","BESTOne Plus Silver","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010009","BESTDental Standard - L","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Premium_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010011","BESTDental Choice - L","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Standard-H_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47731WY0020006","BESTOne Basic Silver","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","Individual","Yes","95-6042390","47731WY0020006","BESTOne Basic Silver","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010011","BESTDental Choice - L","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Standard-H_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010012","BESTDental Value","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Choice-H_Plan.pdf"
"2017","WY","47731","HIOS","2016-07-01 08:12:23","SHOP (Small Group)","Yes","95-6042390","47731WY0010012","BESTDental Value","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/2017/WY_BESTDental_Choice-H_Plan.pdf"
"2017","WY","54763","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","54763WY0040002","EHB High PPO","54763WY004",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","54763WY0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WY","54763","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","54763WY0040001","EHB Low PPO","54763WY004",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","54763WY0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WY","54763","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","54763WY0030002","EHB High Passive","54763WY003",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","54763WY0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WY","54763","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","47-0098400","54763WY0030001","EHB Low Passive","54763WY003",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","54763WY0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WY","76197","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","76197WY0040002","EHB High PPO","76197WY004",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76197WY0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WY","76197","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","76197WY0040001","EHB Low PPO","76197WY004",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76197WY0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WY","76197","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","76197WY0030002","EHB High Passive","76197WY003",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76197WY0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WY","76197","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","36-0883760","76197WY0030001","EHB Low Passive","76197WY003",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76197WY0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WY","80132","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","80132WY0020001","Renaissance Individual Dental PPO, EHB Certified","80132WY002",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","80132WY0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WY","80132","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","80132WY0020002","Renaissance Individual Dental PPO, EHB Certified","80132WY002",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","80132WY0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WY","80132","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","80132WY0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","80132WY004",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_EHB_High_2017","http://www.renaissancedental.com/WY_EHB_High_2017"
"2017","WY","80132","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","80132WY0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","80132WY004",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_EHB_Low_2017","http://www.renaissancedental.com/WY_EHB_Low_2017"
"2017","WY","80132","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","80132WY0050001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","80132WY005",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0050001-01","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_Ped_High_2017","http://www.renaissancedental.com/WY_Ped_High_2017"
"2017","WY","80132","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","80132WY0050002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","80132WY005",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0050002-01","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_Ped_Low_2017","http://www.renaissancedental.com/WY_Ped_Low_2017"
"2017","WY","80132","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","80132WY0060001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","80132WY006",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","80132WY0060001-00","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WY","80132","HIOS","2016-06-25 15:13:19","Individual","Yes","47-0397286","80132WY0060002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","80132WY006",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","80132WY0060002-00","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WY","83964","HIOS","2016-05-16 23:14:35","Individual","Yes","83-0209667","83964WY0010003","Delta Dental Individual & Family Low Plan","83964WY001","7609879839","WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB pediatric coverage is not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0010003-00","Delta Dental Individual & Family Low Plan","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d133500.aspx",
"2017","WY","83964","HIOS","2016-05-16 23:14:35","SHOP (Small Group)","Yes","83-0209667","83964WY0020003","Delta Dental Small Group Low Plan","83964WY002","7609879839","WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB pediatric coverage is not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0020003-00","Delta Dental Small Group Low Plan","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d133502.aspx",
"2017","WY","83964","HIOS","2016-05-16 23:14:35","Individual","Yes","83-0209667","83964WY0010004","Delta Dental Individual & Family High Plan","83964WY001","7609879839","WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB pediatric coverage is not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0010004-00","Delta Dental Individual & Family High Plan","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d133501.aspx",
"2017","WY","90776","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","90776WY0030002","EHB High Passive","90776WY003",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","90776WY0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WY","90776","HIOS","2016-06-28 02:39:00","SHOP (Small Group)","Yes","93-0242990","90776WY0030001","EHB Low Passive","90776WY003",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","90776WY0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0620001","Blue Cross Select Gold, a Multi-State Plan","46944AL062","7346243505","ALN201","ALS201","ALF201","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0620001-01","Blue Cross Select Gold, a Multi-State Plan","Standard Gold On Exchange Plan","78.06%",,"No","Yes","Yes","95%","5%","$900","$500","$0","$200","$20","$1,100","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","20.00%","$850","$850 per person","$1700 per group","20.00%","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017gms.pdf","https://www.alabamablue.com/bb/2017gms.pdf"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0620001","Blue Cross Select Gold, a Multi-State Plan","46944AL062","7346243505","ALN201","ALS201","ALF201","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0620001-02","Blue Cross Select Gold, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$200","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017gms-nocost.pdf","https://www.alabamablue.com/bb/2017gms-nocost.pdf"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0620001","Blue Cross Select Gold, a Multi-State Plan","46944AL062","7346243505","ALN201","ALS201","ALF201","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0620001-03","Blue Cross Select Gold, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.06%",,"No","Yes","Yes","95%","5%","$900","$500","$0","$200","$20","$1,100","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","20.00%","$850","$850 per person","$1700 per group","20.00%","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017gms-limited.pdf","https://www.alabamablue.com/bb/2017gms-limited.pdf"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0630001-01","Blue Cross Select Silver, a Multi-State Plan","Standard Silver On Exchange Plan","68.09%",,"No","Yes","Yes","95%","5%","$2,800","$700","$0","$200","$20","$1,800","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017sms.pdf","https://www.alabamablue.com/bb/2017sms.pdf"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0630001-02","Blue Cross Select Silver, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$200","$0","$0","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017sms-nocost.pdf","https://www.alabamablue.com/bb/2017sms-nocost.pdf"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0630001-03","Blue Cross Select Silver, a Multi-State Plan","Limited Cost Sharing Plan Variation","68.09%",,"No","Yes","Yes","95%","5%","$2,800","$700","$0","$200","$20","$1,800","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017sms-limited.pdf","https://www.alabamablue.com/bb/2017sms-limited.pdf"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0630001-04","Blue Cross Select Silver, a Multi-State Plan","73% AV Level Silver Plan","73.34%",,"No","Yes","Yes","95%","5%","$2,000","$600","$0","$200","$20","$1,100","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017sms-73.pdf","https://www.alabamablue.com/bb/2017sms-73.pdf"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0630001-05","Blue Cross Select Silver, a Multi-State Plan","87% AV Level Silver Plan","87.33%",,"No","Yes","Yes","95%","5%","$500","$600","$0","$200","$20","$800","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20.00%","$450","$450 per person","$900 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017sms-87.pdf","https://www.alabamablue.com/bb/2017sms-87.pdf"
"2017","AL","46944","OPM","2016-09-28 04:33:02","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_AL_6T_Source+Rx_1.0.pdf","46944AL0630001-06","Blue Cross Select Silver, a Multi-State Plan","94% AV Level Silver Plan","93.55%",,"No","Yes","Yes","95%","5%","$100","$200","$0","$200","$20","$500","$0","$400","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%","$100","$100 per person","$200 per group","10.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2017sms-94.pdf","https://www.alabamablue.com/bb/2017sms-94.pdf"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210001","Blue Cross Blue Shield Gold 500, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF201","New","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210001-01","Blue Cross Blue Shield Gold 500, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.816352725028992","Yes","Yes","No","100%",,"$500","$20","$1,200","$40","$500","$1,300","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28002&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210001","Blue Cross Blue Shield Gold 500, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF201","New","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210001-02","Blue Cross Blue Shield Gold 500, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34007&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210001","Blue Cross Blue Shield Gold 500, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF201","New","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210001-03","Blue Cross Blue Shield Gold 500, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.816352725028992","Yes","Yes","No","100%",,"$500","$20","$1,200","$40","$500","$1,300","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=29002&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210002","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF204","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210002-01","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","Standard Silver On Exchange Plan","71.82%","0.730470657348633","No","Yes","No","100%",,"$3,000","$30","$1,100","$40","$1,600","$1,500","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32027&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210002","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF204","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210002-02","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210002","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF204","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210002-06","Blue Cross Blue Shield Silver 3000, a Multi-State Plan","94% AV Level Silver Plan","94.98%","0.946381270885468","No","Yes","No","100%",,"$300","$10","$0","$40","$300","$200","$50","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$854","$854 per person","$1708 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32030&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210003","Blue Cross Blue Shield Bronze 6200, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF210","New","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210003-01","Blue Cross Blue Shield Bronze 6200, a Multi-State Plan","Standard Bronze On Exchange Plan",,"0.618319630622864","Yes","Yes","No","100%",,"$6,200","$30","$200","$40","$1,600","$800","$700","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23004&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210003","Blue Cross Blue Shield Bronze 6200, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF210","New","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210003-02","Blue Cross Blue Shield Bronze 6200, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34013&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","OPM","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1210003","Blue Cross Blue Shield Bronze 6200, a Multi-State Plan","75293AR121","7427051652","ARN201","ARS201","ARF210","New","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1210003-03","Blue Cross Blue Shield Bronze 6200, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.618319630622864","Yes","Yes","No","100%",,"$6,200","$30","$200","$40","$1,600","$800","$700","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=24004&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610004","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610004-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess a Multi State Plan","Standard Gold On Exchange Plan","80.40%","0.813655316829681","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6A","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610004","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610004-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess a Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G6B","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610004","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610004-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess a Multi State Plan","Limited Cost Sharing Plan Variation","80.40%","0.813655316829681","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6A","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610005","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610005-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access a Multi State Plan","Standard Gold On Exchange Plan","80.40%","0.810108661651611","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610005","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610005-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access a Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4R","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610005","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610005-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access a Multi State Plan","Limited Cost Sharing Plan Variation","80.40%","0.810108661651611","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610011","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610011-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Standard Gold On Exchange Plan","80.40%","0.810140609741211","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610011","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610011-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4R","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610011","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610011-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","80.40%","0.810140609741211","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610012","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610012-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Standard Gold On Exchange Plan","80.40%","0.810140609741211","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610014","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610014-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Standard Gold On Exchange Plan","80.40%","0.810140609741211","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610014","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610014-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4R","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610014","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610014-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","80.40%","0.810140609741211","Yes","Yes","Yes","67%","33%","$1,150","$1,100","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$3450 per group","10.00%","$1,150","$1150 per person","$3450 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610003-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan","Standard Silver On Exchange Plan","71.48%","0.739176630973816","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G64","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610003-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G68","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610003-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan","Limited Cost Sharing Plan Variation","71.48%","0.739176630973816","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G64","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610003-04","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan S04","73% AV Level Silver Plan","73.48%","0.756439566612244","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G65","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610003-05","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan S05","87% AV Level Silver Plan","87.38%","0.883041799068451","Yes","Yes","Yes","67%","33%","$700","$500","$500","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%","$700","$700 per person","$1400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G66","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN201","GAS201","GAF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610003-06","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan S06","94% AV Level Silver Plan","94.32%","0.944388210773468","Yes","Yes","Yes","67%","33%","$200","$200","$300","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G67","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610006","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610006-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access a Multi State Plan","Standard Silver On Exchange Plan","71.48%","0.73523473739624","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610006","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610006-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access a Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610006","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610006-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access a Multi State Plan","Limited Cost Sharing Plan Variation","71.48%","0.734291136264801","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610006","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610006-04","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access a Multi State Plan S04","73% AV Level Silver Plan","73.48%","0.752854883670807","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4T","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610006","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610006-05","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access a Multi State Plan S05","87% AV Level Silver Plan","87.38%","0.881216704845428","Yes","Yes","Yes","67%","33%","$700","$500","$500","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%","$700","$700 per person","$1400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4U","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610006","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS202","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610006-06","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access a Multi State Plan S06","94% AV Level Silver Plan","94.32%","0.943415939807892","Yes","Yes","Yes","67%","33%","$200","$200","$300","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4V","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610007","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610007-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Standard Silver On Exchange Plan","71.48%","0.735270261764526","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610007","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610007-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610007","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610007-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.48%","0.734322428703308","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610007","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610007-04","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S04","73% AV Level Silver Plan","73.48%","0.75288712978363","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4T","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610007","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610007-05","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S05","87% AV Level Silver Plan","87.38%","0.881233155727386","Yes","Yes","Yes","67%","33%","$700","$500","$500","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%","$700","$700 per person","$1400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4U","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610007","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS203","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610007-06","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S06","94% AV Level Silver Plan","94.32%","0.943424701690674","Yes","Yes","Yes","67%","33%","$200","$200","$300","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4V","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610008","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610008-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Standard Silver On Exchange Plan","71.48%","0.735270261764526","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610008","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610008-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610008","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610008-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.48%","0.734322428703308","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610008","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610008-04","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S04","73% AV Level Silver Plan","73.48%","0.75288712978363","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4T","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610008","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610008-05","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S05","87% AV Level Silver Plan","87.38%","0.881233155727386","Yes","Yes","Yes","67%","33%","$700","$500","$500","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%","$700","$700 per person","$1400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4U","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610008","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS204","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610008-06","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S06","94% AV Level Silver Plan","94.32%","0.943424701690674","Yes","Yes","Yes","67%","33%","$200","$200","$300","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4V","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610009","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610009-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Standard Silver On Exchange Plan","71.48%","0.735270261764526","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610009","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610009-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610009","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610009-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.48%","0.734322428703308","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610009","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610009-04","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S04","73% AV Level Silver Plan","73.48%","0.75288712978363","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4T","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610009","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610009-05","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S05","87% AV Level Silver Plan","87.38%","0.881233155727386","Yes","Yes","Yes","67%","33%","$700","$500","$500","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%","$700","$700 per person","$1400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4U","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610009","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS205","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610009-06","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S06","94% AV Level Silver Plan","94.32%","0.943424701690674","Yes","Yes","Yes","67%","33%","$200","$200","$300","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4V","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610010","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610010-01","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Standard Silver On Exchange Plan","71.48%","0.735270261764526","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610010","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610010-02","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4W","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610010","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610010-03","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.48%","0.734322428703308","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610010","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610010-04","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S04","73% AV Level Silver Plan","73.48%","0.75288712978363","Yes","Yes","Yes","67%","33%","$2,000","$900","$1,500","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4T","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610010","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610010-05","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S05","87% AV Level Silver Plan","87.38%","0.881233155727386","Yes","Yes","Yes","67%","33%","$700","$500","$500","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%","$700","$700 per person","$1400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4U","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","GA","49046","OPM","2017-01-19 20:15:29","Individual","No","58-1638390","49046GA0610010","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan","49046GA061",,"GAN202","GAS206","GAF201","New","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0610010-06","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan S06","94% AV Level Silver Plan","94.32%","0.943424701690674","Yes","Yes","Yes","67%","33%","$200","$200","$300","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4V","http://editiondigital.net/view/IU65/2017/ON_HIX_GA_KIT_2017"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970003-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970003-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970034","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970034-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970016-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970016-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970017-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970017-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970021-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970021-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970036","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970036-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970017-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970017-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970017-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970003-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970028","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970028-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970028","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970028-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970028","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970028-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970029","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970029-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970029","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970029-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970029","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970029-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970030","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970030-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970030","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970030-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970030","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970030-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970031","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970031-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970031","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970031-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970031","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970031-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970032","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970032-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970032","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970032-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970032","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970032-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970033","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970033-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970033","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970033-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970033","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970033-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970034","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970034-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970034","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970034-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970035","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970035-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970035","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970035-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970035","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970035-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970036","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970036-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970036","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970036-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970037","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970037-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970037","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970037-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970037","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970037-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970038","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970038-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970038","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970038-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970038","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970038-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970039","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970039-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970039","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970039-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970039","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970039-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.28%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970002-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970002-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970002-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970002-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970002-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970002-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970016-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970016-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970016-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970016-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970020-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970021-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970006-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970006-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970015-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940003-02","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3Q","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940003-03","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.36%","0.705444991588593","Yes","Yes","No","100%",,"$2,800","$60","$1,100","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6950","$6950 per person","$13900 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2800","$2800 per person","$5600 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3P","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970017-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970018-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970018-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970018-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970018-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970018-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970018-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970019-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970019-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970019-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970019-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970019-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970019-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970020-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970020-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970020-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970020-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970020-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970021-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970025-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970025-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970026-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970026-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970008-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930005-06","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S06","94% AV Level Silver Plan","94.85%","0.947270631790161","Yes","Yes","Yes","66%","34%","$200","$200","$300","$0","$200","$400","$20","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group","$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFD","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930006-01","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","Standard Gold On Exchange Plan","78.64%","0.79598480463028","Yes","Yes","Yes","66%","34%","$1,000","$1,100","$1,600","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFE","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970021-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970021-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970022-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970022-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970022-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970022-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970022-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970022-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970023-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970023-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970023-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970023-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970023-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970023-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970024-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970024-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970024-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970024-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970024-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970024-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970025-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970025-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970025-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970025-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970026-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970026-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970026-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970026-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970027-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970027-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970027-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.04%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970027-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.52%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970027-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$600","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970027-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970001-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970001-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS016","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970001-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970004-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970004-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS026","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970004-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970005-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970005-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS036","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970005-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS046","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970006-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970007-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970007-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS056","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970007-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970008-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS066","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970008-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970009-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970009-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS076","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970009-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970010-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970010-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS086","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970010-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970011-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970011-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS096","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970011-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970012-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970012-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS106","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970012-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970013-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970013-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS116","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970013-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970014-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970014-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS126","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970014-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970015-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","OPM","2016-08-25 03:47:19","Individual","No","36-1236610","36096IL0970015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN206","ILS136","ILF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0970015-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.69%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$1,100","$200","$1,800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0970001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930005-01","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Standard Silver On Exchange Plan","71.92%","0.7247394323349","Yes","Yes","Yes","66%","34%","$2,000","$900","$1,500","$0","$500","$1,800","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFA","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930005-02","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GG0","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930005-03","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.92%","0.7247394323349","Yes","Yes","Yes","66%","34%","$2,000","$900","$1,500","$0","$500","$1,800","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFA","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930005-04","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S04","73% AV Level Silver Plan","73.95%","0.74326092004776","Yes","Yes","Yes","66%","34%","$2,000","$900","$1,500","$0","$500","$1,800","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFB","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930005-05","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S05","87% AV Level Silver Plan","87.77%","0.876977264881134","Yes","Yes","Yes","66%","34%","$750","$500","$500","$0","$500","$1,300","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFC","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930006-02","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","66%","34%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GG1","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","IN","17575","OPM","2016-08-25 03:47:19","Individual","No","35-0781558","17575IN0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0930006-03","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.64%","0.79598480463028","Yes","Yes","Yes","66%","34%","$1,000","$1,100","$1,600","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFE","http://editiondigital.net/view/IU65/2017/ON_HIX_IN_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130005-01","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Standard Silver On Exchange Plan","71.99%","0.719978392124176","Yes","Yes","Yes","43%","57%","$3,750","$600","$400","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","$6,100","$6100 per person","$12200 per group","$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%","$3,750","$3750 per person","$7500 per group","0.00%","$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GGT","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130005-02","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GHQ","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130005-03","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.99%","0.719978392124176","Yes","Yes","Yes","43%","57%","$3,750","$600","$400","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","$6,100","$6100 per person","$12200 per group","$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%","$3,750","$3750 per person","$7500 per group","0.00%","$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GGT","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130005-04","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S04","73% AV Level Silver Plan","74.00%","0.740166366100311","Yes","Yes","Yes","43%","57%","$3,400","$600","$600","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0.00%","$3,400","$3400 per person","$6800 per group","0.00%","$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GGU","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130005-05","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S05","87% AV Level Silver Plan","87.92%","0.87963193655014","Yes","Yes","Yes","43%","57%","$1,000","$500","$500","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%","$1,000","$1000 per person","$2000 per group","0.00%","$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GGV","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130005-06","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S06","94% AV Level Silver Plan","94.96%","0.949762761592865","Yes","Yes","Yes","43%","57%","$200","$200","$700","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group","$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0.00%","$200","$200 per person","$400 per group","0.00%","$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GGW","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF201","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130006-01","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","Standard Gold On Exchange Plan","78.10%","0.78724730014801","Yes","Yes","Yes","43%","57%","$1,000","$1,100","$1,600","$0","$500","$1,300","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHA","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF201","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130006-02","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GHR","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","OPM","2016-08-24 05:44:16","Individual","No","61-1237516","36239KY1130006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","36239KY113",,"KYN201","KYS201","KYF201","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1130006-03","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.10%","0.78724730014801","Yes","Yes","Yes","43%","57%","$1,000","$1,100","$1,600","$0","$500","$1,300","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","$5,000","$5000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHA","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930004-01","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","Standard Gold On Exchange Plan","78.04%","0.783583343029022","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J57","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930004-02","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J58","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930004-03","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.04%","0.783583343029022","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J57","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930003-01","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","Standard Silver On Exchange Plan","70.36%","0.705359637737274","Yes","Yes","No","100%",,"$2,800","$60","$1,100","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2800","$2800 per person","$5600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4K","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930003-02","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J4L","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930003-03","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.36%","0.705359637737274","Yes","Yes","No","100%",,"$2,800","$60","$1,100","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2800","$2800 per person","$5600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4K","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930003-04","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S04","73% AV Level Silver Plan","73.90%","0.741116940975189","Yes","Yes","No","100%",,"$2,400","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2400","$2400 per person","$4800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4M","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930003-05","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S05","87% AV Level Silver Plan","87.80%","0.88245415687561","Yes","Yes","No","100%",,"$700","$40","$800","$0","$500","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4N","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0930003-06","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S06","94% AV Level Silver Plan","93.57%","0.942129731178284","Yes","Yes","No","100%",,"$150","$40","$500","$0","$150","$500","$30","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4P","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940003-01","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","Standard Silver On Exchange Plan","70.36%","0.705444991588593","Yes","Yes","No","100%",,"$2,800","$60","$1,100","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6950","$6950 per person","$13900 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2800","$2800 per person","$5600 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3P","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940003-04","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S04","73% AV Level Silver Plan","73.90%","0.740118145942688","Yes","Yes","No","100%",,"$2,400","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5250","$5250 per person","$10500 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2400","$2400 per person","$4800 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3R","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940003-05","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S05","87% AV Level Silver Plan","87.80%","0.878035128116608","Yes","Yes","No","100%",,"$700","$40","$800","$0","$500","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1500","$1500 per person","$3000 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3S","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940003-06","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S06","94% AV Level Silver Plan","93.57%","0.935546100139618","Yes","Yes","No","100%",,"$150","$40","$500","$0","$150","$500","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3T","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF201","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940004-01","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","Standard Gold On Exchange Plan","78.04%","0.783583343029022","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6050","$6050 per person","$12100 per group",,,,"$18150","$18150 per person","$36300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$3000 per group","20.00%",,,,,"$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF201","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940004-02","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J40","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF201","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940004-03","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.04%","0.783583343029022","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6050","$6050 per person","$12100 per group",,,,"$18150","$18150 per person","$36300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$3000 per group","20.00%",,,,,"$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940005-01","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","Standard Silver On Exchange Plan","70.36%","0.705444991588593","Yes","Yes","No","100%",,"$2,800","$60","$1,100","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6950","$6950 per person","$13900 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2800","$2800 per person","$5600 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3P","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940005-02","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3Q","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940005-03","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.36%","0.705444991588593","Yes","Yes","No","100%",,"$2,800","$60","$1,100","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6950","$6950 per person","$13900 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2800","$2800 per person","$5600 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3P","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940005-04","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S04","73% AV Level Silver Plan","73.90%","0.740118145942688","Yes","Yes","No","100%",,"$2,400","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5250","$5250 per person","$10500 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2400","$2400 per person","$4800 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3R","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940005-05","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S05","87% AV Level Silver Plan","87.80%","0.878035128116608","Yes","Yes","No","100%",,"$700","$40","$800","$0","$500","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1500","$1500 per person","$3000 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3S","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF200","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940005-06","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan S06","94% AV Level Silver Plan","93.57%","0.935546100139618","Yes","Yes","No","100%",,"$150","$40","$500","$0","$150","$500","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$20850","$20850 per person","$41700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","25.00%",,,,,"$8400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3T","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940006","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF201","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940006-01","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","Standard Gold On Exchange Plan","78.04%","0.783583343029022","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6050","$6050 per person","$12100 per group",,,,"$18150","$18150 per person","$36300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$3000 per group","20.00%",,,,,"$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940006","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF201","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940006-02","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J40","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","OPM","2016-08-24 05:44:16","Individual","No","31-1705652","48396ME0940006","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF201","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0940006-03","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.04%","0.783583343029022","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$0","$500","$1,700","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6050","$6050 per person","$12100 per group",,,,"$18150","$18150 per person","$36300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$3000 per group","20.00%",,,,,"$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880001","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880001-01","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$330","$150","$2,420","$600","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/silver-extra-dental-vision-multi-state-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/multi-state-ppo-extra.html?costshare=70"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880001","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880001-02","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/silver-extra-dental-vision-multi-state-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/silver-extra-dental-vision-multi-state-na-less-than-300-sbc.pdf"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880001","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880001-03","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$330","$150","$2,420","$600","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/silver-extra-dental-vision-multi-state-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/silver-extra-dental-vision-multi-state-na-more-than-300-sbc.pdf"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880001","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880001-04","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$430","$150","$2,420","$400","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/silver-extra-dental-vision-multi-state-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/multi-state-ppo-extra.html?costshare=73"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880001","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880001-05","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$890","$150","$700","$270","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/silver-extra-dental-vision-multi-state-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/multi-state-ppo-extra.html?costshare=87"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880001","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880001-06","Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/silver-extra-dental-vision-multi-state-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/multi-state-ppo-extra.html?costshare=94"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880002","Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF204","Existing","PPO","Gold","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9409",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880002-01","Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$40","$1,220","$150","$1,250","$480","$680","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/gold-extra-dental-vision-multi-state-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/multi-state-ppo-extra.html"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880002","Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF204","Existing","PPO","Gold","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9409",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880002-02","Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/gold-extra-dental-vision-multi-state-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/gold-extra-dental-vision-multi-state-na-less-than-300-sbc.pdf"
"2017","MI","15560","OPM","2016-08-03 04:06:06","Individual","No","38-2069753","15560MI0880002","Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF204","Existing","PPO","Gold","Design 1","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9409",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0880002-03","Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$40","$1,220","$150","$1,250","$480","$680","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/gold-extra-dental-vision-multi-state-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/gold-extra-dental-vision-multi-state-na-more-than-300-sbc.pdf"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF201","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930004-01","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Standard Silver On Exchange Plan","70.28%","0.725004613399506","Yes","Yes","Yes","40%","60%","$1,850","$1,000","$1,300","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK2","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF201","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930004-02","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GK3","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF201","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930004-03","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","70.28%","0.725004613399506","Yes","Yes","Yes","40%","60%","$1,850","$1,000","$1,300","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK2","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF201","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930004-04","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S04","73% AV Level Silver Plan","72.88%","0.747979581356049","Yes","Yes","Yes","40%","60%","$1,700","$1,100","$1,400","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%","$1,700","$1700 per person","$3400 per group","20.00%","$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK5","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF201","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930004-05","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S05","87% AV Level Silver Plan","86.99%","0.876327216625214","Yes","Yes","Yes","40%","60%","$750","$500","$400","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK6","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF201","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930004-06","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S06","94% AV Level Silver Plan","93.42%","0.932759523391724","Yes","Yes","Yes","40%","60%","$150","$200","$500","$0","$150","$600","$70","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20.00%","$150","$150 per person","$300 per group","20.00%","$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK7","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930006-01","Anthem Blue Cross and Blue Shield Gold DirectAccess a Multi State Plan","Standard Gold On Exchange Plan","78.14%","0.794568300247192","Yes","Yes","Yes","40%","60%","$1,000","$1,100","$1,300","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","$6,900","$6900 per person","$13800 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK8","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930006-02","Anthem Blue Cross and Blue Shield Gold DirectAccess a Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GK9","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MO","32753","OPM","2016-11-16 22:15:47","Individual","No","86-0257201","32753MO0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0930006-03","Anthem Blue Cross and Blue Shield Gold DirectAccess a Multi State Plan","Limited Cost Sharing Plan Variation","78.14%","0.794568300247192","Yes","Yes","Yes","40%","60%","$1,000","$1,100","$1,300","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","$6,900","$6900 per person","$13800 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK8","http://editiondigital.net/view/IU65/2017/ON_HIX_MO_KIT_2017"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570008","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570008-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.23%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30.00%","$6,100","$6100 per person","$12200 per group","30.00%","$24,400","$24400 per person","$48800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570008","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570008-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570012","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570012-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.63%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20.00%","$3,350","$3350 per person","$6700 per group","20.00%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570012","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570012-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.50%","0","No","Yes","Yes","60%","40%","$2,900","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","20.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570012","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570012-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.74%","0.877438545227051","No","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570012","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570012-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.75%","0.947514295578003","No","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570013","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570013-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.63%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20.00%","$3,350","$3350 per person","$6700 per group","20.00%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570008","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570008-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.23%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30.00%","$6,100","$6100 per person","$12200 per group","30.00%","$24,400","$24400 per person","$48800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570015-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.23%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30.00%","$6,100","$6100 per person","$12200 per group","30.00%","$24,400","$24400 per person","$48800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570015-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570015-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.23%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30.00%","$6,100","$6100 per person","$12200 per group","30.00%","$24,400","$24400 per person","$48800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570016","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570016-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.23%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30.00%","$6,100","$6100 per person","$12200 per group","30.00%","$24,400","$24400 per person","$48800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570016","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570016-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570016","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570016-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.23%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30.00%","$6,100","$6100 per person","$12200 per group","30.00%","$24,400","$24400 per person","$48800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570017","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570017-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.23%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30.00%","$6,100","$6100 per person","$12200 per group","30.00%","$24,400","$24400 per person","$48800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570017","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570017-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570017","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570017-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.23%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30.00%","$6,100","$6100 per person","$12200 per group","30.00%","$24,400","$24400 per person","$48800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570008-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570007-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.63%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20.00%","$3,350","$3350 per person","$6700 per group","20.00%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570007-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570007-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.63%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20.00%","$3,350","$3350 per person","$6700 per group","20.00%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570007-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.50%","0","No","Yes","Yes","60%","40%","$2,900","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","20.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570007-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.74%","0.877438545227051","No","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570007-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.75%","0.947514295578003","No","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570012","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570012-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.63%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20.00%","$3,350","$3350 per person","$6700 per group","20.00%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570012","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570012-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570013","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570013-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570013","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570013-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.63%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20.00%","$3,350","$3350 per person","$6700 per group","20.00%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570013","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570013-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.50%","0","No","Yes","Yes","60%","40%","$2,900","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","20.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570013","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570013-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.74%","0.877438545227051","No","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570013","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570013-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.75%","0.947514295578003","No","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570014","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570014-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.63%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20.00%","$3,350","$3350 per person","$6700 per group","20.00%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570014","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570014-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200001","CO-OPTIONS Connect Gold HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF201","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200001-02","CO-OPTIONS Connect Gold HMO, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-gold-0-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200001","CO-OPTIONS Connect Gold HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF201","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200001-03","CO-OPTIONS Connect Gold HMO, a Multi-State Plan","Limited Cost Sharing Plan Variation","81.58%","0.83116352558136","Yes","Yes","No","100%",,"$1,750.00","$30.00","$450.00","$150.00","$1,750.00","$250.00","$90.00","$80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-gold-lim-hmo-ind-2017.pdf",
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570014","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570014-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.63%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20.00%","$3,350","$3350 per person","$6700 per group","20.00%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570014","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570014-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.50%","0","No","Yes","Yes","60%","40%","$2,900","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","20.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570014","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570014-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.74%","0.877438545227051","No","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570014","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570014-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.75%","0.947514295578003","No","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570007-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570006-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","78.76%","0","Yes","Yes","Yes","60%","40%","$2,000","$0","$1,100","$200","$2,000","$0","$90","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","20.00%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570006-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS024","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570006-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.76%","0","Yes","Yes","Yes","60%","40%","$2,000","$0","$1,100","$200","$2,000","$0","$90","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","20.00%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570009-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","78.76%","0","Yes","Yes","Yes","60%","40%","$2,000","$0","$1,100","$200","$2,000","$0","$90","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","20.00%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570009-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS014","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570009-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.76%","0","Yes","Yes","Yes","60%","40%","$2,000","$0","$1,100","$200","$2,000","$0","$90","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","20.00%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570010-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","78.76%","0","Yes","Yes","Yes","60%","40%","$2,000","$0","$1,100","$200","$2,000","$0","$90","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","20.00%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570010-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS034","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570010-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.76%","0","Yes","Yes","Yes","60%","40%","$2,000","$0","$1,100","$200","$2,000","$0","$90","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","20.00%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570011-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","78.76%","0","Yes","Yes","Yes","60%","40%","$2,000","$0","$1,100","$200","$2,000","$0","$90","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","20.00%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570011-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","OPM","2016-11-17 20:15:39","Individual","No","36-1236610","30751MT0570011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN204","MTS044","MTF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0570011-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.76%","0","Yes","Yes","Yes","60%","40%","$2,000","$0","$1,100","$200","$2,000","$0","$90","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","20.00%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0570006-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN202","NHS201","NHF202","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330006-01","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","Standard Gold On Exchange Plan","81.22%","0.821562826633453","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GP4","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN202","NHS201","NHF202","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330006-02","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPF","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN202","NHS201","NHF202","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330006-03","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","81.22%","0.821562826633453","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GP4","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330005-01","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Standard Silver On Exchange Plan","69.51%","0.707512617111206","Yes","Yes","No","100%",,"$2,000","$900","$1,300","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPQ","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330005-02","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ5","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330005-03","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.51%","0.707512617111206","Yes","Yes","No","100%",,"$2,000","$900","$1,300","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPQ","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330005-04","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S04","73% AV Level Silver Plan","73.89%","0.748476326465607","Yes","Yes","No","100%",,"$1,500","$1,100","$1,400","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPR","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330005-05","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S05","87% AV Level Silver Plan","87.22%","0.877144575119019","Yes","Yes","No","100%",,"$750","$300","$400","$0","$500","$1,000","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPS","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","OPM","2016-11-16 22:15:47","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF201","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0330005-06","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S06","94% AV Level Silver Plan","94.01%","0.938602805137634","Yes","Yes","No","100%",,"$175","$40","$400","$0","$175","$400","$30","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPT","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200001","CO-OPTIONS Connect Gold HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF201","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200001-00","CO-OPTIONS Connect Gold HMO, a Multi-State Plan","Standard Gold Off Exchange Plan","81.58%","0.83116352558136","Yes","Yes","No","100%",,"$1,750","$30","$450","$150","$1,750","$250","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-gold-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200001","CO-OPTIONS Connect Gold HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF201","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200001-01","CO-OPTIONS Connect Gold HMO, a Multi-State Plan","Standard Gold On Exchange Plan","81.58%","0.83116352558136","Yes","Yes","No","100%",,"$1,750.00","$30.00","$450.00","$150.00","$1,750.00","$250.00","$90.00","$80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-gold-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200002","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF202","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9966",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200002-00","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","Standard Silver Off Exchange Plan","71.19%","0.774186253547668","Yes","Yes","No","100%",,"$3,500","$10","$610","$150","$3,500","$120","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-silver-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200002","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF202","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9966",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200002-01","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","Standard Silver On Exchange Plan","71.19%","0.774186253547668","Yes","Yes","No","100%",,"$3,500.00","$10.00","$610.00","$150.00","$3,500.00","$120.00","$90.00","$80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-silver-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200002","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF202","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9966",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200002-02","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-silver-0-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200002","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF202","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9966",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200002-03","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.19%","0.774186253547668","Yes","Yes","No","100%",,"$3,500.00","$10.00","$610.00","$150.00","$3,500.00","$120.00","$90.00","$80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-silver-lim-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200002","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF202","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9966",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200002-04","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","73% AV Level Silver Plan","73.96%","0.792520105838776","Yes","Yes","No","100%",,"$3,000","$10","$710","$150","$3,000","$190","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-silver-73-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200002","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF202","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9966",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200002-05","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","87% AV Level Silver Plan","86.89%","0.875269830226898","Yes","Yes","No","100%",,"$1,000","$20","$450","$150","$1,000","$240","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-silver-87-hmo-ind-2017.pdf",
"2017","NM","93091","OPM","2017-01-19 20:15:29","Individual","No","45-1294709","93091NM0200002","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","93091NM020",,"NMN201","NMS206","NMF202","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9966",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/uploads/files/Formulary/nmhc-formulary-zero-dollar-copay-drugs-effective010117_corrected.pdf","93091NM0200002-06","CO-OPTIONS Connect Silver HMO, a Multi-State Plan","94% AV Level Silver Plan","93.46%","0.928771495819092","Yes","Yes","No","100%",,"$0","$20","$450","$150","$0","$300","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/msp-silver-94-hmo-ind-2017.pdf",
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390004-01","Anthem Blue Cross and Blue Shield Gold DirectAccess a Multi State Plan","Standard Gold On Exchange Plan","79.53%","0.806666612625122","Yes","Yes","Yes","57%","43%","$1,100","$1,100","$1,300","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$3300 per group","10.00%","$1,100","$1100 per person","$3300 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G3B","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390004-02","Anthem Blue Cross and Blue Shield Gold DirectAccess a Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","57%","43%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2U","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390004-03","Anthem Blue Cross and Blue Shield Gold DirectAccess a Multi State Plan","Limited Cost Sharing Plan Variation","79.53%","0.806666612625122","Yes","Yes","Yes","57%","43%","$1,100","$1,100","$1,300","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$3300 per group","10.00%","$1,100","$1100 per person","$3300 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G3B","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390003-01","Anthem Blue Cross and Blue Shield Silver DirectAccess a Multi State Plan","Standard Silver On Exchange Plan","71.61%","0.728411376476288","Yes","Yes","Yes","57%","43%","$1,750","$80","$1,800","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20.00%","$1,750","$1750 per person","$3500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2H","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390003-02","Anthem Blue Cross and Blue Shield Silver DirectAccess a Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","57%","43%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G3A","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390003-03","Anthem Blue Cross and Blue Shield Silver DirectAccess a Multi State Plan","Limited Cost Sharing Plan Variation","71.61%","0.728411376476288","Yes","Yes","Yes","57%","43%","$1,750","$80","$1,800","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20.00%","$1,750","$1750 per person","$3500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2H","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390003-04","Anthem Blue Cross and Blue Shield Silver DirectAccess a Multi State Plan S04","73% AV Level Silver Plan","73.95%","0.74686473608017","Yes","Yes","Yes","57%","43%","$1,750","$80","$1,800","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group","$5,550","$5550 per person","$11100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20.00%","$1,750","$1750 per person","$3500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G56","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390003-05","Anthem Blue Cross and Blue Shield Silver DirectAccess a Multi State Plan S05","87% AV Level Silver Plan","87.11%","0.872311770915985","Yes","Yes","Yes","57%","43%","$700","$20","$1,100","$0","$500","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%","$700","$700 per person","$1400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G57","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","OPM","2016-11-16 22:15:47","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0390003-06","Anthem Blue Cross and Blue Shield Silver DirectAccess a Multi State Plan S06","94% AV Level Silver Plan","94.44%","0.943467199802399","Yes","Yes","Yes","57%","43%","$200","$20","$400","$0","$200","$400","$20","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G58","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460003-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460003-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460011-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460008-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460009-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460009-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460009-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460009-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.36%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460003-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460008-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460008-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460008-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460008-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.36%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460012","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460012-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460012","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460012-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460012","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460012-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460013","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460013-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460013","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460013-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460013","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460013-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460014","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460014-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460014","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460014-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460014","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460014-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460015-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460015-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF201","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460015-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.17%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$18,750","$18750 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460003-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460002-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460002-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460002-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460002-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.36%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460002-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460002-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460008-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460009-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460009-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460010-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460010-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460010-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460010-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.36%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460010-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460010-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-06.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460011-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460011-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460011-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460011-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.36%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-04.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460011-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460002-05.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460001-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460001-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS015","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460001-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460004-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460004-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS025","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460004-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460005-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460005-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS035","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460005-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460006-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460006-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS045","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460006-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460007-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-01.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460007-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-02.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780062","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780062-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780063","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780063-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780063","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780063-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780063","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780063-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780064","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780064-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","OK","87571","OPM","2017-01-24 20:15:29","Individual","No","36-1236610","87571OK0460007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN205","OKS055","OKF202","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_OK_5T_EX.pdf","87571OK0460007-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation","79.56%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$200","$200","$1,800","$0","$300","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%","$1,750","$1750 per person","$5250 per group","20.00%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/static/ok/pdf/sbc/2017/87571OK0460001-03.pdf","http://www.bcbsok.com/static/ok/pdf/brochure/2017/ok-plan-overview.pdf"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF204","Existing","EPO","Gold","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400001-01","Blue Cross Blue Shield Gold 1, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.81206226348877","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$520","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Gold1","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Gold1"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF204","Existing","EPO","Gold","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400001-02","Blue Cross Blue Shield Gold 1, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Gold1_L300","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Gold1_L300"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF204","Existing","EPO","Gold","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400001-03","Blue Cross Blue Shield Gold 1, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.81206226348877","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$520","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Gold1_G300","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Gold1_G300"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780058","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780058-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780076","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780076-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780077","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780077-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780077","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780077-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF250","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400002-01","Blue Cross Blue Shield Silver 1, a Multi-State Plan","Standard Silver On Exchange Plan",,"0.717749655246735","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$1,150","$800","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF250","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400002-02","Blue Cross Blue Shield Silver 1, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_L300","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_L300"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF250","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400002-03","Blue Cross Blue Shield Silver 1, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.717749655246735","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$1,150","$800","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_G300","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_G300"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF250","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400002-04","Blue Cross Blue Shield Silver 1, a Multi-State Plan","73% AV Level Silver Plan",,"0.737866818904877","No","Yes","No","100%",,"$2,300","$20","$1,490","$150","$2,300","$390","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_201-250","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_201-250"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF250","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400002-05","Blue Cross Blue Shield Silver 1, a Multi-State Plan","87% AV Level Silver Plan",,"0.879810214042664","No","Yes","No","100%",,"$100","$20","$1,430","$150","$100","$600","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_151-200","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_151-200"
"2017","SC","26065","OPM","2016-08-24 05:44:16","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF250","Existing","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,"2017-01-01",,"Yes","BlueCard Worldwide","Yes","Benefits are available outside the company's service area (the state of South Carolina) only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0400002-06","Blue Cross Blue Shield Silver 1, a Multi-State Plan","94% AV Level Silver Plan",,"0.935498595237732","No","Yes","No","100%",,"$0","$0","$360","$150","$0","$0","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_100-150","https://www.southcarolinablues.com/links/metallic/2017/MSPP/Silver1_100-150"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780058","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780058-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780058","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780058-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780059","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780059-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780059","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780059-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780059","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780059-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780060","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780060-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780060","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780060-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780060","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780060-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780061","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780061-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780061","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780061-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780061","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780061-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780062","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780062-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780062","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780062-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780064","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780064-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780064","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780064-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780065","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780065-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780074","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780074-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780033-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780033-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780033-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780033-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780065","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780065-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780065","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780065-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780066","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780066-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780066","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780066-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780066","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780066-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780067","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780067-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780067","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780067-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780067","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780067-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780068","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780068-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780068","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780068-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780068","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780068-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780069","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780069-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780069","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780069-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780069","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780069-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780070","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780070-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780070","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780070-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780070","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780070-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780071","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780071-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780071","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780071-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780071","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780071-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780072","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780072-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780072","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780072-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780072","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780072-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780073","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780073-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780073","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780073-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780073","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780073-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780074","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780074-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780074","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780074-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780075","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780075-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780075","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780075-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780075","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780075-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780076","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780076-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780076","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780076-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780077","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780077-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780078","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780078-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780078","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780078-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780078","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780078-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780003-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780003-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780034-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780034-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780003-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780054","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780054-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780054","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780054-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780054","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780054-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780055","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780055-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780055","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780055-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780055","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780055-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780056","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780056-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780056","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780056-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780056","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780056-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780057","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780057-01","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Standard Bronze On Exchange Plan","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780057","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780057-02","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780057","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF201","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780057-03","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","Limited Cost Sharing Plan Variation","61.20%","0","Yes","Yes","Yes","60%","40%","$6,300","$800","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$14300 per group","30.00%","$6,250","$6250 per person","$14300 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780003-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780033-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780033-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780034-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780034-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780038-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780042-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780043-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780043-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780034-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780047-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780047-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780047-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780047-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780048-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780048-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780034-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780035-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780035-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780035-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780035-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780035-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780035-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780036-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780036-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780036-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780036-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780036-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780036-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780037-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780037-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780037-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780037-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780037-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780037-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780038-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780038-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780038-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780038-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780038-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780039-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780039-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780039-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780039-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780039-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780039-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780040-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780040-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780040-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780040-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780040-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780040-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780041-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780041-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780041-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780041-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780041-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780041-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780042-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780042-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780042-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780042-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780042-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780043-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780043-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780043-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780043-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780044-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780048-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780053-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780053-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780044-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780044-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780044-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780044-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780044-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780045-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780045-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780045-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780045-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780045-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780045-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780046-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780046-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780046-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780046-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780046-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780046-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780047-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780047-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780048-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780048-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780048-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780052-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780030-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780031-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780031-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780031-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780049-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780049-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780049-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780049-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780049-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780049-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780050-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780050-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780050-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780050-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780050-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780050-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780051-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780051-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780051-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780051-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780051-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780051-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780052-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780052-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780052-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780052-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780052-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780053-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780053-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780053-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780053-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780002-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780002-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780002-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780002-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780002-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780002-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780008-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780017","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780017-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780029-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780029-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780029-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780029-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780029-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780029-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780030-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780030-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780030-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780030-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780030-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780031-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780031-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780012-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780012-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780013-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780013-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS064","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780013-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780014-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780031-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780032-01","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Standard Silver On Exchange Plan","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780032-02","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780032-03","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","Limited Cost Sharing Plan Variation","69.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$400","$0","$200","$3,800","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20.00%","$3,750","$3750 per person","$11250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780032-04","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","73% AV Level Silver Plan","73.41%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$0","$200","$3,400","$0","$100","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$10900 per group","$4,800","$4800 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20.00%","$3,400","$3400 per person","$10200 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-04.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780032-05","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87% AV Level Silver Plan","87.71%","0.877149164676666","Yes","Yes","Yes","60%","40%","$800","$0","$900","$200","$800","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4500 per group","$1,600","$1600 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20.00%","$750","$750 per person","$2250 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-05.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780032-06","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","94% AV Level Silver Plan","94.57%","0.945690333843231","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$100","$80","$0","$0","$0","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20.00%","$100","$100 per person","$300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780002-06.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780008-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS014","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780008-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780009-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780009-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS024","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780009-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780010-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780010-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS034","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780010-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780011-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780011-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS044","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780011-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS054","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780012-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780014-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780021","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780021-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780021","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780021-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780022","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780022-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780022","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780022-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780005-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780006-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780006-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS074","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780014-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780015-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780015-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS084","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780015-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780016","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780016-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780016","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780016-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780016","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS094","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780016-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780017","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780017-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780017","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS104","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780017-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780018","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780018-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780018","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780018-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780018","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS114","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780018-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780019","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780019-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780019","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780019-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780019","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS124","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780019-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780004-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780020","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780020-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780020","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780020-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780020","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS134","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780020-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780021","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS144","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780021-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780022","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS154","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780022-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780023","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780023-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780023","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780023-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780023","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS164","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780023-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780024","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780024-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780024","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780024-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780024","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS174","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780024-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780025","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780025-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780025","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780025-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780025","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS184","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780025-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780026","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780026-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780026","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780026-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780026","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS194","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780026-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780027","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780027-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780027","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780027-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780027","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS204","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780027-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780028","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780028-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780028","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780028-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780028","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS214","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780028-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780001-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780001-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS224","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780001-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780004-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS234","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780004-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780005-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS244","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780005-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS254","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780006-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780007-01","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Standard Gold On Exchange Plan",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-01.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780007-02","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-02.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","TX","33602","OPM","2016-11-20 20:15:52","Individual","No","36-1236610","33602TX0780007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN204","TXS264","TXF202","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_TX_5T_EX.pdf","33602TX0780007-03","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","Limited Cost Sharing Plan Variation",,"0.790014386177063","Yes","Yes","Yes","60%","40%","$1,000","$20","$1,000","$200","$1,000","$100","$200","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$14300 per group","$5,800","$5800 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/static/tx/pdf/sbc/2017/33602TX0780001-03.pdf","http://www.bcbstx.com/static/tx/pdf/brochure/2017/tx-plan-overview.pdf"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880006","Anthem HealthKeepers Gold, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880006-01","Anthem HealthKeepers Gold a Blue Cross and Blue Shield Multi State Plan","Standard Gold On Exchange Plan","78.01%","0.777838170528412","Yes","Yes","Yes","70%","30%","$1,000","$80","$2,300","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB4","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880006","Anthem HealthKeepers Gold, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880006-02","Anthem HealthKeepers Gold a Blue Cross and Blue Shield Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GB5","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880006","Anthem HealthKeepers Gold, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF201","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880006-03","Anthem HealthKeepers Gold a Blue Cross and Blue Shield Multi State Plan","Limited Cost Sharing Plan Variation","78.01%","0.777838170528412","Yes","Yes","Yes","70%","30%","$1,000","$80","$2,300","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$3000 per group","20.00%","$1,000","$1000 per person","$3000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB4","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880005-01","Anthem HealthKeepers Silver a Blue Cross and Blue Shield Multi State Plan","Standard Silver On Exchange Plan","70.15%","0.700012981891632","Yes","Yes","Yes","70%","30%","$1,800","$100","$2,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%","$1,800","$1800 per person","$3600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAV","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880005-02","Anthem HealthKeepers Silver a Blue Cross and Blue Shield Multi State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAW","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880005-03","Anthem HealthKeepers Silver a Blue Cross and Blue Shield Multi State Plan","Limited Cost Sharing Plan Variation","70.15%","0.700012981891632","Yes","Yes","Yes","70%","30%","$1,800","$100","$2,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%","$1,800","$1800 per person","$3600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAV","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880005-04","Anthem HealthKeepers Silver a Blue Cross and Blue Shield Multi State Plan S04","73% AV Level Silver Plan","73.60%","0.734911203384399","Yes","Yes","Yes","70%","30%","$1,650","$100","$2,300","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%","$1,650","$1650 per person","$3300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAX","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880005-05","Anthem HealthKeepers Silver a Blue Cross and Blue Shield Multi State Plan S05","87% AV Level Silver Plan","87.95%","0.879524707794189","Yes","Yes","Yes","70%","30%","$900","$40","$500","$0","$500","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","$1,450","$1450 per person","$2900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","30.00%","$900","$900 per person","$1800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAY","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","OPM","2016-08-24 05:44:16","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF202","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0880005-06","Anthem HealthKeepers Silver a Blue Cross and Blue Shield Multi State Plan S06","94% AV Level Silver Plan","94.30%","0.943242311477661","Yes","Yes","Yes","70%","30%","$175","$40","$400","$0","$175","$400","$30","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30.00%","$175","$175 per person","$350 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAZ","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF207","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500003-01","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Standard Silver On Exchange Plan","71.95%","0.726957857608795","Yes","Yes","Yes","51%","49%","$1,850","$1,300","$1,400","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETM","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF207","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500003-02","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ETN","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF207","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500003-03","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","71.95%","0.726957857608795","Yes","Yes","Yes","51%","49%","$1,850","$1,300","$1,400","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETM","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF207","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500003-04","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S04","73% AV Level Silver Plan","73.95%","0.745171546936035","Yes","Yes","Yes","51%","49%","$1,850","$1,000","$1,500","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETP","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF207","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500003-05","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S05","87% AV Level Silver Plan","86.86%","0.867241621017456","Yes","Yes","Yes","51%","49%","$750","$900","$300","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETQ","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF207","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500003-06","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan S06","94% AV Level Silver Plan","94.83%","0.946184933185577","Yes","Yes","Yes","51%","49%","$175","$200","$300","$0","$175","$500","$20","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20.00%","$175","$175 per person","$350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETR","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF208","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500004-01","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","Standard Gold On Exchange Plan","78.24%","0.794183552265167","Yes","Yes","Yes","51%","49%","$1,000","$1,100","$1,600","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETT","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF208","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500004-02","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","51%","49%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ETU","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","WI","79475","OPM","2016-09-29 04:19:41","Individual","No","39-1462554","79475WI0500004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF208","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0500004-03","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","Limited Cost Sharing Plan Variation","78.24%","0.794183552265167","Yes","Yes","Yes","51%","49%","$1,000","$1,100","$1,600","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETT","http://editiondigital.net/view/IU65/2017/ON_HIX_WI_KIT_2017"
"2017","AR","26904","SERFF","2016-08-30 08:46:54","Individual","Yes","95-6042390","26904AR0020003","BESTOne Advantage Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full Covreage","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2017/AR_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AR","26904","SERFF","2016-08-30 08:46:54","Individual","Yes","95-6042390","26904AR0020003","BESTOne Advantage Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full Covreage","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2017/AR_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","AR","26904","SERFF","2016-08-30 08:46:54","Individual","Yes","95-6042390","26904AR0020004","BESTOne Plus Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full Coverage","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2017/AR_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AR","26904","SERFF","2016-08-30 08:46:54","Individual","Yes","95-6042390","26904AR0020004","BESTOne Plus Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full Coverage","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2017/AR_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","AR","26904","SERFF","2016-08-30 08:46:54","Individual","Yes","95-6042390","26904AR0020005","BESTOne Plus Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/20176/AR_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","AR","26904","SERFF","2016-08-30 08:46:54","Individual","Yes","95-6042390","26904AR0020005","BESTOne Plus Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/20176/AR_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","AR","26904","SERFF","2016-08-30 08:46:54","Individual","Yes","95-6042390","26904AR0020006","BESTOne Basic Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2017/AR_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","AR","26904","SERFF","2016-08-30 08:46:54","Individual","Yes","95-6042390","26904AR0020006","BESTOne Basic Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2017/AR_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","AR","28348","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0561140","28348AR0090001","Delta Dental Pediatric Silver Plan","28348AR009",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0090001-01","Delta Dental Pediatric Silver Plan","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2017-pediatric-silver-ehb-plan","http://www.deltadentalar.com/ACA-Marketplace/2017-pediatric-silver-ehb-plan"
"2017","AR","28348","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0561140","28348AR0090002","Delta Dental Pediatric Gold Plan","28348AR009",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0090002-01","Delta Dental Pediatric Gold Plan","Standard High On Exchange Plan","85.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2017-pediatric-gold-ehb-plan","http://www.deltadentalar.com/ACA-Marketplace/2017-pediatric-gold-ehb-plan"
"2017","AR","28348","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0561140","28348AR0100001","Delta Dental Family Silver Plus Plan","28348AR010",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0100001-01","Delta Dental Family Silver Plus Plan","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2017-family-silver-plus-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2017-family-silver-plus-plan-ehb-covered-benefits"
"2017","AR","28348","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0561140","28348AR0100002","Delta Dental Family Gold Plan","28348AR010",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0100002-01","Delta Dental Family Gold Plan","Standard High On Exchange Plan","85.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2017-family-gold-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2017-family-gold-plan-ehb-covered-benefits"
"2017","AR","28348","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0561140","28348AR0100003","Delta Dental Family Silver Plan","28348AR010",,"ARN001","ARS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0100003-01","Delta Dental Family Silver Plan","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2017-family-silver-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2017-family-silver-plan-ehb-covered-benefits"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9304",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-03","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.695115387439728","No","Yes","No","100%",,"$3,000","$1,100","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100007-03.pdf","https://api.centene.com/Brochures/2017/62141AR0100007-03.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9304",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-04","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739193737506866","No","Yes","No","100%",,"$3,000","$1,000","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$12,000","$12000 per person","$24000 per group","$17,700","$17700 per person","$35400 per group","$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100007-04.pdf","https://api.centene.com/Brochures/2017/62141AR0100007-04.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9304",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-05","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.874518215656281","No","Yes","No","100%",,"$750","$300","$0","$200","$750","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","$14,250","$14250 per person","$28500 per group","$750","$750 per person","$1500 per group","5%",,,,,"$6,000","$6000 per person","$12000 per group","$6,750","$6750 per person","$13500 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100007-05.pdf","https://api.centene.com/Brochures/2017/62141AR0100007-05.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9304",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-06","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949696958065033","No","Yes","No","100%",,"$250","$200","$0","$200","$250","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$854","$854 per person","$1708 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,854","$12854 per person","$25708 per group","$250","$250 per person","$500 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100007-06.pdf","https://api.centene.com/Brochures/2017/62141AR0100007-06.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9305",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100008-00","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0100008-00.pdf","https://api.centene.com/Brochures/2017/62141AR0100008-00.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9305",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100008-01","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0100008-01.pdf","https://api.centene.com/Brochures/2017/62141AR0100008-01.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070001","Silver 4000","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070001-00","Silver 4000","Standard Silver Off Exchange Plan",,"0.680998742580414","No","Yes","No","100%",,"$4,000","$1,000","$900","$200","$2,900","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_4000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070001","Silver 4000","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070001-01","Silver 4000","Standard Silver On Exchange Plan",,"0.680998742580414","No","Yes","No","100%",,"$4,000","$1,000","$900","$200","$2,900","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_4000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070001","Silver 4000","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070001-02","Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070001","Silver 4000","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070001-03","Silver 4000-I","Limited Cost Sharing Plan Variation",,"0.680998742580414","No","Yes","No","100%",,"$4,000","$1,000","$900","$200","$2,900","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_4000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070001","Silver 4000","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070001-04","Silver 2700","73% AV Level Silver Plan",,"0.738505601882935","No","Yes","No","100%",,"$2,700","$600","$1,000","$200","$2,700","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_2700.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070001","Silver 4000","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070001-05","Silver 500","87% AV Level Silver Plan",,"0.879797160625458","No","Yes","No","100%",,"$500","$600","$400","$200","$500","$1,000","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070001","Silver 4000","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070001-06","Silver 250","94% AV Level Silver Plan",,"0.949718594551086","No","Yes","No","100%",,"$300","$300","$300","$200","$300","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$854","$854 per person","$1708 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_250.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070008-00","Gold 2000","Standard Gold Off Exchange Plan",,"0.795915603637695","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$2,000","$1,000","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Gold_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070008-01","Gold 2000","Standard Gold On Exchange Plan",,"0.795915603637695","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$2,000","$1,000","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Gold_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070008-02","Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Gold.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","37903","SERFF","2016-09-29 04:19:41","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","37903AR0070008-03","Gold 2000-I","Limited Cost Sharing Plan Variation",,"0.795915603637695","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$2,000","$1,000","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Gold_2000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-PPO.pdf"
"2017","AR","60559","SERFF","2016-08-30 08:46:54","Individual","Yes","75-1233841","60559AR0010011","Dentegra Dental PPO Family Basic Plan","60559AR001",,"ARN001","ARS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","60559AR0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","per person not applicable","per group not applicable",,,,,,"$90","per person not applicable","per group not applicable","$90","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ar/60559ar0010011-17"
"2017","AR","60559","SERFF","2016-08-30 08:46:54","Individual","Yes","75-1233841","60559AR0010012","Dentegra Dental PPO Family Preferred Plan","60559AR001",,"ARN001","ARS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","60559AR0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ar/60559ar0010012-17"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2017) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080002-00","Ambetter Secure Care 2 (2017) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080002-00.pdf","https://api.centene.com/Brochures/2017/62141AR0080002-00.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2017) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080002-01","Ambetter Secure Care 2 (2017) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080002-01.pdf","https://api.centene.com/Brochures/2017/62141AR0080002-01.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2017) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080002-02","Ambetter Secure Care 2 (2017) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080002-02.pdf","https://api.centene.com/Brochures/2017/62141AR0080002-02.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2017) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080002-03","Ambetter Secure Care 2 (2017) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080002-03.pdf","https://api.centene.com/Brochures/2017/62141AR0080002-03.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080005-00","Ambetter Essential Care 6 (2017)","Standard Bronze Off Exchange Plan",,"0.610985934734344","No","Yes","No","100%",,"$5,000","$20","$900","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080005-00.pdf","https://api.centene.com/Brochures/2017/62141AR0080005-00.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080005-01","Ambetter Essential Care 6 (2017)","Standard Bronze On Exchange Plan",,"0.610985934734344","No","Yes","No","100%",,"$5,000","$20","$900","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080005-01.pdf","https://api.centene.com/Brochures/2017/62141AR0080005-01.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080005-02","Ambetter Essential Care 6 (2017)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080005-02.pdf","https://api.centene.com/Brochures/2017/62141AR0080005-02.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080005-03","Ambetter Essential Care 6 (2017)","Limited Cost Sharing Plan Variation",,"0.610985934734344","No","Yes","No","100%",,"$5,000","$20","$900","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080005-03.pdf","https://api.centene.com/Brochures/2017/62141AR0080005-03.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2017)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-00","Ambetter Balanced Care 7 (2017)","Standard Silver Off Exchange Plan",,"0.695115387439728","No","Yes","No","100%",,"$3,000","$1,100","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080007-00.pdf","https://api.centene.com/Brochures/2017/62141AR0080007-00.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2017)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-01","Ambetter Balanced Care 7 (2017)","Standard Silver On Exchange Plan",,"0.695115387439728","No","Yes","No","100%",,"$3,000","$1,100","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080007-01.pdf","https://api.centene.com/Brochures/2017/62141AR0080007-01.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2017)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-02","Ambetter Balanced Care 7 (2017)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080007-02.pdf","https://api.centene.com/Brochures/2017/62141AR0080007-02.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2017)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-03","Ambetter Balanced Care 7 (2017)","Limited Cost Sharing Plan Variation",,"0.695115387439728","No","Yes","No","100%",,"$3,000","$1,100","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080007-03.pdf","https://api.centene.com/Brochures/2017/62141AR0080007-03.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2017)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-04","Ambetter Balanced Care 7 (2017)","73% AV Level Silver Plan",,"0.739193737506866","No","Yes","No","100%",,"$3,000","$1,000","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$12,000","$12000 per person","$24000 per group","$17,700","$17700 per person","$35400 per group","$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080007-04.pdf","https://api.centene.com/Brochures/2017/62141AR0080007-04.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2017)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-05","Ambetter Balanced Care 7 (2017)","87% AV Level Silver Plan",,"0.874518215656281","No","Yes","No","100%",,"$750","$300","$0","$200","$750","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","$14,250","$14250 per person","$28500 per group","$750","$750 per person","$1500 per group","5%",,,,,"$6,000","$6000 per person","$12000 per group","$6,750","$6750 per person","$13500 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080007-05.pdf","https://api.centene.com/Brochures/2017/62141AR0080007-05.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2017)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-06","Ambetter Balanced Care 7 (2017)","94% AV Level Silver Plan",,"0.949696958065033","No","Yes","No","100%",,"$250","$200","$0","$200","$250","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$854","$854 per person","$1708 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,854","$12854 per person","$25708 per group","$250","$250 per person","$500 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0080007-06.pdf","https://api.centene.com/Brochures/2017/62141AR0080007-06.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080008-00","Ambetter Balanced Care 6 (2017)","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0080008-00.pdf","https://api.centene.com/Brochures/2017/62141AR0080008-00.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080008-01","Ambetter Balanced Care 6 (2017)","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0080008-01.pdf","https://api.centene.com/Brochures/2017/62141AR0080008-01.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080008-02","Ambetter Balanced Care 6 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0080008-02.pdf","https://api.centene.com/Brochures/2017/62141AR0080008-02.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080008-03","Ambetter Balanced Care 6 (2017)","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0080008-03.pdf","https://api.centene.com/Brochures/2017/62141AR0080008-03.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080008-04","Ambetter Balanced Care 6 (2017)","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$13,000","$13000 per person","$26000 per group","$18,700","$18700 per person","$37400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,250","$7250 per person","$14500 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0080008-04.pdf","https://api.centene.com/Brochures/2017/62141AR0080008-04.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080008-05","Ambetter Balanced Care 6 (2017)","87% AV Level Silver Plan",,"0.877158164978027","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$13,000","$13000 per person","$26000 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,250","$6250 per person","$12500 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0080008-05.pdf","https://api.centene.com/Brochures/2017/62141AR0080008-05.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2017)","62141AR008",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080008-06","Ambetter Balanced Care 6 (2017)","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"$13,000","$13000 per person","$26000 per group","$13,425","$13425 per person","$26850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0080008-06.pdf","https://api.centene.com/Brochures/2017/62141AR0080008-06.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100005-00","Ambetter Essential Care 6 (2017) + Vision + Adult Dental","Standard Bronze Off Exchange Plan",,"0.610985934734344","No","Yes","No","100%",,"$5,000","$20","$900","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100005-00.pdf","https://api.centene.com/Brochures/2017/62141AR0100005-00.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100005-01","Ambetter Essential Care 6 (2017) + Vision + Adult Dental","Standard Bronze On Exchange Plan",,"0.610985934734344","No","Yes","No","100%",,"$5,000","$20","$900","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100005-01.pdf","https://api.centene.com/Brochures/2017/62141AR0100005-01.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100005-02","Ambetter Essential Care 6 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100005-02.pdf","https://api.centene.com/Brochures/2017/62141AR0100005-02.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100005-03","Ambetter Essential Care 6 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.610985934734344","No","Yes","No","100%",,"$5,000","$20","$900","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100005-03.pdf","https://api.centene.com/Brochures/2017/62141AR0100005-03.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9304",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-00","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.695115387439728","No","Yes","No","100%",,"$3,000","$1,100","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100007-00.pdf","https://api.centene.com/Brochures/2017/62141AR0100007-00.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9304",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-01","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.695115387439728","No","Yes","No","100%",,"$3,000","$1,100","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100007-01.pdf","https://api.centene.com/Brochures/2017/62141AR0100007-01.pdf"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200002","Gold 1000 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200002-00","Gold 1000 with PCP/Specialist/Rx Copays","Standard Gold Off Exchange Plan",,"0.810860097408295","Yes","Yes","No","100%",,"$1,000","$20","$1,100","$40","$1,000","$1,000","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0226428","75293AR1230003","Dental Gold","75293AR123","7427051652","ARN002","ARS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230003-00","Dental Gold","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0226428","75293AR1230003","Dental Gold","75293AR123","7427051652","ARN002","ARS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230003-01","Dental Gold","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200005","Silver 2500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF035","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200005-02","Silver 2500 with PCP/Rx Copays","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34008&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200005","Silver 2500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF035","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200005-03","Silver 2500 with PCP/Rx Copays","Limited Cost Sharing Plan Variation",,"0.717772960662842","Yes","Yes","No","100%",,"$2,500","$30","$800","$40","$1,600","$1,300","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200005","Silver 2500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF035","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200005-04","Silver 2500 with PCP/Rx Copays","73% AV Level Silver Plan",,"0.73829710483551","Yes","Yes","No","100%",,"$2,400","$20","$900","$40","$1,600","$1,200","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32002&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200005","Silver 2500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF035","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200005-05","Silver 2500 with PCP/Rx Copays","87% AV Level Silver Plan",,"0.877272725105286","Yes","Yes","No","100%",,"$500","$20","$900","$40","$500","$800","$200","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32003&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200005","Silver 2500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF035","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200005-06","Silver 2500 with PCP/Rx Copays","94% AV Level Silver Plan",,"0.946650207042694","Yes","Yes","No","100%",,"$200","$20","$300","$40","$0","$600","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32004&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9304",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-02","Ambetter Balanced Care 7 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/62141AR0100007-02.pdf","https://api.centene.com/Brochures/2017/62141AR0100007-02.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9305",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100008-02","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0100008-02.pdf","https://api.centene.com/Brochures/2017/62141AR0100008-02.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9305",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100008-03","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0100008-03.pdf","https://api.centene.com/Brochures/2017/62141AR0100008-03.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9305",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100008-04","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$13,000","$13000 per person","$26000 per group","$18,700","$18700 per person","$37400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,250","$7250 per person","$14500 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0100008-04.pdf","https://api.centene.com/Brochures/2017/62141AR0100008-04.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9305",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100008-05","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.877158164978027","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$13,000","$13000 per person","$26000 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,250","$6250 per person","$12500 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0100008-05.pdf","https://api.centene.com/Brochures/2017/62141AR0100008-05.pdf"
"2017","AR","62141","SERFF","2016-08-25 03:47:19","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9305",,,"2017-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100008-06","Ambetter Balanced Care 6 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"$13,000","$13000 per person","$26000 per group","$13,425","$13425 per person","$26850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"https://api.centene.com/SBC/2017/62141AR0100008-06.pdf","https://api.centene.com/Brochures/2017/62141AR0100008-06.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070006","Catastrophic","70525AR007",,"ARN001","ARS001","ARF001","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070006-00","Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Catastrophic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/IQC-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070006","Catastrophic","70525AR007",,"ARN001","ARS001","ARF001","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070006-01","Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Catastrophic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070001-00","Bronze Classic Saver 5000","Standard Bronze Off Exchange Plan",,"0.618566155433655","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Bronze_Classic_Saver_5000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/IQC-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070001-01","Bronze Classic Saver 5000","Standard Bronze On Exchange Plan",,"0.618566155433655","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Bronze_Classic_Saver_5000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070001-02","Bronze Classic Saver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Bronze_Classic_Saver.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070001-03","Bronze Classic Saver 5000-I","Limited Cost Sharing Plan Variation",,"0.618566155433655","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Bronze_Classic_Saver_5000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070003","Silver Classic 4000","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070003-00","Silver Classic 4000","Standard Silver Off Exchange Plan",,"0.680998742580414","No","Yes","No","100%",,"$4,000","$1,000","$900","$200","$2,900","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_4000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/IQC-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070003","Silver Classic 4000","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070003-01","Silver Classic 4000","Standard Silver On Exchange Plan",,"0.680998742580414","No","Yes","No","100%",,"$4,000","$1,000","$900","$200","$2,900","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_4000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070003","Silver Classic 4000","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070003-02","Silver Classic","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070003","Silver Classic 4000","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070003-03","Silver Classic 4000-I","Limited Cost Sharing Plan Variation",,"0.680998742580414","No","Yes","No","100%",,"$4,000","$1,000","$900","$200","$2,900","$1,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_4000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070003","Silver Classic 4000","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070003-04","Silver Classic 2700","73% AV Level Silver Plan",,"0.738505601882935","No","Yes","No","100%",,"$2,700","$600","$1,000","$200","$2,700","$1,200","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_2700.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070003","Silver Classic 4000","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070003-05","Silver Classic 500","87% AV Level Silver Plan",,"0.879797160625458","No","Yes","No","100%",,"$500","$600","$400","$200","$500","$1,000","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070003","Silver Classic 4000","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070003-06","Silver Classic 250","94% AV Level Silver Plan",,"0.949718594551086","No","Yes","No","100%",,"$300","$300","$300","$200","$300","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$854","$854 per person","$1708 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_250.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070151-00","Silver Classic Saver 3500","Standard Silver Off Exchange Plan",,"0.69464772939682","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_Saver_3500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/IQC-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070151-01","Silver Classic Saver 3500","Standard Silver On Exchange Plan",,"0.69464772939682","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_Saver_3500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070151-02","Silver Classic Saver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_Saver.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070151-03","Silver Classic Saver 3500-I","Limited Cost Sharing Plan Variation",,"0.69464772939682","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_Saver_3500_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070151-04","Silver Classic Saver 2500","73% AV Level Silver Plan",,"0.739498674869537","Yes","Yes","No","100%",,"$2,500","$0","$500","$200","$2,500","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_Saver_2500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070151-05","Silver Classic Saver 1000","87% AV Level Silver Plan",,"0.865824282169342","Yes","Yes","No","100%",,"$1,000","$0","$300","$200","$1,000","$0","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","5.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_Saver_1000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070151-06","Silver Classic Saver 500","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Silver_Classic_Saver_500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070050-00","Gold Classic 2000","Standard Gold Off Exchange Plan",,"0.795915603637695","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$2,000","$1,000","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Gold_Classic_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/IQC-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070050-01","Gold Classic 2000","Standard Gold On Exchange Plan",,"0.795915603637695","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$2,000","$1,000","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Gold_Classic_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070050-02","Gold Classic","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Gold_Classic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","70525","SERFF","2016-09-29 04:19:41","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2017-Formulary-Essential-Comp-Med.pdf","70525AR0070050-03","Gold Classic 2000-I","Limited Cost Sharing Plan Variation",,"0.795915603637695","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$2,000","$1,000","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Gold_Classic_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2017/Mktpl-POS-HMO.pdf"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200001","Gold 500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200001-00","Gold 500 with PCP/Rx Copays","Standard Gold Off Exchange Plan",,"0.816264033317566","Yes","Yes","No","100%",,"$500","$20","$1,200","$40","$500","$1,200","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0226428","75293AR1230001","Pediatric Dental","75293AR123","7427051652","ARN002","ARS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"0.995","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230001-00","Pediatric Dental","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0226428","75293AR1230001","Pediatric Dental","75293AR123","7427051652","ARN002","ARS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"0.995","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230001-01","Pediatric Dental","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200001","Gold 500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200001-01","Gold 500 with PCP/Rx Copays","Standard Gold On Exchange Plan",,"0.816264033317566","Yes","Yes","No","100%",,"$500","$20","$1,200","$40","$500","$1,200","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200001","Gold 500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200001-02","Gold 500 with PCP/Rx Copays","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34005&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200001","Gold 500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200001-03","Gold 500 with PCP/Rx Copays","Limited Cost Sharing Plan Variation",,"0.816264033317566","Yes","Yes","No","100%",,"$500","$20","$1,200","$40","$500","$1,200","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=29001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200002","Gold 1000 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200002-01","Gold 1000 with PCP/Specialist/Rx Copays","Standard Gold On Exchange Plan",,"0.810860097408295","Yes","Yes","No","100%",,"$1,000","$20","$1,100","$40","$1,000","$1,000","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200002","Gold 1000 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200002-02","Gold 1000 with PCP/Specialist/Rx Copays","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34006&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200004","Silver 3500 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200004-02","Silver 3500 with PCP/Specialist/Rx Copays","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34009&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200004","Silver 3500 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200004-03","Silver 3500 with PCP/Specialist/Rx Copays","Limited Cost Sharing Plan Variation","72.00%","0.73125433921814","No","Yes","No","100%",,"$3,500","$30","$1,000","$40","$1,600","$1,400","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33002&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200004","Silver 3500 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200004-04","Silver 3500 with PCP/Specialist/Rx Copays","73% AV Level Silver Plan","74.00%","0.746868968009949","No","Yes","No","100%",,"$3,500","$30","$1,000","$40","$1,600","$1,400","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32008&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200004","Silver 3500 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200004-05","Silver 3500 with PCP/Specialist/Rx Copays","87% AV Level Silver Plan","87.68%","0.873172640800476","No","Yes","No","100%",,"$500","$20","$600","$40","$500","$1,000","$300","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32009&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200004","Silver 3500 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200004-06","Silver 3500 with PCP/Specialist/Rx Copays","94% AV Level Silver Plan","94.98%","0.946488320827484","No","Yes","No","100%",,"$300","$10","$0","$40","$300","$300","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$854","$854 per person","$1708 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32010&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","DE","19005","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","19005DE0040002","EHB High PPO","19005DE004",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","19005DE0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","DE","19005","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","19005DE0040001","EHB Low PPO","19005DE004",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","19005DE0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0226428","75293AR1230004","Dental Gold Plus Vision","75293AR123","7427051652","ARN002","ARS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.817","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230004-00","Dental Gold Plus Vision","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0226428","75293AR1230004","Dental Gold Plus Vision","75293AR123","7427051652","ARN002","ARS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.817","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230004-01","Dental Gold Plus Vision","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200002","Gold 1000 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200002-03","Gold 1000 with PCP/Specialist/Rx Copays","Limited Cost Sharing Plan Variation",,"0.810860097408295","Yes","Yes","No","100%",,"$1,000","$20","$1,100","$40","$1,000","$1,000","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=31001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200003","Silver 1500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF014","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200003-00","Silver 1500 with PCP/Rx Copays","Standard Silver Off Exchange Plan",,"0.717720150947571","Yes","Yes","No","100%",,"$1,500","$30","$1,600","$40","$1,500","$1,600","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0226428","75293AR1230002","Dental Silver","75293AR123","7217051652","ARN002","ARS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230002-00","Dental Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","Yes","71-0226428","75293AR1230002","Dental Silver","75293AR123","7217051652","ARN002","ARS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230002-01","Dental Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200003","Silver 1500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF014","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200003-01","Silver 1500 with PCP/Rx Copays","Standard Silver On Exchange Plan",,"0.717720150947571","Yes","Yes","No","100%",,"$1,500","$30","$1,600","$40","$1,500","$1,600","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200003","Silver 1500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF014","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200003-02","Silver 1500 with PCP/Rx Copays","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34011&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200003","Silver 1500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF014","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200003-03","Silver 1500 with PCP/Rx Copays","Limited Cost Sharing Plan Variation",,"0.717720150947571","Yes","Yes","No","100%",,"$1,500","$30","$1,600","$40","$1,500","$1,600","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33004&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200003","Silver 1500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF014","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200003-04","Silver 1500 with PCP/Rx Copays","73% AV Level Silver Plan",,"0.738089621067047","Yes","Yes","No","100%",,"$1,500","$30","$1,600","$40","$1,500","$1,600","$30","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32020&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200003","Silver 1500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF014","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200003-05","Silver 1500 with PCP/Rx Copays","87% AV Level Silver Plan",,"0.872705698013306","Yes","Yes","No","100%",,"$800","$20","$600","$40","$700","$1,000","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32021&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200003","Silver 1500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF014","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200003-06","Silver 1500 with PCP/Rx Copays","94% AV Level Silver Plan",,"0.942226350307465","Yes","Yes","No","100%",,"$300","$20","$200","$40","$0","$500","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32022&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200006","Silver 3600 HSA","75293AR120","7427051652","ARN001","ARS001","ARF042","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200006-00","Silver 3600 HSA","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32023&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200006","Silver 3600 HSA","75293AR120","7427051652","ARN001","ARS001","ARF042","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200006-01","Silver 3600 HSA","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32023&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200006","Silver 3600 HSA","75293AR120","7427051652","ARN001","ARS001","ARF042","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200006-02","Silver 3600 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34012&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200006","Silver 3600 HSA","75293AR120","7427051652","ARN001","ARS001","ARF042","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200006-03","Silver 3600 HSA","Limited Cost Sharing Plan Variation",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33006&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200006","Silver 3600 HSA","75293AR120","7427051652","ARN001","ARS001","ARF042","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200006-04","Silver 3600 HSA","73% AV Level Silver Plan",,"0.738653838634491","Yes","Yes","No","100%",,"$3,200","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32024&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200006","Silver 3600 HSA","75293AR120","7427051652","ARN001","ARS001","ARF042","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200006-05","Silver 3600 HSA","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$1,400","$0","$0","$40","$1,400","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32025&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200006","Silver 3600 HSA","75293AR120","7427051652","ARN001","ARS001","ARF042","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200006-06","Silver 3600 HSA","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$40","$500","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32026&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200005","Silver 2500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF035","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200005-00","Silver 2500 with PCP/Rx Copays","Standard Silver Off Exchange Plan",,"0.717772960662842","Yes","Yes","No","100%",,"$2,500","$30","$800","$40","$1,600","$1,300","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200005","Silver 2500 with PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF035","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200005-01","Silver 2500 with PCP/Rx Copays","Standard Silver On Exchange Plan",,"0.717772960662842","Yes","Yes","No","100%",,"$2,500","$30","$800","$40","$1,600","$1,300","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200007","Bronze 6350 PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF053","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200007-00","Bronze 6350 PCP/Rx Copays","Standard Bronze Off Exchange Plan",,"0.611492455005646","Yes","Yes","No","100%",,"$6,400","$30","$200","$40","$1,600","$800","$900","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50.00%",,,,,"$12,700","$12700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23005&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200007","Bronze 6350 PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF053","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200007-01","Bronze 6350 PCP/Rx Copays","Standard Bronze On Exchange Plan",,"0.611492455005646","Yes","Yes","No","100%",,"$6,400","$30","$200","$40","$1,600","$800","$900","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50.00%",,,,,"$12,700","$12700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23005&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200007","Bronze 6350 PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF053","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200007-02","Bronze 6350 PCP/Rx Copays","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34014&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200007","Bronze 6350 PCP/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF053","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200007-03","Bronze 6350 PCP/Rx Copays","Limited Cost Sharing Plan Variation",,"0.611492455005646","Yes","Yes","No","100%",,"$6,400","$30","$200","$40","$1,600","$800","$900","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50.00%",,,,,"$12,700","$12700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=24005&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200008","Bronze 6400 HSA","75293AR120","7427051652","ARN001","ARS001","ARF057","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200008-00","Bronze 6400 HSA","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200008","Bronze 6400 HSA","75293AR120","7427051652","ARN001","ARS001","ARF057","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200008-01","Bronze 6400 HSA","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200008","Bronze 6400 HSA","75293AR120","7427051652","ARN001","ARS001","ARF057","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200008-02","Bronze 6400 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34003&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200008","Bronze 6400 HSA","75293AR120","7427051652","ARN001","ARS001","ARF057","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200008-03","Bronze 6400 HSA","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=26001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200009","Catastrophic","75293AR120","7427051652","ARN001","ARS001","ARF061","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200009-00","Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,700","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=27001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200009","Catastrophic","75293AR120","7427051652","ARN001","ARS001","ARF061","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200009-01","Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,700","$0","$0","$40","$1,600","$0","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=27001&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200004","Silver 3500 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200004-00","Silver 3500 with PCP/Specialist/Rx Copays","Standard Silver Off Exchange Plan","72.00%","0.73125433921814","No","Yes","No","100%",,"$3,500","$30","$1,000","$40","$1,600","$1,400","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","AR","75293","SERFF","2016-08-25 03:47:19","Individual","No","71-0226428","75293AR1200004","Silver 3500 with PCP/Specialist/Rx Copays","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2017-01-01","2017-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2017","75293AR1200004-01","Silver 3500 with PCP/Specialist/Rx Copays","Standard Silver On Exchange Plan","72.00%","0.73125433921814","No","Yes","No","100%",,"$3,500","$30","$1,000","$40","$1,600","$1,400","$0","$100","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007&year=2017","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2017","DE","19005","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","19005DE0030002","EHB High Passive","19005DE003",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","19005DE0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","DE","19005","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","19005DE0030001","EHB Low Passive","19005DE003",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","19005DE0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","DE","26018","SERFF","2016-08-24 05:44:16","Individual","Yes","94-2761537","26018DE0010002","Delta Dental PPO Pediatric Preferred Plan","26018DE001",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010002-17"
"2017","DE","26018","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","94-2761537","26018DE0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020002-17"
"2017","DE","26018","SERFF","2016-08-24 05:44:16","Individual","Yes","94-2761537","26018DE0010001","Delta Dental PPO Pediatric Basic Plan","26018DE001",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010001-17"
"2017","DE","26018","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","94-2761537","26018DE0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020001-17"
"2017","DE","26018","SERFF","2016-08-24 05:44:16","Individual","Yes","94-2761537","26018DE0010006","Delta Dental PPO Basic Plan for Families","26018DE001",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010006-17"
"2017","DE","26018","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","94-2761537","26018DE0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020006-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020006-17"
"2017","DE","26018","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","94-2761537","26018DE0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020004-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020004-17"
"2017","DE","26018","SERFF","2016-08-24 05:44:16","Individual","Yes","94-2761537","26018DE0010004","Delta Dental PPO Preferred Plan for Families","26018DE001",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010004-17"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","06-6033492","29497DE0070025","Aetna Bronze PPO 5500 80/50 HSA","29497DE007",,"DEN002","DES002","DEF002","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","29497DE0070025-00","Aetna Bronze PPO 5500 80/50 HSA","Standard Bronze Off Exchange Plan","61.99%","0.620592176914215","Yes","Yes","No","100%",,"$5,500","$0","$1,100","$60","$5,500","$300","$20","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033229&D=01-01-2017",
"2017","DE","29497","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","06-6033492","29497DE0070025","Aetna Bronze PPO 5500 80/50 HSA","29497DE007",,"DEN002","DES002","DEF002","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","29497DE0070025-01","Aetna Bronze PPO 5500 80/50 HSA","Standard Bronze On Exchange Plan","61.99%","0.620592176914215","Yes","Yes","No","100%",,"$5,500","$0","$1,100","$60","$5,500","$300","$20","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033231&D=01-01-2017",
"2017","DE","29497","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","06-6033492","29497DE0100003","Aetna Gold PPO 2500 100/50","29497DE010",,"DEN002","DES002","DEF016","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","29497DE0100003-00","Aetna Gold PPO 2500 100/50","Standard Gold Off Exchange Plan","80.13%","0","No","Yes","No","100%",,"$2,500","$60","$0","$60","$0","$1,200","$0","$20","$600","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033214&D=01-01-2017",
"2017","DE","29497","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","06-6033492","29497DE0100003","Aetna Gold PPO 2500 100/50","29497DE010",,"DEN002","DES002","DEF016","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","29497DE0100003-01","Aetna Gold PPO 2500 100/50","Standard Gold On Exchange Plan","80.13%","0","No","Yes","No","100%",,"$2,500","$60","$0","$60","$0","$1,200","$0","$20","$600","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033230&D=01-01-2017",
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090001","Aetna Bronze $45 Copay PPO","29497DE009",,"DEN001","DES001","DEF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090001-00","Aetna Bronze $45 Copay PPO","Standard Bronze Off Exchange Plan","61.86%","0.619648456573486","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718464_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090001","Aetna Bronze $45 Copay PPO","29497DE009",,"DEN001","DES001","DEF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090001-01","Aetna Bronze $45 Copay PPO","Standard Bronze On Exchange Plan","61.86%","0.619648456573486","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718464_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090001","Aetna Bronze $45 Copay PPO","29497DE009",,"DEN001","DES001","DEF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090001-02","Aetna Bronze $45 Copay PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718464_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090001","Aetna Bronze $45 Copay PPO","29497DE009",,"DEN001","DES001","DEF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090001-03","Aetna Bronze $45 Copay PPO","Limited Cost Sharing Plan Variation","61.86%","0.619648456573486","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718464_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090002","Aetna Bronze Deductible Only HSA Eligible PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5647347606","29497DE0090002-00","Aetna Bronze Deductible Only HSA Eligible PPO","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718469_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090002","Aetna Bronze Deductible Only HSA Eligible PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5647347606","29497DE0090002-01","Aetna Bronze Deductible Only HSA Eligible PPO","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718469_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090002","Aetna Bronze Deductible Only HSA Eligible PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5647347606","29497DE0090002-02","Aetna Bronze Deductible Only HSA Eligible PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718469_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090002","Aetna Bronze Deductible Only HSA Eligible PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5647347606","29497DE0090002-03","Aetna Bronze Deductible Only HSA Eligible PPO","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718469_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090006","Aetna Silver $15 Copay $5500 PPO","29497DE009",,"DEN001","DES001","DEF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090006-00","Aetna Silver $15 Copay $5500 PPO","Standard Silver Off Exchange Plan","69.14%","0.687512278556824","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721287_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090006","Aetna Silver $15 Copay $5500 PPO","29497DE009",,"DEN001","DES001","DEF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090006-01","Aetna Silver $15 Copay $5500 PPO","Standard Silver On Exchange Plan","69.14%","0.687512278556824","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721287_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090006","Aetna Silver $15 Copay $5500 PPO","29497DE009",,"DEN001","DES001","DEF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090006-02","Aetna Silver $15 Copay $5500 PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721287_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090006","Aetna Silver $15 Copay $5500 PPO","29497DE009",,"DEN001","DES001","DEF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090006-03","Aetna Silver $15 Copay $5500 PPO","Limited Cost Sharing Plan Variation","69.14%","0.687512278556824","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721287_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090006","Aetna Silver $15 Copay $5500 PPO","29497DE009",,"DEN001","DES001","DEF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090006-04","Aetna Silver $15 Copay $5500 PPO","73% AV Level Silver Plan","73.65%","0.734200000762939","Yes","Yes","No","100%",,"$3,900","$10","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721287_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090006","Aetna Silver $15 Copay $5500 PPO","29497DE009",,"DEN001","DES001","DEF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090006-05","Aetna Silver $15 Copay $5500 PPO","87% AV Level Silver Plan","87.39%","0.873599350452423","Yes","Yes","No","100%",,"$500","$10","$900","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721287_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090006","Aetna Silver $15 Copay $5500 PPO","29497DE009",,"DEN001","DES001","DEF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090006-06","Aetna Silver $15 Copay $5500 PPO","94% AV Level Silver Plan","93.35%","0.932405471801758","Yes","Yes","No","100%",,"$0","$10","$500","$200","$0","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721287_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090007","Aetna Silver $20 Copay $5950 PPO","29497DE009",,"DEN001","DES001","DEF012","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090007-00","Aetna Silver $20 Copay $5950 PPO","Standard Silver Off Exchange Plan","68.02%","0.680700540542603","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718482_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090007","Aetna Silver $20 Copay $5950 PPO","29497DE009",,"DEN001","DES001","DEF012","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090007-01","Aetna Silver $20 Copay $5950 PPO","Standard Silver On Exchange Plan","68.02%","0.680700540542603","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718482_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090007","Aetna Silver $20 Copay $5950 PPO","29497DE009",,"DEN001","DES001","DEF012","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090007-02","Aetna Silver $20 Copay $5950 PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718482_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090007","Aetna Silver $20 Copay $5950 PPO","29497DE009",,"DEN001","DES001","DEF012","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090007-03","Aetna Silver $20 Copay $5950 PPO","Limited Cost Sharing Plan Variation","68.02%","0.680700540542603","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718482_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090007","Aetna Silver $20 Copay $5950 PPO","29497DE009",,"DEN001","DES001","DEF012","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090007-04","Aetna Silver $20 Copay $5950 PPO","73% AV Level Silver Plan","72.02%","0.722555935382843","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718482_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090007","Aetna Silver $20 Copay $5950 PPO","29497DE009",,"DEN001","DES001","DEF012","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090007-05","Aetna Silver $20 Copay $5950 PPO","87% AV Level Silver Plan","86.98%","0.870895445346832","Yes","Yes","No","100%",,"$1,700","$0","$0","$200","$1,600","$60","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718482_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090007","Aetna Silver $20 Copay $5950 PPO","29497DE009",,"DEN001","DES001","DEF012","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090007-06","Aetna Silver $20 Copay $5950 PPO","94% AV Level Silver Plan","93.07%","0.931585550308228","Yes","Yes","No","100%",,"$700","$10","$0","$200","$700","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718482_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090003","Aetna Gold $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF009","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090003-00","Aetna Gold $10 Copay PPO","Standard Gold Off Exchange Plan","78.09%","0.777344703674316","No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718451_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090003","Aetna Gold $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF009","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090003-01","Aetna Gold $10 Copay PPO","Standard Gold On Exchange Plan","78.09%","0.777344703674316","No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718451_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090003","Aetna Gold $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF009","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090003-02","Aetna Gold $10 Copay PPO","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718451_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090003","Aetna Gold $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF009","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090003-03","Aetna Gold $10 Copay PPO","Limited Cost Sharing Plan Variation","78.09%","0.777344703674316","No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718451_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090004","Aetna Silver $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090004-00","Aetna Silver $15 Copay PPO","Standard Silver Off Exchange Plan","68.04%","0.681276977062225","No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718456_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090004","Aetna Silver $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090004-01","Aetna Silver $15 Copay PPO","Standard Silver On Exchange Plan","68.04%","0.681276977062225","No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718456_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090004","Aetna Silver $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090004-02","Aetna Silver $15 Copay PPO","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718456_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090004","Aetna Silver $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090004-03","Aetna Silver $15 Copay PPO","Limited Cost Sharing Plan Variation","68.04%","0.681276977062225","No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718456_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090004","Aetna Silver $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090004-04","Aetna Silver $15 Copay PPO","73% AV Level Silver Plan","72.01%","0.723344266414642","No","Yes","No","100%",,"$3,300","$500","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718456_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090004","Aetna Silver $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090004-05","Aetna Silver $15 Copay PPO","87% AV Level Silver Plan","87.03%","0.86135345697403","No","Yes","No","100%",,"$800","$10","$400","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","10.00%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718456_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","Individual","No","06-6033492","29497DE0090004","Aetna Silver $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","29497DE0090004-06","Aetna Silver $15 Copay PPO","94% AV Level Silver Plan","93.93%","0.937477767467499","No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718456_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","29497","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","06-6033492","29497DE0100004","Aetna Silver PPO 3000 100/50 300A HSA","29497DE010",,"DEN002","DES002","DEF017","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","29497DE0100004-00","Aetna Silver PPO 3000 100/50 300A HSA","Standard Silver Off Exchange Plan","70.07%","0","Yes","Yes","No","100%",,"$3,000","$300","$0","$60","$3,000","$600","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033843&D=01-01-2017",
"2017","DE","29497","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","06-6033492","29497DE0100004","Aetna Silver PPO 3000 100/50 300A HSA","29497DE010",,"DEN002","DES002","DEF017","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","29497DE0100004-01","Aetna Silver PPO 3000 100/50 300A HSA","Standard Silver On Exchange Plan","70.07%","0","Yes","Yes","No","100%",,"$3,000","$300","$0","$60","$3,000","$600","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033842&D=01-01-2017",
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080008","Aetna Silver $15 Copay $5500 HNOnly","67190DE008",,"DEN001","DES001","DEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080008-02","Aetna Silver $15 Copay $5500 HNOnly","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721295_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080008","Aetna Silver $15 Copay $5500 HNOnly","67190DE008",,"DEN001","DES001","DEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080008-03","Aetna Silver $15 Copay $5500 HNOnly","Limited Cost Sharing Plan Variation","69.14%","0.687512278556824","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721295_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080008","Aetna Silver $15 Copay $5500 HNOnly","67190DE008",,"DEN001","DES001","DEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080008-04","Aetna Silver $15 Copay $5500 HNOnly","73% AV Level Silver Plan","73.65%","0.734130680561066","Yes","Yes","No","100%",,"$3,900","$10","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721295_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080008","Aetna Silver $15 Copay $5500 HNOnly","67190DE008",,"DEN001","DES001","DEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080008-05","Aetna Silver $15 Copay $5500 HNOnly","87% AV Level Silver Plan","87.39%","0.873599350452423","Yes","Yes","No","100%",,"$500","$10","$900","$200","$500","$100","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721295_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","60359","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5581829","60359DE0090001","EHB Basic Dental Plan (Low)","60359DE009",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","60359DE0090001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.metlife.com/reform","www.metlife.com/reform"
"2017","DE","61298","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","61298DE0040002","EHB High PPO","61298DE004",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","61298DE0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","DE","61298","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","61298DE0040001","EHB Low PPO","61298DE004",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","61298DE0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","DE","61298","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","61298DE0030002","EHB High Passive","61298DE003",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","61298DE0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","DE","61298","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","61298DE0030001","EHB Low Passive","61298DE003",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","61298DE0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080001","Aetna Bronze $45 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080001-00","Aetna Bronze $45 Copay HNOnly","Standard Bronze Off Exchange Plan","61.86%","0.619648456573486","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718425_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080001","Aetna Bronze $45 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080001-01","Aetna Bronze $45 Copay HNOnly","Standard Bronze On Exchange Plan","61.86%","0.619648456573486","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718425_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080001","Aetna Bronze $45 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080001-02","Aetna Bronze $45 Copay HNOnly","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718425_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080001","Aetna Bronze $45 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080001-03","Aetna Bronze $45 Copay HNOnly","Limited Cost Sharing Plan Variation","61.86%","0.619648456573486","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718425_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080002","Aetna Bronze Deductible Only HSA Eligible HNOnly","67190DE008",,"DEN001","DES001","DEF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5647347606","67190DE0080002-00","Aetna Bronze Deductible Only HSA Eligible HNOnly","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718430_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080002","Aetna Bronze Deductible Only HSA Eligible HNOnly","67190DE008",,"DEN001","DES001","DEF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5647347606","67190DE0080002-01","Aetna Bronze Deductible Only HSA Eligible HNOnly","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718430_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080002","Aetna Bronze Deductible Only HSA Eligible HNOnly","67190DE008",,"DEN001","DES001","DEF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5647347606","67190DE0080002-02","Aetna Bronze Deductible Only HSA Eligible HNOnly","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718430_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080002","Aetna Bronze Deductible Only HSA Eligible HNOnly","67190DE008",,"DEN001","DES001","DEF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5647347606","67190DE0080002-03","Aetna Bronze Deductible Only HSA Eligible HNOnly","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718430_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080008","Aetna Silver $15 Copay $5500 HNOnly","67190DE008",,"DEN001","DES001","DEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080008-00","Aetna Silver $15 Copay $5500 HNOnly","Standard Silver Off Exchange Plan","69.14%","0.687512278556824","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721295_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080008","Aetna Silver $15 Copay $5500 HNOnly","67190DE008",,"DEN001","DES001","DEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080008-01","Aetna Silver $15 Copay $5500 HNOnly","Standard Silver On Exchange Plan","69.14%","0.687512278556824","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721295_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080008","Aetna Silver $15 Copay $5500 HNOnly","67190DE008",,"DEN001","DES001","DEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080008-06","Aetna Silver $15 Copay $5500 HNOnly","94% AV Level Silver Plan","93.35%","0.932405471801758","Yes","Yes","No","100%",,"$0","$10","$500","$200","$0","$100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_721295_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080007","Aetna Silver $20 Copay $5950 HNOnly","67190DE008",,"DEN001","DES001","DEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080007-00","Aetna Silver $20 Copay $5950 HNOnly","Standard Silver Off Exchange Plan","68.02%","0.680700540542603","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718443_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080007","Aetna Silver $20 Copay $5950 HNOnly","67190DE008",,"DEN001","DES001","DEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080007-01","Aetna Silver $20 Copay $5950 HNOnly","Standard Silver On Exchange Plan","68.02%","0.680700540542603","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718443_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080007","Aetna Silver $20 Copay $5950 HNOnly","67190DE008",,"DEN001","DES001","DEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080007-02","Aetna Silver $20 Copay $5950 HNOnly","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718443_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080007","Aetna Silver $20 Copay $5950 HNOnly","67190DE008",,"DEN001","DES001","DEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080007-03","Aetna Silver $20 Copay $5950 HNOnly","Limited Cost Sharing Plan Variation","68.02%","0.680700540542603","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718443_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080007","Aetna Silver $20 Copay $5950 HNOnly","67190DE008",,"DEN001","DES001","DEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080007-04","Aetna Silver $20 Copay $5950 HNOnly","73% AV Level Silver Plan","72.02%","0.722555935382843","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718443_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080007","Aetna Silver $20 Copay $5950 HNOnly","67190DE008",,"DEN001","DES001","DEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080007-05","Aetna Silver $20 Copay $5950 HNOnly","87% AV Level Silver Plan","86.98%","0.870895445346832","Yes","Yes","No","100%",,"$1,700","$0","$0","$200","$1,600","$60","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718443_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080007","Aetna Silver $20 Copay $5950 HNOnly","67190DE008",,"DEN001","DES001","DEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080007-06","Aetna Silver $20 Copay $5950 HNOnly","94% AV Level Silver Plan","93.07%","0.931585550308228","Yes","Yes","No","100%",,"$700","$10","$0","$200","$700","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718443_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080003","Aetna Gold $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080003-00","Aetna Gold $10 Copay HNOnly","Standard Gold Off Exchange Plan","78.09%","0.777344703674316","No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718412_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080003","Aetna Gold $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080003-01","Aetna Gold $10 Copay HNOnly","Standard Gold On Exchange Plan","78.09%","0.777344703674316","No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718412_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080003","Aetna Gold $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080003-02","Aetna Gold $10 Copay HNOnly","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718412_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080003","Aetna Gold $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080003-03","Aetna Gold $10 Copay HNOnly","Limited Cost Sharing Plan Variation","78.09%","0.777344703674316","No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718412_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080004","Aetna Silver $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080004-00","Aetna Silver $15 Copay HNOnly","Standard Silver Off Exchange Plan","68.04%","0.681276977062225","No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718417_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","23-2169745","67190DE0060004","Aetna Bronze HNOption 5500 80/50 HSA","67190DE006",,"DEN001","DES001","DEF003","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","67190DE0060004-00","Aetna Bronze HNOption 5500 80/50 HSA","Standard Bronze Off Exchange Plan","61.99%","0.620592176914215","Yes","Yes","No","100%",,"$5,500","$0","$1,100","$60","$5,500","$300","$20","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033210&D=01-01-2017",
"2017","DE","67190","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","23-2169745","67190DE0060004","Aetna Bronze HNOption 5500 80/50 HSA","67190DE006",,"DEN001","DES001","DEF003","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","67190DE0060004-01","Aetna Bronze HNOption 5500 80/50 HSA","Standard Bronze On Exchange Plan","61.99%","0.620592176914215","Yes","Yes","No","100%",,"$5,500","$0","$1,100","$60","$5,500","$300","$20","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033209&D=01-01-2017",
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080004","Aetna Silver $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080004-01","Aetna Silver $15 Copay HNOnly","Standard Silver On Exchange Plan","68.04%","0.681276977062225","No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718417_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080004","Aetna Silver $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080004-02","Aetna Silver $15 Copay HNOnly","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718417_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","23-2169745","67190DE0040048","Aetna Gold HNOption 2500 100/50","67190DE004",,"DEN001","DES001","DEF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","67190DE0040048-00","Aetna Gold HNOption 2500 100/50","Standard Gold Off Exchange Plan","80.13%","0","No","Yes","No","100%",,"$2,500","$60","$0","$60","$0","$1,200","$0","$20","$600","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033211&D=01-01-2017",
"2017","DE","67190","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","23-2169745","67190DE0040048","Aetna Gold HNOption 2500 100/50","67190DE004",,"DEN001","DES001","DEF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","67190DE0040048-01","Aetna Gold HNOption 2500 100/50","Standard Gold On Exchange Plan","80.13%","0","No","Yes","No","100%",,"$2,500","$60","$0","$60","$0","$1,200","$0","$20","$600","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033206&D=01-01-2017",
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080004","Aetna Silver $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080004-03","Aetna Silver $15 Copay HNOnly","Limited Cost Sharing Plan Variation","68.04%","0.681276977062225","No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718417_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080004","Aetna Silver $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080004-04","Aetna Silver $15 Copay HNOnly","73% AV Level Silver Plan","72.01%","0.723344266414642","No","Yes","No","100%",,"$3,300","$500","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718417_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080004","Aetna Silver $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080004-05","Aetna Silver $15 Copay HNOnly","87% AV Level Silver Plan","87.03%","0.86135345697403","No","Yes","No","100%",,"$800","$10","$400","$200","$800","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718417_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","Individual","No","23-2169745","67190DE0080004","Aetna Silver $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5644738991","67190DE0080004-06","Aetna Silver $15 Copay HNOnly","94% AV Level Silver Plan","93.93%","0.937477767467499","No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/DE/SBC_2017_DE_718417_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_DE.html"
"2017","DE","67190","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","23-2169745","67190DE0060005","Aetna Silver HNOption 3000 100/50 300A HSA","67190DE006",,"DEN001","DES001","DEF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","67190DE0060005-00","Aetna Silver HNOption 3000 100/50 300A HSA","Standard Silver Off Exchange Plan","70.07%","0","Yes","Yes","No","100%",,"$3,000","$300","$0","$60","$3,000","$600","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033845&D=01-01-2017",
"2017","DE","67190","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","No","23-2169745","67190DE0060005","Aetna Silver HNOption 3000 100/50 300A HSA","67190DE006",,"DEN001","DES001","DEF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=0310823520","67190DE0060005-01","Aetna Silver HNOption 3000 100/50 300A HSA","Standard Silver On Exchange Plan","70.07%","0","Yes","Yes","No","100%",,"$3,000","$300","$0","$60","$3,000","$600","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.aetna.com/sbcsearch/getmysbc?T=14033844&D=01-01-2017",
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0010003","Select Plan Basic Kids","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010003-00","Select Plan Basic Kids","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBLINDPEDEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","67775DE0040004","Choice PPO Basic","67775DE004","7962405180","DEN002","DES002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040004-00","Choice PPO Basic","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLSMGFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","67775DE0040004","Choice PPO Basic","67775DE004","7962405180","DEN002","DES002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040004-01","Choice PPO Basic","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLSMGFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0010003","Select Plan Basic Kids","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010003-01","Select Plan Basic Kids","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBLINDPEDEHB.PDF"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3250","76168DE042",,"DEN001","DES001","DEF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420004-03","Health Savings Embedded Blue EPO 3250","Limited Cost Sharing Plan Variation",,"0.687343835830688","Yes","Yes","No","100%",,"$3,250","$0","$400","$0","$3,250","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111019530/I_2111019530_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3250","76168DE042",,"DEN001","DES001","DEF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420004-04","Health Savings Embedded Blue EPO 3250","73% AV Level Silver Plan",,"0.723451673984528","Yes","Yes","No","100%",,"$2,600","$0","$500","$0","$2,600","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111090081/I_2111090081_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","67775DE0040005","Choice PPO Premium","67775DE004","7962405180","DEN002","DES002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040005-00","Choice PPO Premium","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHSMGFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0010005","Select Plan Premium Kids","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010005-00","Select Plan Premium Kids","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHINDPEDEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0010005","Select Plan Premium Kids","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010005-01","Select Plan Premium Kids","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHINDPEDEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","67775DE0040005","Choice PPO Premium","67775DE004","7962405180","DEN002","DES002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040005-01","Choice PPO Premium","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHSMGFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020005","Elite PPO Basic Kids","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020005-00","Elite PPO Basic Kids","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLINDPEDEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020005","Elite PPO Basic Kids","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020005-01","Elite PPO Basic Kids","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLINDPEDEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020003","Elite PPO Premium Kids","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020003-00","Elite PPO Premium Kids","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHINDPEDEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020003","Elite PPO Premium Kids","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020003-01","Elite PPO Premium Kids","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHINDPEDEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","67775DE0030004","Select Plan Premium","67775DE003","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0030004-00","Select Plan Premium","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHSMGFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0010004","Select Plan Basic","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010004-00","Select Plan Basic","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBLINDFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0010004","Select Plan Basic","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010004-01","Select Plan Basic","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBLINDFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","67775DE0030004","Select Plan Premium","67775DE003","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0030004-01","Select Plan Premium","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHSMGFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0010006","Select Plan Premium","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010006-00","Select Plan Premium","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHINDFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0010006","Select Plan Premium","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010006-01","Select Plan Premium","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17DBHINDFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020004","Elite PPO Basic","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020004-00","Elite PPO Basic","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLINDFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020004","Elite PPO Basic","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020004-01","Elite PPO Basic","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBLINDFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020006","Elite PPO Premium","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020006-00","Elite PPO Premium","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHINDFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020006","Elite PPO Premium","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020006-01","Elite PPO Premium","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE17SBHINDFAMEHB.PDF"
"2017","DE","67775","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","67775DE0020007","Elite PPO Plus","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020007-00","Elite PPO Plus","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","DE","68245","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-0883760","68245DE0040002","EHB High PPO","68245DE004",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68245DE0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","DE","68245","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-0883760","68245DE0040001","EHB Low PPO","68245DE004",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68245DE0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","DE","68245","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-0883760","68245DE0030002","EHB High Passive","68245DE003",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68245DE0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","DE","68245","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-0883760","68245DE0030001","EHB Low Passive","68245DE003",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68245DE0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0430002","Shared Cost EPO Basic $2000-75","76168DE043",,"DEN001","DES001","DEF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9973",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0430002-00","Shared Cost EPO Basic $2000-75","Standard Silver Off Exchange Plan","71.71%","0.725102066993713","No","Yes","No","100%",,"$2,000","$200","$1,100","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0650001","Health Savings Blue EPO 1700","76168DE065",,"DEN001","DES001","DEF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0650001-00","Health Savings Blue EPO 1700","Standard Gold Off Exchange Plan",,"0.791006028652191","Yes","Yes","No","100%",,"$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0650001","Health Savings Blue EPO 1700","76168DE065",,"DEN001","DES001","DEF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0650001-01","Health Savings Blue EPO 1700","Standard Gold On Exchange Plan",,"0.791006028652191","Yes","Yes","No","100%",,"$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110150030/I_2110150030_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0430002","Shared Cost EPO Basic $2000-75","76168DE043",,"DEN001","DES001","DEF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9973",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0430002-01","Shared Cost EPO Basic $2000-75","Standard Silver On Exchange Plan","71.71%","0.725102066993713","No","Yes","No","100%",,"$2,000","$200","$1,100","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2097256647/SE_2097256647_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/DE"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0500004","Shared Cost EPO Basic $6600-75","76168DE050",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9968",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0500004-00","Shared Cost EPO Basic $6600-75","Standard Bronze Off Exchange Plan",,"0.617596030235291","No","Yes","No","100%",,"$6,600","$30","$200","$0","$4,600","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0650001","Health Savings Blue EPO 1700","76168DE065",,"DEN001","DES001","DEF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0650001-02","Health Savings Blue EPO 1700","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110150193/I_2110150193_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0650001","Health Savings Blue EPO 1700","76168DE065",,"DEN001","DES001","DEF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0650001-03","Health Savings Blue EPO 1700","Limited Cost Sharing Plan Variation",,"0.791006028652191","Yes","Yes","No","100%",,"$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110150206/I_2110150206_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0500004","Shared Cost EPO Basic $6600-75","76168DE050",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9968",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0500004-01","Shared Cost EPO Basic $6600-75","Standard Bronze On Exchange Plan",,"0.617596030235291","No","Yes","No","100%",,"$6,600","$30","$200","$0","$1,600","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111726221/SE_2111726221_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/DE"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3250","76168DE042",,"DEN001","DES001","DEF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420004-00","Health Savings Embedded Blue EPO 3250","Standard Silver Off Exchange Plan",,"0.687343835830688","Yes","Yes","No","100%",,"$3,250","$0","$400","$0","$3,250","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3250","76168DE042",,"DEN001","DES001","DEF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420004-01","Health Savings Embedded Blue EPO 3250","Standard Silver On Exchange Plan",,"0.687343835830688","Yes","Yes","No","100%",,"$3,250","$0","$400","$0","$3,250","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111016783/I_2111016783_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3250","76168DE042",,"DEN001","DES001","DEF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420004-02","Health Savings Embedded Blue EPO 3250","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111021607/I_2111021607_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0640003","Total Health Flex Blue EPO 3000","76168DE064",,"DEN001","DES001","DEF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0640003-05","Total Health Flex Blue EPO 3000","87% AV Level Silver Plan",,"0.863719165325165","No","Yes","Yes","98%","2%","$1,000","$200","$6,000","$0","$1,000","$300","$60","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110806225/I_2110806225_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","HI","10046","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","10046HI0020003","BESTOne Advantage Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2017/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","HI","10046","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","10046HI0020004","BESTOne Plus Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2017/HI_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","HI","10046","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","10046HI0020004","BESTOne Plus Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2017/HI_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","HI","10046","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","10046HI0020005","BESTOne Plus Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2017/HI_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","HI","10046","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","10046HI0020005","BESTOne Plus Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2017/HI_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","HI","10046","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","10046HI0020006","BESTOne Basic Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2017/HI_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","HI","10046","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","10046HI0020006","BESTOne Basic Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2017/HI_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN002","HIS001","HIF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9828",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880001-00","HMSA Platinum PPO","Standard Platinum Off Exchange Plan",,"0.88229912519455","Yes","Yes","No","100%",,"$0","$10","$1,170","$150","$0","$480","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/platinum-ppo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","Yes","99-0040115","18350HI0920005","HMSA Individual Dental PPP Pediatric Essential","18350HI092",,"HIN006","HIS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","yes","covered","yes","covered","yes",,"","18350HI0920005-01","HMSA Individual Dental PPP Pediatric Essential","Standard High On Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","Yes","99-0040115","18350HI0920006","HMSA Individual Dental PPP Pediatric Essential","18350HI092",,"HIN006","HIS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","yes","covered","yes","covered","yes",,"","18350HI0920006-00","HMSA Individual Dental PPP Pediatric Essential","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN002","HIS001","HIF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9828",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880001-01","HMSA Platinum PPO","Standard Platinum On Exchange Plan",,"0.88229912519455","Yes","Yes","No","100%",,"$0","$10","$1,170","$150","$0","$480","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/platinum-ppo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN002","HIS001","HIF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9828",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880001-02","HMSA Platinum PPO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/platinum-ppo-ai-an-zero-cs.pdf",
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3250","76168DE042",,"DEN001","DES001","DEF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420004-05","Health Savings Embedded Blue EPO 3250","87% AV Level Silver Plan",,"0.862460255622864","Yes","Yes","No","100%",,"$900","$0","$600","$0","$900","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111094953/I_2111094953_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3250","76168DE042",,"DEN001","DES001","DEF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420004-06","Health Savings Embedded Blue EPO 3250","94% AV Level Silver Plan",,"0.940437078475952","Yes","Yes","No","100%",,"$300","$0","$600","$0","$300","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111095197/I_2111095197_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6500","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420001-00","Health Savings Embedded Blue EPO 6500","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6500","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420001-01","Health Savings Embedded Blue EPO 6500","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110885508/I_2110885508_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6500","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420001-02","Health Savings Embedded Blue EPO 6500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$6,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110882595/I_2110882595_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6500","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0420001-03","Health Savings Embedded Blue EPO 6500","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110885421/I_2110885421_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0510011","Health Savings EPO HSA $1950-100","76168DE051",,"DEN001","DES001","DEF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0510011-00","Health Savings EPO HSA $1950-100","Standard Gold Off Exchange Plan",,"0.818500995635986","Yes","Yes","No","100%",,"$1,950","$0","$0","$0","$1,950","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$3900 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$3900 per person","$3900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0400001","Major Events Blue EPO 7150","76168DE040",,"DEN001","DES001","DEF001","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0400001-00","Major Events Blue EPO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0400001","Major Events Blue EPO 7150","76168DE040",,"DEN001","DES001","DEF001","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0400001-01","Major Events Blue EPO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111244198/I_2111244198_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0510011","Health Savings EPO HSA $1950-100","76168DE051",,"DEN001","DES001","DEF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0510011-01","Health Savings EPO HSA $1950-100","Standard Gold On Exchange Plan",,"0.818500995635986","Yes","Yes","No","100%",,"$1,950","$0","$0","$0","$1,950","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$3900 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$3900 per person","$3900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111768473/SE_2111768473_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/DE"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0580001","Total Health Flex Blue EPO $750-100","76168DE058",,"DEN001","DES001","DEF009","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0580001-00","Total Health Flex Blue EPO $750-100","Standard Gold Off Exchange Plan","81.53%","0.833477199077606","No","Yes","Yes","98%","2%","$750","$200","$0","$0","$750","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0.00%","$750","$750 per person","$1500 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0640003","Total Health Flex Blue EPO 3000","76168DE064",,"DEN001","DES001","DEF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0640003-00","Total Health Flex Blue EPO 3000","Standard Silver Off Exchange Plan",,"0.684088587760925","No","Yes","Yes","98%","2%","$3,000","$300","$700","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0640003","Total Health Flex Blue EPO 3000","76168DE064",,"DEN001","DES001","DEF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0640003-01","Total Health Flex Blue EPO 3000","Standard Silver On Exchange Plan",,"0.684088587760925","No","Yes","Yes","98%","2%","$3,000","$300","$700","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110804089/I_2110804089_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0580001","Total Health Flex Blue EPO $750-100","76168DE058",,"DEN001","DES001","DEF009","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0580001-01","Total Health Flex Blue EPO $750-100","Standard Gold On Exchange Plan","81.53%","0.833477199077606","No","Yes","Yes","98%","2%","$750","$200","$0","$0","$750","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0.00%","$750","$750 per person","$1500 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109820268/SE_2109820268_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/DE"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0640003","Total Health Flex Blue EPO 3000","76168DE064",,"DEN001","DES001","DEF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0640003-02","Total Health Flex Blue EPO 3000","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","98%","2%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110806930/I_2110806930_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0640003","Total Health Flex Blue EPO 3000","76168DE064",,"DEN001","DES001","DEF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0640003-03","Total Health Flex Blue EPO 3000","Limited Cost Sharing Plan Variation",,"0.684088587760925","No","Yes","Yes","98%","2%","$3,000","$300","$700","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110806862/I_2110806862_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0640003","Total Health Flex Blue EPO 3000","76168DE064",,"DEN001","DES001","DEF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0640003-04","Total Health Flex Blue EPO 3000","73% AV Level Silver Plan",,"0.725579917430878","No","Yes","Yes","98%","2%","$3,000","$300","$700","$0","$1,600","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110805625/I_2110805625_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0640003","Total Health Flex Blue EPO 3000","76168DE064",,"DEN001","DES001","DEF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0640003-06","Total Health Flex Blue EPO 3000","94% AV Level Silver Plan",,"0.931718111038208","No","Yes","Yes","98%","2%","$250","$200","$600","$0","$250","$300","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110805843/I_2110805843_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0590001","Total Health Flex Blue PPO $2500-100","76168DE059",,"DEN001","DES001","DEF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0590001-00","Total Health Flex Blue PPO $2500-100","Standard Silver Off Exchange Plan","71.43%","0.734642505645752","No","Yes","Yes","98%","2%","$2,500","$200","$0","$0","$1,600","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group","$7,100","$7100 per person","$14200 per group","$14,200","$14200 per person","$28400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%","$2,500","$2500 per person","$5000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-02","HMSA Silver PPO 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-1500-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-03","HMSA Silver PPO 1500","Limited Cost Sharing Plan Variation",,"0.718043804168701","Yes","Yes","No","100%",,"$1,500","$20","$1,830","$150","$1,500","$530","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","40.00%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-1500-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-04","HMSA Silver PPO 1500","73% AV Level Silver Plan",,"0.739581346511841","Yes","Yes","No","100%",,"$1,500","$20","$1,790","$150","$1,500","$530","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","40.00%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-1500-csr-73.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-05","HMSA Silver PPO 1500","87% AV Level Silver Plan",,"0.872478008270264","Yes","Yes","No","100%",,"$500","$10","$1,350","$150","$500","$370","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-1500-csr-87.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-06","HMSA Silver PPO 1500","94% AV Level Silver Plan",,"0.930951058864594","Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$250","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-1500-csr-94.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880029-00","HMSA Silver PPO 2500","Standard Silver Off Exchange Plan",,"0.71927797794342","Yes","Yes","No","100%",,"$2,500","$20","$960","$150","$2,500","$360","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-2500.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880029-01","HMSA Silver PPO 2500","Standard Silver On Exchange Plan",,"0.71927797794342","Yes","Yes","No","100%",,"$2,500","$20","$960","$150","$2,500","$360","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-2500.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880029-02","HMSA Silver PPO 2500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-2500-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880029-03","HMSA Silver PPO 2500","Limited Cost Sharing Plan Variation",,"0.71927797794342","Yes","Yes","No","100%",,"$2,500","$20","$960","$150","$2,500","$360","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-2500-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880029-04","HMSA Silver PPO 2500","73% AV Level Silver Plan",,"0.739828824996948","Yes","Yes","No","100%",,"$2,350","$20","$980","$150","$2,350","$390","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","20.00%",,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-2500-csr-73.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880029-05","HMSA Silver PPO 2500","87% AV Level Silver Plan",,"0.872478008270264","Yes","Yes","No","100%",,"$500","$10","$1,350","$150","$500","$370","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-2500-csr-87.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880029-06","HMSA Silver PPO 2500","94% AV Level Silver Plan",,"0.930951058864594","Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$250","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-2500-csr-94.pdf",
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410012-00","Shared Cost Blue EPO 1000","Standard Gold Off Exchange Plan",,"0.780855298042297","No","Yes","No","100%",,"$1,000","$200","$1,100","$0","$1,000","$900","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410012-01","Shared Cost Blue EPO 1000","Standard Gold On Exchange Plan",,"0.780855298042297","No","Yes","No","100%",,"$1,000","$200","$1,100","$0","$1,000","$900","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111238256/I_2111238256_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","No","51-0020405","76168DE0590001","Total Health Flex Blue PPO $2500-100","76168DE059",,"DEN001","DES001","DEF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0590001-01","Total Health Flex Blue PPO $2500-100","Standard Silver On Exchange Plan","71.43%","0.734642505645752","No","Yes","Yes","98%","2%","$2,500","$200","$0","$0","$1,600","$300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group","$7,100","$7100 per person","$14200 per group","$14,200","$14200 per person","$28400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%","$2,500","$2500 per person","$5000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111451946/SE_2111451946_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/DE"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410012-02","Shared Cost Blue EPO 1000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111238435/I_2111238435_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410012-03","Shared Cost Blue EPO 1000","Limited Cost Sharing Plan Variation",,"0.780855298042297","No","Yes","No","100%",,"$1,000","$200","$1,100","$0","$1,000","$900","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111238642/I_2111238642_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4200","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410013-00","Shared Cost Blue EPO 4200","Standard Silver Off Exchange Plan",,"0.681870102882385","No","Yes","No","100%",,"$4,200","$200","$500","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4200","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410013-01","Shared Cost Blue EPO 4200","Standard Silver On Exchange Plan",,"0.681870102882385","No","Yes","No","100%",,"$4,200","$200","$500","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110876463/I_2110876463_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4200","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410013-02","Shared Cost Blue EPO 4200","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110876776/I_2110876776_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4200","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410013-03","Shared Cost Blue EPO 4200","Limited Cost Sharing Plan Variation",,"0.681870102882385","No","Yes","No","100%",,"$4,200","$200","$500","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110876600/I_2110876600_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4200","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410013-04","Shared Cost Blue EPO 4200","73% AV Level Silver Plan",,"0.722083628177643","No","Yes","No","100%",,"$4,000","$200","$500","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110876917/I_2110876917_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4200","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410013-05","Shared Cost Blue EPO 4200","87% AV Level Silver Plan",,"0.861143589019775","No","Yes","No","100%",,"$900","$100","$600","$0","$900","$700","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110877059/I_2110877059_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4200","76168DE041",,"DEN001","DES001","DEF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410013-06","Shared Cost Blue EPO 4200","94% AV Level Silver Plan",,"0.931561708450317","No","Yes","No","100%",,"$350","$90","$600","$0","$350","$700","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110877435/I_2110877435_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6800","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410010-00","Shared Cost Blue EPO 6800","Standard Bronze Off Exchange Plan","61.22%","0.621118187904358","No","Yes","No","100%",,"$6,600","$200","$0","$0","$1,600","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6800","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410010-01","Shared Cost Blue EPO 6800","Standard Bronze On Exchange Plan","61.22%","0.621118187904358","No","Yes","No","100%",,"$6,600","$200","$0","$0","$1,600","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110887674/I_2110887674_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6800","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410010-02","Shared Cost Blue EPO 6800","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110888040/I_2110888040_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","DE","76168","SERFF","2016-09-28 04:33:02","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6800","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=7597050967","76168DE0410010-03","Shared Cost Blue EPO 6800","Limited Cost Sharing Plan Variation","61.22%","0.621118187904358","No","Yes","No","100%",,"$6,600","$200","$0","$0","$1,600","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110888109/I_2110888109_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2017_ProductBrochure.pdf"
"2017","HI","10046","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","10046HI0020003","BESTOne Advantage Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2017/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN002","HIS001","HIF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9828",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880001-03","HMSA Platinum PPO","Limited Cost Sharing Plan Variation",,"0.88229912519455","Yes","Yes","No","100%",,"$0","$10","$1,170","$150","$0","$480","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/platinum-ppo-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880007-00","HMSA Gold PPO","Standard Gold Off Exchange Plan",,"0.815258800983429","Yes","Yes","No","100%",,"$0","$10","$2,180","$150","$0","$580","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-ppo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","Yes","99-0040115","18350HI0920001","HMSA Individual Dental PPP High","18350HI092",,"HIN006","HIS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","covered","Yes","covered","Yes",,"","18350HI0920001-01","HMSA Individual Dental PPP High","Standard High On Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","Yes","99-0040115","18350HI0920003","HMSA Individual Dental PPP High","18350HI092",,"HIN006","HIS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","covered","Yes","covered","Yes",,"","18350HI0920003-00","HMSA Individual Dental PPP High","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880007-01","HMSA Gold PPO","Standard Gold On Exchange Plan",,"0.815258800983429","Yes","Yes","No","100%",,"$0","$10","$2,180","$150","$0","$580","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-ppo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880007-02","HMSA Gold PPO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-ppo-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880007-03","HMSA Gold PPO","Limited Cost Sharing Plan Variation",,"0.815258800983429","Yes","Yes","No","100%",,"$0","$10","$2,180","$150","$0","$580","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-ppo-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","Yes","99-0040115","18350HI0920002","HMSA Individual Dental PPP Basic","18350HI092",,"HIN006","HIS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","covered","Yes","covered","Yes",,"","18350HI0920002-01","HMSA Individual Dental PPP Basic","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880013-00","HMSA Gold PPO 1000","Standard Gold Off Exchange Plan",,"0.795333027839661","Yes","Yes","No","100%",,"$1,000","$10","$1,250","$150","$1,000","$390","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-ppo-1000.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880013-01","HMSA Gold PPO 1000","Standard Gold On Exchange Plan",,"0.795333027839661","Yes","Yes","No","100%",,"$1,000","$10","$1,250","$150","$1,000","$390","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-ppo-1000.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","Yes","99-0040115","18350HI0920004","HMSA Individual Dental PPP Basic","18350HI092",,"HIN006","HIS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","covered","Yes","covered","Yes",,"","18350HI0920004-00","HMSA Individual Dental PPP Basic","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880013-02","HMSA Gold PPO 1000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-ppo-1000-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880013-03","HMSA Gold PPO 1000","Limited Cost Sharing Plan Variation",,"0.795333027839661","Yes","Yes","No","100%",,"$1,000","$10","$1,250","$150","$1,000","$390","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-ppo-1000-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","Yes","99-0040115","18350HI0930001","HMSA Individual Dental HMO Basic","18350HI093",,"HIN007","HIS002",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency only","No",,"","18350HI0930001-01","HMSA Individual Dental HMO Basic","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-00","HMSA Silver PPO 1500","Standard Silver Off Exchange Plan",,"0.718043804168701","Yes","Yes","No","100%",,"$1,500","$20","$1,830","$150","$1,500","$530","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","40.00%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-1500.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-01","HMSA Silver PPO 1500","Standard Silver On Exchange Plan",,"0.718043804168701","Yes","Yes","No","100%",,"$1,500","$20","$1,830","$150","$1,500","$530","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","40.00%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-1500.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","Yes","99-0040115","18350HI0930002","HMSA Individual Dental HMO Basic","18350HI093",,"HIN007","HIS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency only","No",,"","18350HI0930002-00","HMSA Individual Dental HMO Basic","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-00","HMSA Silver PPO 3500","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-3500.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-01","HMSA Silver PPO 3500","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-3500.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-02","HMSA Silver PPO 3500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-3500-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-03","HMSA Silver PPO 3500","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-3500-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-04","HMSA Silver PPO 3500","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-3500-csr-73.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-05","HMSA Silver PPO 3500","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$150","$700","$280","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-3500-csr-87.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-06","HMSA Silver PPO 3500","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$350","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$250","$250 per person","$500 per group","$250","$250 per person","$500 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-ppo-3500-csr-94.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 7150","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880033-00","HMSA Bronze PPO 7150","Standard Bronze Off Exchange Plan","61.87%","0.61565089225769","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.hmsa.com/sbc/2017/bronze-ppo-7150.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 7150","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880033-01","HMSA Bronze PPO 7150","Standard Bronze On Exchange Plan","61.87%","0.61565089225769","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.hmsa.com/sbc/2017/bronze-ppo-7150.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 7150","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880033-02","HMSA Bronze PPO 7150","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/bronze-ppo-7150-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 7150","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880033-03","HMSA Bronze PPO 7150","Limited Cost Sharing Plan Variation","61.87%","0.61565089225769","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","No",,,"http://www.hmsa.com/sbc/2017/bronze-ppo-7150-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN003","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","Refer to plan for details.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9828",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890003-00","HMSA Platinum HMO","Standard Platinum Off Exchange Plan",,"0.895877599716187","Yes","Yes","No","100%",,"$0","$600","$210","$150","$0","$480","$130","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/platinum-hmo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN003","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","Refer to plan for details.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9828",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890003-01","HMSA Platinum HMO","Standard Platinum On Exchange Plan",,"0.895877599716187","Yes","Yes","No","100%",,"$0","$600","$210","$150","$0","$480","$130","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/platinum-hmo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN003","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","Refer to plan for details.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9828",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890003-02","HMSA Platinum HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/platinum-hmo-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN003","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","Refer to plan for details.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9828",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890003-03","HMSA Platinum HMO","Limited Cost Sharing Plan Variation",,"0.895877599716187","Yes","Yes","No","100%",,"$0","$600","$210","$150","$0","$480","$130","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/platinum-hmo-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890004-00","HMSA Gold HMO","Standard Gold Off Exchange Plan",,"0.80496871471405","Yes","Yes","No","100%",,"$1,000","$680","$240","$150","$1,000","$400","$210","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-hmo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890004-01","HMSA Gold HMO","Standard Gold On Exchange Plan",,"0.80496871471405","Yes","Yes","No","100%",,"$1,000","$680","$240","$150","$1,000","$400","$210","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-hmo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890004-02","HMSA Gold HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-hmo-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890004-03","HMSA Gold HMO","Limited Cost Sharing Plan Variation",,"0.80496871471405","Yes","Yes","No","100%",,"$1,000","$680","$240","$150","$1,000","$400","$210","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2017/gold-hmo-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-00","HMSA Silver HMO","Standard Silver Off Exchange Plan",,"0.713364124298096","Yes","Yes","No","100%",,"$2,500","$580","$0","$150","$2,500","$360","$220","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-hmo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-01","HMSA Silver HMO","Standard Silver On Exchange Plan",,"0.713364124298096","Yes","Yes","No","100%",,"$2,500","$580","$0","$150","$2,500","$360","$220","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-hmo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-02","HMSA Silver HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-hmo-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-03","HMSA Silver HMO","Limited Cost Sharing Plan Variation",,"0.713364124298096","Yes","Yes","No","100%",,"$2,500","$580","$0","$150","$2,500","$360","$220","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-hmo-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-04","HMSA Silver HMO","73% AV Level Silver Plan",,"0.737816333770752","Yes","Yes","No","100%",,"$2,000","$720","$60","$150","$2,000","$430","$270","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-hmo-csr-73.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-05","HMSA Silver HMO","87% AV Level Silver Plan",,"0.878355026245117","Yes","Yes","No","100%",,"$500","$530","$170","$150","$500","$470","$100","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-hmo-csr-87.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-06","HMSA Silver HMO","94% AV Level Silver Plan",,"0.931314051151276","Yes","Yes","No","100%",,"$0","$400","$210","$150","$0","$350","$130","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/silver-hmo-csr-94.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890006-00","HMSA Bronze HMO","Standard Bronze Off Exchange Plan","61.58%","0.614611804485321","Yes","Yes","No","100%",,"$6,000","$420","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"4","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.hmsa.com/sbc/2017/bronze-hmo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890006-01","HMSA Bronze HMO","Standard Bronze On Exchange Plan","61.58%","0.614611804485321","Yes","Yes","No","100%",,"$6,000","$420","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"4","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.hmsa.com/sbc/2017/bronze-hmo.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890006-02","HMSA Bronze HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2017/bronze-hmo-ai-an-zero-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9916",,,"2017-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890006-03","HMSA Bronze HMO","Limited Cost Sharing Plan Variation","61.58%","0.614611804485321","Yes","Yes","No","100%",,"$6,000","$420","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"4","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.hmsa.com/sbc/2017/bronze-hmo-ai-an-limited-cs.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880003","HMSA Catastrophic Plan","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880003-00","HMSA Catastrophic Plan","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","per group not applicable",,,,"$7,150","$7150 per person","per group not applicable","$7,150","$7150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","per group not applicable","0.00%",,,,,"$7,150","$7150 per person","per group not applicable","$7,150","$7150 per person","per group not applicable","No",,,"http://www.hmsa.com/sbc/2017/catastrophic-plan.pdf",
"2017","HI","18350","SERFF","2017-01-24 20:15:29","Individual","No","99-0040115","18350HI0880003","HMSA Catastrophic Plan","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,"2017-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880003-01","HMSA Catastrophic Plan","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","per group not applicable",,,,"$7,150","$7150 per person","per group not applicable","$7,150","$7150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","per group not applicable","0.00%",,,,,"$7,150","$7150 per person","per group not applicable","$7,150","$7150 per person","per group not applicable","No",,,"http://www.hmsa.com/sbc/2017/catastrophic-plan.pdf",
"2017","HI","46082","SERFF","2016-08-24 05:44:16","Individual","Yes","99-0107971","46082HI0030008","Kaiser Permanente - KPIF Pediatric Dental","46082HI003",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0030008-00","Kaiser Permanente - KPIF Pediatric Dental","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com","www.hawaiidentalservice.com"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952242393853228",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-04","KP Silver III $20 Fit CSR 73","73% AV Level Silver Plan","73.76%","0.743073403835297","No","Yes","No","100%",,"$2,900","$30","$400","$200","$0","$1,000","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_III_20_Fit_CSR_73.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","46082","SERFF","2016-08-24 05:44:16","Individual","Yes","99-0107971","46082HI0020001","HDS Individual Dental Plan for Children","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020001-00","HDS Individual Dental Plan for Children","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Individual_Dental_Plan_for_Children_0817.pdf",
"2017","HI","46082","SERFF","2016-08-24 05:44:16","Individual","Yes","99-0107971","46082HI0020001","HDS Individual Dental Plan for Children","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020001-01","HDS Individual Dental Plan for Children","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Individual_Dental_Plan_for_Children_0817.pdf",
"2017","HI","46082","SERFF","2016-08-24 05:44:16","Individual","Yes","99-0107971","46082HI0020003","HDS Preferred Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"0.884","Guaranteed Rate","2017-01-01","2017-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020003-00","HDS Preferred Dental Plan","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Preferred_Dental_Plan_0817.pdf",
"2017","HI","46082","SERFF","2016-08-24 05:44:16","Individual","Yes","99-0107971","46082HI0020003","HDS Preferred Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"0.884","Guaranteed Rate","2017-01-01","2017-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020003-01","HDS Preferred Dental Plan","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Preferred_Dental_Plan_0817.pdf",
"2017","HI","46082","SERFF","2016-08-24 05:44:16","Individual","Yes","99-0107971","46082HI0020004","HDS Classic Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020004-00","HDS Classic Dental Plan","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Classic_Dental_Plan_0817.pdf",
"2017","HI","46082","SERFF","2016-08-24 05:44:16","Individual","Yes","99-0107971","46082HI0020004","HDS Classic Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020004-01","HDS Classic Dental Plan","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Classic_Dental_Plan_0817.pdf",
"2017","HI","46082","SERFF","2016-08-24 05:44:16","Individual","Yes","99-0107971","46082HI0020005","HDS Deluxe Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01","2017-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020005-00","HDS Deluxe Dental Plan","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Deluxe_Dental_Plan_0817.pdf",
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.946211647015084",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110001-01","KP Platinum $10 - Fit","Standard Platinum On Exchange Plan","90.24%","0.907163083553314","Yes","Yes","No","100%",,"$0","$300","$0","$200","$0","$500","$700","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Platinum_10_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.946211647015084",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110001-02","KP Platinum $10 - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Platinum_10_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.946211647015084",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110001-03","KP Platinum $10 - Fit - AI/LTD","Limited Cost Sharing Plan Variation","90.24%","0.907163083553314","Yes","Yes","No","100%",,"$0","$300","$0","$200","$0","$500","$700","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Platinum_10_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.958104143490724",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110002-01","KP Gold I $20 - Fit","Standard Gold On Exchange Plan",,"0.813658237457275","Yes","Yes","No","100%",,"$0","$20","$300","$200","$0","$600","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_I_20_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.958104143490724",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110002-02","KP Gold I $20 - Fit - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_I_20_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.958104143490724",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110002-03","KP Gold I $20 - Fit - AI/LTD","Limited Cost Sharing Plan Variation",,"0.813658237457275","Yes","Yes","No","100%",,"$0","$20","$300","$200","$0","$600","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_I_20_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.956555905347859",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110011-01","KP Gold III $20 - Fit","Standard Gold On Exchange Plan","78.01%","0.781323552131653","No","Yes","No","100%",,"$1,900","$500","$0","$200","$0","$1,000","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$250","$250 per person","$500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_III_20_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.956555905347859",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110011-02","KP Gold III $20 - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_III_20_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.956555905347859",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110011-03","KP Gold III $20 - Fit - AI/LTD","Limited Cost Sharing Plan Variation","78.01%","0.781323552131653","No","Yes","No","100%",,"$1,900","$500","$0","$200","$0","$1,000","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$250","$250 per person","$500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_III_20_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.946520148138804",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110005-01","KP Bronze I $50 - Fit","Standard Bronze On Exchange Plan","61.87%","0.644445598125458","No","Yes","No","100%",,"$6,600","$30","$0","$200","$0","$1,900","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_I_50_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.946520148138804",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110005-02","KP Bronze I $50 - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_I_50_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.946520148138804",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110005-03","KP Bronze I $50 - Fit - AI/LTD","Limited Cost Sharing Plan Variation","61.87%","0.644445598125458","No","Yes","No","100%",,"$6,600","$30","$0","$200","$0","$1,900","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_I_50_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954113799250758",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-01","KP Silver II $30 - Fit","Standard Silver On Exchange Plan","70.68%","0.716527044773102","No","Yes","No","100%",,"$2,400","$30","$800","$200","$0","$1,100","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$250","$250 per person","$500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_30_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954113799250758",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-02","KP Silver II $30 - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_30_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954113799250758",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-03","KP Silver II $30 - Fit - AI/LTD","Limited Cost Sharing Plan Variation","70.68%","0.716527044773102","No","Yes","No","100%",,"$2,400","$30","$800","$200","$0","$1,100","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$250","$250 per person","$500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_30_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954113799250758",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-04","KP Silver II $20 - Fit CSR 73","73% AV Level Silver Plan","73.57%","0.745053470134735","No","Yes","No","100%",,"$2,400","$30","$800","$200","$0","$1,000","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$250","$250 per person","$500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_20_Fit_CSR_73.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954113799250758",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-05","KP Silver II $15 - Fit CSR 87","87% AV Level Silver Plan","87.90%","0.884040534496307","No","Yes","No","100%",,"$0","$20","$200","$200","$0","$600","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_15_Fit_CSR_87.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954113799250758",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-06","KP Silver II $5 - Fit CSR 94","94% AV Level Silver Plan","94.00%","0.944479525089264","No","Yes","No","100%",,"$0","$20","$90","$200","$0","$300","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_5_Fit_CSR_94.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952242393853228",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-01","KP Silver III $30 - Fit","Standard Silver On Exchange Plan","69.21%","0.696921706199646","No","Yes","No","100%",,"$3,400","$30","$600","$200","$0","$1,100","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_III_30_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952242393853228",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-02","KP Silver III $30 Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_III_30_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952242393853228",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-03","KP Silver III $30 Fit - AI/LTD","Limited Cost Sharing Plan Variation","69.21%","0.696921706199646","No","Yes","No","100%",,"$3,400","$30","$600","$200","$0","$1,100","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_III_30_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952242393853228",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-05","KP Silver III $5 Fit CSR 87","87% AV Level Silver Plan","87.85%","0.88681972026825","No","Yes","No","100%",,"$0","$30","$90","$200","$0","$700","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_III_5_Fit_CSR_87.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952242393853228",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-06","KP Silver III $5 Fit CSR 94","94% AV Level Silver Plan","94.65%","0.952633321285248","No","Yes","No","100%",,"$0","$20","$90","$200","$0","$500","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_III_5_Fit_CSR_94.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110015","KP Bronze II 30% - Fit","60612HI011",,"HIN001","HIS001","HIF006","New","HMO","Bronze","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.942104265560098",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110015-01","KP Bronze II 30% - Fit","Standard Bronze On Exchange Plan",,"0.616105139255524","Yes","Yes","No","100%",,"$6,400","$0","$300","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_II_30_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110015","KP Bronze II 30% - Fit","60612HI011",,"HIN001","HIS001","HIF006","New","HMO","Bronze","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.942104265560098",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110015-02","KP Bronze II 30% - Fit - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_II_30_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110015","KP Bronze II 30% - Fit","60612HI011",,"HIN001","HIS001","HIF006","New","HMO","Bronze","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.942104265560098",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110015-03","KP Bronze II 30% - Fit - AI/LTD","Limited Cost Sharing Plan Variation",,"0.616105139255524","Yes","Yes","No","100%",,"$6,400","$0","$300","$200","$2,400","$0","$900","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_II_30_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400022","Aetna Leap Basic POS","18973IA040",,"IAN001","IAS001","IAF022","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400022-00","Aetna Leap Basic POS","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723048_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.936255655825206",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110006-01","KP Platinum $10 - ChiroAcuMassage - Fit","Standard Platinum On Exchange Plan","90.24%","0.907163083553314","Yes","Yes","No","100%",,"$0","$300","$0","$200","$0","$500","$700","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Platinum_10_ChiroAcuMassage_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.936255655825206",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110006-02","KP Platinum $10 - ChiroAcuMassage - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Platinum_10_ChiroAcuMassage_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.936255655825206",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110006-03","KP Platinum $10 - ChiroAcuMassage - Fit - AI/LTD","Limited Cost Sharing Plan Variation","90.24%","0.907163083553314","Yes","Yes","No","100%",,"$0","$300","$0","$200","$0","$500","$700","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Platinum_10_ChiroAcuMassage_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.947035016423461",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110007-01","KP Gold I $20 - ChiroAcuMassage - Fit","Standard Gold On Exchange Plan",,"0.813658237457275","Yes","Yes","No","100%",,"$0","$20","$300","$200","$0","$600","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_I_20_ChiroAcuMassage_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.947035016423461",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110007-02","KP Gold I $20 - ChiroAcuMassage - Fit - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_I_20_ChiroAcuMassage_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.947035016423461",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110007-03","KP Gold I $20 - ChiroAcuMassage - Fit - AI/LTD","Limited Cost Sharing Plan Variation",,"0.813658237457275","Yes","Yes","No","100%",,"$0","$20","$300","$200","$0","$600","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Gold_I_20_ChiroAcuMassage_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.930092467105389",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110010-01","KP Bronze I $50 - ChiroAcuMassage - Fit","Standard Bronze On Exchange Plan","61.87%","0.644445598125458","No","Yes","No","100%",,"$6,600","$30","$0","$200","$0","$1,900","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_I_50_ChiroAcuMassage_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.930092467105389",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110010-02","KP Bronze I $50 - ChiroAcuMassage - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_I_50_ChiroAcuMassage_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.930092467105389",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110010-03","KP Bronze I $50 - ChiroAcuMassage - Fit - AI/LTD","Limited Cost Sharing Plan Variation","61.87%","0.644445598125458","No","Yes","No","100%",,"$6,600","$30","$0","$200","$0","$1,900","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Bronze_I_50_ChiroAcuMassage_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.941198617270903",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-01","KP Silver II $30 - ChiroAcuMassage - Fit","Standard Silver On Exchange Plan","70.68%","0.716527044773102","No","Yes","No","100%",,"$2,400","$30","$800","$200","$0","$1,100","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$250","$250 per person","$500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_30_ChiroAcuMassage_Fit.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.941198617270903",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-02","KP Silver II $30 - ChiroAcuMassage - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_30_ChiroAcuMassage_Fit_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.941198617270903",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-03","KP Silver II $30 - ChiroAcuMassage - Fit - AI/LTD","Limited Cost Sharing Plan Variation","70.68%","0.716527044773102","No","Yes","No","100%",,"$2,400","$30","$800","$200","$0","$1,100","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$250","$250 per person","$500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_30_ChiroAcuMassage_Fit_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400001","Aetna Leap Basic Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF001","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400001-01","Aetna Leap Basic Mercy Medical Center","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723092_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400001","Aetna Leap Basic Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF001","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400001-02","Aetna Leap Basic Mercy Medical Center","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723092_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400001","Aetna Leap Basic Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF001","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400001-03","Aetna Leap Basic Mercy Medical Center","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723092_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400008","Aetna Leap Basic MIPPA","18973IA040",,"IAN002","IAS002","IAF008","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400008-00","Aetna Leap Basic MIPPA","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722512_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400008","Aetna Leap Basic MIPPA","18973IA040",,"IAN002","IAS002","IAF008","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400008-01","Aetna Leap Basic MIPPA","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722512_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400008","Aetna Leap Basic MIPPA","18973IA040",,"IAN002","IAS002","IAF008","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400008-02","Aetna Leap Basic MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722512_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400008","Aetna Leap Basic MIPPA","18973IA040",,"IAN002","IAS002","IAF008","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400008-03","Aetna Leap Basic MIPPA","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722512_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.941198617270903",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-04","KP Silver II $20 - ChiroAcuMassage - Fit CSR 73","73% AV Level Silver Plan","73.57%","0.745053470134735","No","Yes","No","100%",,"$2,400","$30","$800","$200","$0","$1,000","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$250","$250 per person","$500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_20_ChiroAcuMassage_Fit_CSR_73.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.941198617270903",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-05","KP Silver II $15 - ChiroAcuMassage - Fit CSR 87","87% AV Level Silver Plan","87.90%","0.884040534496307","No","Yes","No","100%",,"$0","$20","$200","$200","$0","$600","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_15_ChiroAcuMassage_Fit_CSR_87.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","HI","60612","SERFF","2017-01-24 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.941198617270903",,,"2017-01-01",,"No",,"Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://www.kp.org/paypremium","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-06","KP Silver II $5 - ChiroAcuMassage - Fit CSR 94","94% AV Level Silver Plan","94.00%","0.944479525089264","No","Yes","No","100%",,"$0","$20","$90","$200","$0","$300","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2017-ON-Exchange/KP_Silver_II_5_ChiroAcuMassage_Fit_CSR_94.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/hi2017planbrochure.pdf"
"2017","IA","11738","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-3757528","11738IA0030001","TruAssure Dental Small Group Basic Plan","11738IA003",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","11738","SERFF","2016-08-25 03:47:19","Individual","Yes","36-3757528","11738IA0010001","TruAssure Basic Adult or Child Dental Plan","11738IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA"
"2017","IA","11738","SERFF","2016-08-25 03:47:19","Individual","Yes","36-3757528","11738IA0010001","TruAssure Basic Adult or Child Dental Plan","11738IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA"
"2017","IA","11738","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-3757528","11738IA0040001","TruAssure Dental Small Group Preferred Plan","11738IA004",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","11738","SERFF","2016-08-25 03:47:19","Individual","Yes","36-3757528","11738IA0020001","TruAssure Preferred Adult or Child Dental Plan","11738IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA"
"2017","IA","11738","SERFF","2016-08-25 03:47:19","Individual","Yes","36-3757528","11738IA0020001","TruAssure Preferred Adult or Child Dental Plan","11738IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400001","Aetna Leap Basic Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF001","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400001-00","Aetna Leap Basic Mercy Medical Center","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723092_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400015","Aetna Leap Basic Patient Preferred","18973IA040",,"IAN003","IAS003","IAF015","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400015-00","Aetna Leap Basic Patient Preferred","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723178_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400015","Aetna Leap Basic Patient Preferred","18973IA040",,"IAN003","IAS003","IAF015","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400015-01","Aetna Leap Basic Patient Preferred","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723178_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400015","Aetna Leap Basic Patient Preferred","18973IA040",,"IAN003","IAS003","IAF015","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400015-02","Aetna Leap Basic Patient Preferred","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723178_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400015","Aetna Leap Basic Patient Preferred","18973IA040",,"IAN003","IAS003","IAF015","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400015-03","Aetna Leap Basic Patient Preferred","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723178_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400022","Aetna Leap Basic POS","18973IA040",,"IAN001","IAS001","IAF022","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400022-01","Aetna Leap Basic POS","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723048_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400022","Aetna Leap Basic POS","18973IA040",,"IAN001","IAS001","IAF022","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400022-02","Aetna Leap Basic POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723048_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400022","Aetna Leap Basic POS","18973IA040",,"IAN001","IAS001","IAF022","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400022-03","Aetna Leap Basic POS","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723048_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400029","Aetna Leap Basic UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF029","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400029-00","Aetna Leap Basic UnityPoint Health Cedar Rapids","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723252_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400029","Aetna Leap Basic UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF029","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400029-01","Aetna Leap Basic UnityPoint Health Cedar Rapids","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723252_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400029","Aetna Leap Basic UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF029","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400029-02","Aetna Leap Basic UnityPoint Health Cedar Rapids","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723252_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400029","Aetna Leap Basic UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF029","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400029-03","Aetna Leap Basic UnityPoint Health Cedar Rapids","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723252_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400004","Aetna Leap Diabetes Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400004-00","Aetna Leap Diabetes Mercy Medical Center","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723081_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400004","Aetna Leap Diabetes Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400004-01","Aetna Leap Diabetes Mercy Medical Center","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723081_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400004","Aetna Leap Diabetes Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400004-02","Aetna Leap Diabetes Mercy Medical Center","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723081_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400004","Aetna Leap Diabetes Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400004-03","Aetna Leap Diabetes Mercy Medical Center","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723081_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400004","Aetna Leap Diabetes Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400004-04","Aetna Leap Diabetes Mercy Medical Center","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723081_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400004","Aetna Leap Diabetes Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400004-05","Aetna Leap Diabetes Mercy Medical Center","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723081_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400004","Aetna Leap Diabetes Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF004","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400004-06","Aetna Leap Diabetes Mercy Medical Center","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723081_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400011","Aetna Leap Diabetes MIPPA","18973IA040",,"IAN002","IAS002","IAF011","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400011-00","Aetna Leap Diabetes MIPPA","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722501_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400011","Aetna Leap Diabetes MIPPA","18973IA040",,"IAN002","IAS002","IAF011","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400011-01","Aetna Leap Diabetes MIPPA","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722501_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400011","Aetna Leap Diabetes MIPPA","18973IA040",,"IAN002","IAS002","IAF011","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400011-02","Aetna Leap Diabetes MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722501_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400011","Aetna Leap Diabetes MIPPA","18973IA040",,"IAN002","IAS002","IAF011","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400011-03","Aetna Leap Diabetes MIPPA","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722501_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400011","Aetna Leap Diabetes MIPPA","18973IA040",,"IAN002","IAS002","IAF011","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400011-04","Aetna Leap Diabetes MIPPA","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722501_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400011","Aetna Leap Diabetes MIPPA","18973IA040",,"IAN002","IAS002","IAF011","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400011-05","Aetna Leap Diabetes MIPPA","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722501_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400011","Aetna Leap Diabetes MIPPA","18973IA040",,"IAN002","IAS002","IAF011","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400011-06","Aetna Leap Diabetes MIPPA","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722501_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400018","Aetna Leap Diabetes Patient Preferred","18973IA040",,"IAN003","IAS003","IAF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400018-00","Aetna Leap Diabetes Patient Preferred","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723161_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400018","Aetna Leap Diabetes Patient Preferred","18973IA040",,"IAN003","IAS003","IAF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400018-01","Aetna Leap Diabetes Patient Preferred","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723161_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400018","Aetna Leap Diabetes Patient Preferred","18973IA040",,"IAN003","IAS003","IAF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400018-02","Aetna Leap Diabetes Patient Preferred","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723161_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400018","Aetna Leap Diabetes Patient Preferred","18973IA040",,"IAN003","IAS003","IAF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400018-03","Aetna Leap Diabetes Patient Preferred","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723161_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400018","Aetna Leap Diabetes Patient Preferred","18973IA040",,"IAN003","IAS003","IAF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400018-04","Aetna Leap Diabetes Patient Preferred","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723161_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400018","Aetna Leap Diabetes Patient Preferred","18973IA040",,"IAN003","IAS003","IAF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400018-05","Aetna Leap Diabetes Patient Preferred","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723161_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400018","Aetna Leap Diabetes Patient Preferred","18973IA040",,"IAN003","IAS003","IAF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400018-06","Aetna Leap Diabetes Patient Preferred","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723161_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400025","Aetna Leap Diabetes POS","18973IA040",,"IAN001","IAS001","IAF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400025-00","Aetna Leap Diabetes POS","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723035_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400025","Aetna Leap Diabetes POS","18973IA040",,"IAN001","IAS001","IAF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400025-01","Aetna Leap Diabetes POS","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723035_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400025","Aetna Leap Diabetes POS","18973IA040",,"IAN001","IAS001","IAF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400025-02","Aetna Leap Diabetes POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723035_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400025","Aetna Leap Diabetes POS","18973IA040",,"IAN001","IAS001","IAF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400025-03","Aetna Leap Diabetes POS","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723035_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400025","Aetna Leap Diabetes POS","18973IA040",,"IAN001","IAS001","IAF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400025-04","Aetna Leap Diabetes POS","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723035_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400025","Aetna Leap Diabetes POS","18973IA040",,"IAN001","IAS001","IAF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400025-05","Aetna Leap Diabetes POS","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723035_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400025","Aetna Leap Diabetes POS","18973IA040",,"IAN001","IAS001","IAF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400025-06","Aetna Leap Diabetes POS","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723035_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400005","Aetna Leap Everyday Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF005","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400005-00","Aetna Leap Everyday Mercy Medical Center","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723056_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400005","Aetna Leap Everyday Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF005","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400005-01","Aetna Leap Everyday Mercy Medical Center","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723056_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400005","Aetna Leap Everyday Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF005","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400005-02","Aetna Leap Everyday Mercy Medical Center","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723056_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400005","Aetna Leap Everyday Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF005","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400005-03","Aetna Leap Everyday Mercy Medical Center","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723056_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400005","Aetna Leap Everyday Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF005","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400005-04","Aetna Leap Everyday Mercy Medical Center","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723056_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400005","Aetna Leap Everyday Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF005","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400005-05","Aetna Leap Everyday Mercy Medical Center","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723056_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400005","Aetna Leap Everyday Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF005","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400005-06","Aetna Leap Everyday Mercy Medical Center","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723056_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400012","Aetna Leap Everyday MIPPA","18973IA040",,"IAN002","IAS002","IAF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400012-00","Aetna Leap Everyday MIPPA","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722480_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400012","Aetna Leap Everyday MIPPA","18973IA040",,"IAN002","IAS002","IAF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400012-01","Aetna Leap Everyday MIPPA","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722480_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400012","Aetna Leap Everyday MIPPA","18973IA040",,"IAN002","IAS002","IAF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400012-02","Aetna Leap Everyday MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722480_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400012","Aetna Leap Everyday MIPPA","18973IA040",,"IAN002","IAS002","IAF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400012-03","Aetna Leap Everyday MIPPA","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722480_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400012","Aetna Leap Everyday MIPPA","18973IA040",,"IAN002","IAS002","IAF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400012-04","Aetna Leap Everyday MIPPA","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722480_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400012","Aetna Leap Everyday MIPPA","18973IA040",,"IAN002","IAS002","IAF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400012-05","Aetna Leap Everyday MIPPA","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722480_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400012","Aetna Leap Everyday MIPPA","18973IA040",,"IAN002","IAS002","IAF012","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400012-06","Aetna Leap Everyday MIPPA","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722480_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400019","Aetna Leap Everyday Patient Preferred","18973IA040",,"IAN003","IAS003","IAF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400019-00","Aetna Leap Everyday Patient Preferred","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723140_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400019","Aetna Leap Everyday Patient Preferred","18973IA040",,"IAN003","IAS003","IAF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400019-01","Aetna Leap Everyday Patient Preferred","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723140_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400019","Aetna Leap Everyday Patient Preferred","18973IA040",,"IAN003","IAS003","IAF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400019-02","Aetna Leap Everyday Patient Preferred","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723140_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400019","Aetna Leap Everyday Patient Preferred","18973IA040",,"IAN003","IAS003","IAF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400019-03","Aetna Leap Everyday Patient Preferred","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723140_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400019","Aetna Leap Everyday Patient Preferred","18973IA040",,"IAN003","IAS003","IAF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400019-04","Aetna Leap Everyday Patient Preferred","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723140_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400019","Aetna Leap Everyday Patient Preferred","18973IA040",,"IAN003","IAS003","IAF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400019-05","Aetna Leap Everyday Patient Preferred","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723140_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400019","Aetna Leap Everyday Patient Preferred","18973IA040",,"IAN003","IAS003","IAF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400019-06","Aetna Leap Everyday Patient Preferred","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723140_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400006","Aetna Leap Everyday Plus Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF006","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400006-00","Aetna Leap Everyday Plus Mercy Medical Center","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723065_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400006","Aetna Leap Everyday Plus Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF006","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400006-01","Aetna Leap Everyday Plus Mercy Medical Center","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723065_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400006","Aetna Leap Everyday Plus Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF006","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400006-02","Aetna Leap Everyday Plus Mercy Medical Center","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723065_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400006","Aetna Leap Everyday Plus Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF006","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400006-03","Aetna Leap Everyday Plus Mercy Medical Center","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723065_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400006","Aetna Leap Everyday Plus Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF006","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400006-04","Aetna Leap Everyday Plus Mercy Medical Center","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723065_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400006","Aetna Leap Everyday Plus Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF006","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400006-05","Aetna Leap Everyday Plus Mercy Medical Center","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723065_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400006","Aetna Leap Everyday Plus Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF006","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400006-06","Aetna Leap Everyday Plus Mercy Medical Center","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723065_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400013","Aetna Leap Everyday Plus MIPPA","18973IA040",,"IAN002","IAS002","IAF013","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400013-00","Aetna Leap Everyday Plus MIPPA","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722487_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400013","Aetna Leap Everyday Plus MIPPA","18973IA040",,"IAN002","IAS002","IAF013","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400013-01","Aetna Leap Everyday Plus MIPPA","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722487_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400013","Aetna Leap Everyday Plus MIPPA","18973IA040",,"IAN002","IAS002","IAF013","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400013-02","Aetna Leap Everyday Plus MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722487_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400013","Aetna Leap Everyday Plus MIPPA","18973IA040",,"IAN002","IAS002","IAF013","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400013-03","Aetna Leap Everyday Plus MIPPA","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722487_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400013","Aetna Leap Everyday Plus MIPPA","18973IA040",,"IAN002","IAS002","IAF013","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400013-04","Aetna Leap Everyday Plus MIPPA","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722487_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400013","Aetna Leap Everyday Plus MIPPA","18973IA040",,"IAN002","IAS002","IAF013","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400013-05","Aetna Leap Everyday Plus MIPPA","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722487_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400013","Aetna Leap Everyday Plus MIPPA","18973IA040",,"IAN002","IAS002","IAF013","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400013-06","Aetna Leap Everyday Plus MIPPA","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722487_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400020","Aetna Leap Everyday Plus Patient Preferred","18973IA040",,"IAN003","IAS003","IAF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400020-00","Aetna Leap Everyday Plus Patient Preferred","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723147_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400020","Aetna Leap Everyday Plus Patient Preferred","18973IA040",,"IAN003","IAS003","IAF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400020-01","Aetna Leap Everyday Plus Patient Preferred","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723147_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400020","Aetna Leap Everyday Plus Patient Preferred","18973IA040",,"IAN003","IAS003","IAF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400020-02","Aetna Leap Everyday Plus Patient Preferred","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723147_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400020","Aetna Leap Everyday Plus Patient Preferred","18973IA040",,"IAN003","IAS003","IAF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400020-03","Aetna Leap Everyday Plus Patient Preferred","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723147_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400020","Aetna Leap Everyday Plus Patient Preferred","18973IA040",,"IAN003","IAS003","IAF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400020-04","Aetna Leap Everyday Plus Patient Preferred","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723147_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400020","Aetna Leap Everyday Plus Patient Preferred","18973IA040",,"IAN003","IAS003","IAF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400020-05","Aetna Leap Everyday Plus Patient Preferred","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723147_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400020","Aetna Leap Everyday Plus Patient Preferred","18973IA040",,"IAN003","IAS003","IAF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400020-06","Aetna Leap Everyday Plus Patient Preferred","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723147_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400027","Aetna Leap Everyday Plus POS","18973IA040",,"IAN001","IAS001","IAF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400027-00","Aetna Leap Everyday Plus POS","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723015_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400027","Aetna Leap Everyday Plus POS","18973IA040",,"IAN001","IAS001","IAF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400027-01","Aetna Leap Everyday Plus POS","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723015_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400027","Aetna Leap Everyday Plus POS","18973IA040",,"IAN001","IAS001","IAF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400027-02","Aetna Leap Everyday Plus POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723015_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400027","Aetna Leap Everyday Plus POS","18973IA040",,"IAN001","IAS001","IAF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400027-03","Aetna Leap Everyday Plus POS","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723015_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400027","Aetna Leap Everyday Plus POS","18973IA040",,"IAN001","IAS001","IAF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400027-04","Aetna Leap Everyday Plus POS","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723015_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400027","Aetna Leap Everyday Plus POS","18973IA040",,"IAN001","IAS001","IAF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400027-05","Aetna Leap Everyday Plus POS","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723015_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400027","Aetna Leap Everyday Plus POS","18973IA040",,"IAN001","IAS001","IAF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400027-06","Aetna Leap Everyday Plus POS","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723015_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400026","Aetna Leap Everyday POS","18973IA040",,"IAN001","IAS001","IAF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400026-00","Aetna Leap Everyday POS","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723001_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400026","Aetna Leap Everyday POS","18973IA040",,"IAN001","IAS001","IAF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400026-01","Aetna Leap Everyday POS","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723001_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400026","Aetna Leap Everyday POS","18973IA040",,"IAN001","IAS001","IAF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400026-02","Aetna Leap Everyday POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723001_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400026","Aetna Leap Everyday POS","18973IA040",,"IAN001","IAS001","IAF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400026-03","Aetna Leap Everyday POS","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723001_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400026","Aetna Leap Everyday POS","18973IA040",,"IAN001","IAS001","IAF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400026-04","Aetna Leap Everyday POS","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723001_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400026","Aetna Leap Everyday POS","18973IA040",,"IAN001","IAS001","IAF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400026-05","Aetna Leap Everyday POS","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723001_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400026","Aetna Leap Everyday POS","18973IA040",,"IAN001","IAS001","IAF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400026-06","Aetna Leap Everyday POS","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723001_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400007","Aetna Leap Healthy Minds Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF007","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400007-00","Aetna Leap Healthy Minds Mercy Medical Center","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723072_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400007","Aetna Leap Healthy Minds Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF007","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400007-01","Aetna Leap Healthy Minds Mercy Medical Center","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723072_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400007","Aetna Leap Healthy Minds Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF007","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400007-02","Aetna Leap Healthy Minds Mercy Medical Center","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723072_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400007","Aetna Leap Healthy Minds Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF007","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400007-03","Aetna Leap Healthy Minds Mercy Medical Center","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723072_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400007","Aetna Leap Healthy Minds Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF007","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400007-04","Aetna Leap Healthy Minds Mercy Medical Center","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723072_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400007","Aetna Leap Healthy Minds Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF007","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400007-05","Aetna Leap Healthy Minds Mercy Medical Center","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723072_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400007","Aetna Leap Healthy Minds Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF007","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400007-06","Aetna Leap Healthy Minds Mercy Medical Center","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723072_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400014","Aetna Leap Healthy Minds MIPPA","18973IA040",,"IAN002","IAS002","IAF014","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400014-00","Aetna Leap Healthy Minds MIPPA","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722494_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400014","Aetna Leap Healthy Minds MIPPA","18973IA040",,"IAN002","IAS002","IAF014","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400014-01","Aetna Leap Healthy Minds MIPPA","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722494_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400014","Aetna Leap Healthy Minds MIPPA","18973IA040",,"IAN002","IAS002","IAF014","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400014-02","Aetna Leap Healthy Minds MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722494_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400014","Aetna Leap Healthy Minds MIPPA","18973IA040",,"IAN002","IAS002","IAF014","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400014-03","Aetna Leap Healthy Minds MIPPA","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722494_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400014","Aetna Leap Healthy Minds MIPPA","18973IA040",,"IAN002","IAS002","IAF014","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400014-04","Aetna Leap Healthy Minds MIPPA","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722494_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400014","Aetna Leap Healthy Minds MIPPA","18973IA040",,"IAN002","IAS002","IAF014","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400014-05","Aetna Leap Healthy Minds MIPPA","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722494_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400014","Aetna Leap Healthy Minds MIPPA","18973IA040",,"IAN002","IAS002","IAF014","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400014-06","Aetna Leap Healthy Minds MIPPA","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722494_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400021","Aetna Leap Healthy Minds Patient Preferred","18973IA040",,"IAN003","IAS003","IAF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400021-00","Aetna Leap Healthy Minds Patient Preferred","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723154_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400021","Aetna Leap Healthy Minds Patient Preferred","18973IA040",,"IAN003","IAS003","IAF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400021-01","Aetna Leap Healthy Minds Patient Preferred","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723154_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400021","Aetna Leap Healthy Minds Patient Preferred","18973IA040",,"IAN003","IAS003","IAF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400021-02","Aetna Leap Healthy Minds Patient Preferred","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723154_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400021","Aetna Leap Healthy Minds Patient Preferred","18973IA040",,"IAN003","IAS003","IAF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400021-03","Aetna Leap Healthy Minds Patient Preferred","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723154_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400021","Aetna Leap Healthy Minds Patient Preferred","18973IA040",,"IAN003","IAS003","IAF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400021-04","Aetna Leap Healthy Minds Patient Preferred","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723154_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400021","Aetna Leap Healthy Minds Patient Preferred","18973IA040",,"IAN003","IAS003","IAF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400021-05","Aetna Leap Healthy Minds Patient Preferred","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723154_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400021","Aetna Leap Healthy Minds Patient Preferred","18973IA040",,"IAN003","IAS003","IAF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400021-06","Aetna Leap Healthy Minds Patient Preferred","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723154_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400028","Aetna Leap Healthy Minds POS","18973IA040",,"IAN001","IAS001","IAF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400028-00","Aetna Leap Healthy Minds POS","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723026_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400028","Aetna Leap Healthy Minds POS","18973IA040",,"IAN001","IAS001","IAF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400028-01","Aetna Leap Healthy Minds POS","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723026_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400028","Aetna Leap Healthy Minds POS","18973IA040",,"IAN001","IAS001","IAF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400028-02","Aetna Leap Healthy Minds POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723026_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400028","Aetna Leap Healthy Minds POS","18973IA040",,"IAN001","IAS001","IAF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400028-03","Aetna Leap Healthy Minds POS","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723026_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400028","Aetna Leap Healthy Minds POS","18973IA040",,"IAN001","IAS001","IAF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400028-04","Aetna Leap Healthy Minds POS","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723026_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400028","Aetna Leap Healthy Minds POS","18973IA040",,"IAN001","IAS001","IAF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400028-05","Aetna Leap Healthy Minds POS","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723026_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400028","Aetna Leap Healthy Minds POS","18973IA040",,"IAN001","IAS001","IAF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400028-06","Aetna Leap Healthy Minds POS","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723026_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400010","Aetna Leap Diabetes Gold MIPPA","18973IA040",,"IAN002","IAS002","IAF010","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400010-00","Aetna Leap Diabetes Gold MIPPA","Standard Gold Off Exchange Plan","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722508_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400010","Aetna Leap Diabetes Gold MIPPA","18973IA040",,"IAN002","IAS002","IAF010","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400010-01","Aetna Leap Diabetes Gold MIPPA","Standard Gold On Exchange Plan","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722508_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400010","Aetna Leap Diabetes Gold MIPPA","18973IA040",,"IAN002","IAS002","IAF010","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400010-02","Aetna Leap Diabetes Gold MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722508_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400010","Aetna Leap Diabetes Gold MIPPA","18973IA040",,"IAN002","IAS002","IAF010","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400010-03","Aetna Leap Diabetes Gold MIPPA","Limited Cost Sharing Plan Variation","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722508_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420001","Aetna Leap Basic CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF057","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420001-00","Aetna Leap Basic CHI Health Omaha","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723554_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420001","Aetna Leap Basic CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF057","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420001-01","Aetna Leap Basic CHI Health Omaha","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723554_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420001","Aetna Leap Basic CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF057","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420001-02","Aetna Leap Basic CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723554_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420001","Aetna Leap Basic CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF057","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420001-03","Aetna Leap Basic CHI Health Omaha","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723554_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400036","Aetna Leap Basic UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF036","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400036-00","Aetna Leap Basic UnityPoint Health Des Moines","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723134_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400036","Aetna Leap Basic UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF036","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400036-01","Aetna Leap Basic UnityPoint Health Des Moines","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723134_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400036","Aetna Leap Basic UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF036","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400036-02","Aetna Leap Basic UnityPoint Health Des Moines","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723134_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400036","Aetna Leap Basic UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF036","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400036-03","Aetna Leap Basic UnityPoint Health Des Moines","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723134_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400043","Aetna Leap Basic UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF043","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400043-00","Aetna Leap Basic UnityPoint Health Quad Cities","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723313_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400043","Aetna Leap Basic UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF043","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400043-01","Aetna Leap Basic UnityPoint Health Quad Cities","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723313_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400043","Aetna Leap Basic UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF043","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400043-02","Aetna Leap Basic UnityPoint Health Quad Cities","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723313_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400043","Aetna Leap Basic UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF043","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400043-03","Aetna Leap Basic UnityPoint Health Quad Cities","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723313_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400050","Aetna Leap Basic UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF050","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400050-00","Aetna Leap Basic UnityPoint Health Waterloo","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723355_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400050","Aetna Leap Basic UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF050","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400050-01","Aetna Leap Basic UnityPoint Health Waterloo","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723355_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400050","Aetna Leap Basic UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF050","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400050-02","Aetna Leap Basic UnityPoint Health Waterloo","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723355_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400050","Aetna Leap Basic UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF050","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400050-03","Aetna Leap Basic UnityPoint Health Waterloo","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723355_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400032","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF032","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400032-00","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723218_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400032","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF032","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400032-01","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723218_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400032","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF032","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400032-02","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723218_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400032","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF032","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400032-03","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723218_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400032","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF032","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400032-04","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723218_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400032","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF032","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400032-05","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723218_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400032","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF032","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400032-06","Aetna Leap Diabetes UnityPoint Health Cedar Rapids","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723218_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400039","Aetna Leap Diabetes UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF039","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400039-00","Aetna Leap Diabetes UnityPoint Health Des Moines","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723123_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400039","Aetna Leap Diabetes UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF039","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400039-01","Aetna Leap Diabetes UnityPoint Health Des Moines","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723123_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400039","Aetna Leap Diabetes UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF039","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400039-02","Aetna Leap Diabetes UnityPoint Health Des Moines","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723123_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400039","Aetna Leap Diabetes UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF039","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400039-03","Aetna Leap Diabetes UnityPoint Health Des Moines","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723123_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400039","Aetna Leap Diabetes UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF039","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400039-04","Aetna Leap Diabetes UnityPoint Health Des Moines","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723123_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400039","Aetna Leap Diabetes UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF039","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400039-05","Aetna Leap Diabetes UnityPoint Health Des Moines","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723123_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400039","Aetna Leap Diabetes UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF039","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400039-06","Aetna Leap Diabetes UnityPoint Health Des Moines","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723123_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400046","Aetna Leap Diabetes UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF046","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400046-00","Aetna Leap Diabetes UnityPoint Health Quad Cities","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723297_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400046","Aetna Leap Diabetes UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF046","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400046-01","Aetna Leap Diabetes UnityPoint Health Quad Cities","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723297_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400046","Aetna Leap Diabetes UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF046","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400046-02","Aetna Leap Diabetes UnityPoint Health Quad Cities","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723297_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400046","Aetna Leap Diabetes UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF046","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400046-03","Aetna Leap Diabetes UnityPoint Health Quad Cities","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723297_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400046","Aetna Leap Diabetes UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF046","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400046-04","Aetna Leap Diabetes UnityPoint Health Quad Cities","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723297_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400046","Aetna Leap Diabetes UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF046","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400046-05","Aetna Leap Diabetes UnityPoint Health Quad Cities","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723297_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400046","Aetna Leap Diabetes UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF046","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400046-06","Aetna Leap Diabetes UnityPoint Health Quad Cities","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723297_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400053","Aetna Leap Diabetes UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF053","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400053-00","Aetna Leap Diabetes UnityPoint Health Waterloo","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723343_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400053","Aetna Leap Diabetes UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF053","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400053-01","Aetna Leap Diabetes UnityPoint Health Waterloo","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723343_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400053","Aetna Leap Diabetes UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF053","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400053-02","Aetna Leap Diabetes UnityPoint Health Waterloo","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723343_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400053","Aetna Leap Diabetes UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF053","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400053-03","Aetna Leap Diabetes UnityPoint Health Waterloo","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723343_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400053","Aetna Leap Diabetes UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF053","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400053-04","Aetna Leap Diabetes UnityPoint Health Waterloo","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723343_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400053","Aetna Leap Diabetes UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF053","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400053-05","Aetna Leap Diabetes UnityPoint Health Waterloo","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723343_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400053","Aetna Leap Diabetes UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF053","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400053-06","Aetna Leap Diabetes UnityPoint Health Waterloo","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723343_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400034","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF034","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400034-00","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723197_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400034","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF034","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400034-01","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723197_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400034","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF034","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400034-02","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723197_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400034","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF034","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400034-03","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723197_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400034","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF034","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400034-04","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723197_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400034","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF034","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400034-05","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723197_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400034","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF034","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400034-06","Aetna Leap Everyday Plus UnityPoint Health Cedar Rapids","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723197_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400041","Aetna Leap Everyday Plus UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF041","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400041-00","Aetna Leap Everyday Plus UnityPoint Health Des Moines","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723109_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400041","Aetna Leap Everyday Plus UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF041","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400041-01","Aetna Leap Everyday Plus UnityPoint Health Des Moines","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723109_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400041","Aetna Leap Everyday Plus UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF041","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400041-02","Aetna Leap Everyday Plus UnityPoint Health Des Moines","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723109_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400041","Aetna Leap Everyday Plus UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF041","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400041-03","Aetna Leap Everyday Plus UnityPoint Health Des Moines","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723109_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400041","Aetna Leap Everyday Plus UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF041","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400041-04","Aetna Leap Everyday Plus UnityPoint Health Des Moines","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723109_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400041","Aetna Leap Everyday Plus UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF041","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400041-05","Aetna Leap Everyday Plus UnityPoint Health Des Moines","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723109_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400041","Aetna Leap Everyday Plus UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF041","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400041-06","Aetna Leap Everyday Plus UnityPoint Health Des Moines","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723109_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400048","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF048","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400048-00","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723274_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400048","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF048","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400048-01","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723274_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400048","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF048","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400048-02","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723274_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400048","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF048","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400048-03","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723274_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400048","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF048","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400048-04","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723274_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400048","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF048","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400048-05","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723274_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400048","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF048","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400048-06","Aetna Leap Everyday Plus UnityPoint Health Quad Cities","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723274_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400055","Aetna Leap Everyday Plus UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF055","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400055-00","Aetna Leap Everyday Plus UnityPoint Health Waterloo","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723329_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400055","Aetna Leap Everyday Plus UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF055","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400055-01","Aetna Leap Everyday Plus UnityPoint Health Waterloo","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723329_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400055","Aetna Leap Everyday Plus UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF055","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400055-02","Aetna Leap Everyday Plus UnityPoint Health Waterloo","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723329_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400055","Aetna Leap Everyday Plus UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF055","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400055-03","Aetna Leap Everyday Plus UnityPoint Health Waterloo","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723329_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400055","Aetna Leap Everyday Plus UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF055","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400055-04","Aetna Leap Everyday Plus UnityPoint Health Waterloo","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723329_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400055","Aetna Leap Everyday Plus UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF055","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400055-05","Aetna Leap Everyday Plus UnityPoint Health Waterloo","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723329_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400055","Aetna Leap Everyday Plus UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF055","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400055-06","Aetna Leap Everyday Plus UnityPoint Health Waterloo","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723329_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400033","Aetna Leap Everyday UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF033","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400033-00","Aetna Leap Everyday UnityPoint Health Cedar Rapids","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723185_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400033","Aetna Leap Everyday UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF033","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400033-01","Aetna Leap Everyday UnityPoint Health Cedar Rapids","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723185_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400033","Aetna Leap Everyday UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF033","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400033-02","Aetna Leap Everyday UnityPoint Health Cedar Rapids","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723185_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400033","Aetna Leap Everyday UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF033","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400033-03","Aetna Leap Everyday UnityPoint Health Cedar Rapids","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723185_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400033","Aetna Leap Everyday UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF033","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400033-04","Aetna Leap Everyday UnityPoint Health Cedar Rapids","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723185_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400033","Aetna Leap Everyday UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF033","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400033-05","Aetna Leap Everyday UnityPoint Health Cedar Rapids","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723185_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400033","Aetna Leap Everyday UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF033","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400033-06","Aetna Leap Everyday UnityPoint Health Cedar Rapids","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723185_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400040","Aetna Leap Everyday UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF040","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400040-00","Aetna Leap Everyday UnityPoint Health Des Moines","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723102_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400040","Aetna Leap Everyday UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF040","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400040-01","Aetna Leap Everyday UnityPoint Health Des Moines","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723102_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400040","Aetna Leap Everyday UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF040","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400040-02","Aetna Leap Everyday UnityPoint Health Des Moines","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723102_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400040","Aetna Leap Everyday UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF040","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400040-03","Aetna Leap Everyday UnityPoint Health Des Moines","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723102_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400040","Aetna Leap Everyday UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF040","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400040-04","Aetna Leap Everyday UnityPoint Health Des Moines","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723102_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400040","Aetna Leap Everyday UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF040","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400040-05","Aetna Leap Everyday UnityPoint Health Des Moines","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723102_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400040","Aetna Leap Everyday UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF040","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400040-06","Aetna Leap Everyday UnityPoint Health Des Moines","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723102_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400047","Aetna Leap Everyday UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF047","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400047-00","Aetna Leap Everyday UnityPoint Health Quad Cities","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723267_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400047","Aetna Leap Everyday UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF047","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400047-01","Aetna Leap Everyday UnityPoint Health Quad Cities","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723267_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400047","Aetna Leap Everyday UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF047","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400047-02","Aetna Leap Everyday UnityPoint Health Quad Cities","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723267_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400047","Aetna Leap Everyday UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF047","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400047-03","Aetna Leap Everyday UnityPoint Health Quad Cities","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723267_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400047","Aetna Leap Everyday UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF047","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400047-04","Aetna Leap Everyday UnityPoint Health Quad Cities","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723267_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400047","Aetna Leap Everyday UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF047","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400047-05","Aetna Leap Everyday UnityPoint Health Quad Cities","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723267_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400047","Aetna Leap Everyday UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF047","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400047-06","Aetna Leap Everyday UnityPoint Health Quad Cities","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723267_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400054","Aetna Leap Everyday UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF054","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400054-00","Aetna Leap Everyday UnityPoint Health Waterloo","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723322_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400054","Aetna Leap Everyday UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF054","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400054-01","Aetna Leap Everyday UnityPoint Health Waterloo","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723322_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400054","Aetna Leap Everyday UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF054","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400054-02","Aetna Leap Everyday UnityPoint Health Waterloo","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723322_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400054","Aetna Leap Everyday UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF054","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400054-03","Aetna Leap Everyday UnityPoint Health Waterloo","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723322_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400054","Aetna Leap Everyday UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF054","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400054-04","Aetna Leap Everyday UnityPoint Health Waterloo","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723322_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400054","Aetna Leap Everyday UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF054","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400054-05","Aetna Leap Everyday UnityPoint Health Waterloo","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723322_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400054","Aetna Leap Everyday UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF054","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400054-06","Aetna Leap Everyday UnityPoint Health Waterloo","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723322_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400035","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF035","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400035-00","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723211_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400035","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF035","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400035-01","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723211_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400035","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF035","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400035-02","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723211_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400035","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF035","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400035-03","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723211_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400035","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF035","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400035-04","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723211_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400035","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF035","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400035-05","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723211_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400035","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF035","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400035-06","Aetna Leap Healthy Minds UnityPoint Health Cedar Rapids","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723211_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400042","Aetna Leap Healthy Minds UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF042","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400042-00","Aetna Leap Healthy Minds UnityPoint Health Des Moines","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723116_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400042","Aetna Leap Healthy Minds UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF042","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400042-01","Aetna Leap Healthy Minds UnityPoint Health Des Moines","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723116_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400042","Aetna Leap Healthy Minds UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF042","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400042-02","Aetna Leap Healthy Minds UnityPoint Health Des Moines","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723116_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400042","Aetna Leap Healthy Minds UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF042","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400042-03","Aetna Leap Healthy Minds UnityPoint Health Des Moines","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723116_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400042","Aetna Leap Healthy Minds UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF042","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400042-04","Aetna Leap Healthy Minds UnityPoint Health Des Moines","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723116_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400042","Aetna Leap Healthy Minds UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF042","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400042-05","Aetna Leap Healthy Minds UnityPoint Health Des Moines","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723116_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400042","Aetna Leap Healthy Minds UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF042","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400042-06","Aetna Leap Healthy Minds UnityPoint Health Des Moines","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723116_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400049","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF049","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400049-00","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723287_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400049","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF049","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400049-01","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723287_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400049","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF049","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400049-02","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723287_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400049","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF049","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400049-03","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723287_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400049","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF049","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400049-04","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723287_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400049","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF049","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400049-05","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723287_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400049","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF049","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400049-06","Aetna Leap Healthy Minds UnityPoint Health Quad Cities","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723287_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400056","Aetna Leap Healthy Minds UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF056","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400056-00","Aetna Leap Healthy Minds UnityPoint Health Waterloo","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723336_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400056","Aetna Leap Healthy Minds UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF056","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400056-01","Aetna Leap Healthy Minds UnityPoint Health Waterloo","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723336_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400056","Aetna Leap Healthy Minds UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF056","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400056-02","Aetna Leap Healthy Minds UnityPoint Health Waterloo","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723336_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400056","Aetna Leap Healthy Minds UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF056","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400056-03","Aetna Leap Healthy Minds UnityPoint Health Waterloo","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723336_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400056","Aetna Leap Healthy Minds UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF056","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400056-04","Aetna Leap Healthy Minds UnityPoint Health Waterloo","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723336_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400056","Aetna Leap Healthy Minds UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF056","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400056-05","Aetna Leap Healthy Minds UnityPoint Health Waterloo","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723336_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400056","Aetna Leap Healthy Minds UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF056","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400056-06","Aetna Leap Healthy Minds UnityPoint Health Waterloo","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723336_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420008","Aetna Leap Basic Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF064","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420008-00","Aetna Leap Basic Nebraska Health Network","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723657_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420008","Aetna Leap Basic Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF064","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420008-01","Aetna Leap Basic Nebraska Health Network","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723657_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420008","Aetna Leap Basic Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF064","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420008-02","Aetna Leap Basic Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723657_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420008","Aetna Leap Basic Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF064","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420008-03","Aetna Leap Basic Nebraska Health Network","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723657_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420004","Aetna Leap Diabetes CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF060","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420004-00","Aetna Leap Diabetes CHI Health Omaha","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723543_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420004","Aetna Leap Diabetes CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF060","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420004-01","Aetna Leap Diabetes CHI Health Omaha","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723543_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420004","Aetna Leap Diabetes CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF060","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420004-02","Aetna Leap Diabetes CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723543_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420004","Aetna Leap Diabetes CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF060","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420004-03","Aetna Leap Diabetes CHI Health Omaha","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723543_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420004","Aetna Leap Diabetes CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF060","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420004-04","Aetna Leap Diabetes CHI Health Omaha","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723543_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420004","Aetna Leap Diabetes CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF060","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420004-05","Aetna Leap Diabetes CHI Health Omaha","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723543_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420004","Aetna Leap Diabetes CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF060","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420004-06","Aetna Leap Diabetes CHI Health Omaha","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723543_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420011","Aetna Leap Diabetes Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF067","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420011-00","Aetna Leap Diabetes Nebraska Health Network","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723646_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420011","Aetna Leap Diabetes Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF067","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420011-01","Aetna Leap Diabetes Nebraska Health Network","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723646_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420011","Aetna Leap Diabetes Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF067","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420011-02","Aetna Leap Diabetes Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723646_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420011","Aetna Leap Diabetes Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF067","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420011-03","Aetna Leap Diabetes Nebraska Health Network","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723646_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420011","Aetna Leap Diabetes Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF067","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420011-04","Aetna Leap Diabetes Nebraska Health Network","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723646_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420011","Aetna Leap Diabetes Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF067","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420011-05","Aetna Leap Diabetes Nebraska Health Network","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723646_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420011","Aetna Leap Diabetes Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF067","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420011-06","Aetna Leap Diabetes Nebraska Health Network","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723646_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420005","Aetna Leap Everyday CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF061","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420005-00","Aetna Leap Everyday CHI Health Omaha","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723522_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420005","Aetna Leap Everyday CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF061","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420005-01","Aetna Leap Everyday CHI Health Omaha","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723522_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420005","Aetna Leap Everyday CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF061","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420005-02","Aetna Leap Everyday CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723522_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420005","Aetna Leap Everyday CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF061","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420005-03","Aetna Leap Everyday CHI Health Omaha","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723522_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420005","Aetna Leap Everyday CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF061","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420005-04","Aetna Leap Everyday CHI Health Omaha","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723522_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420005","Aetna Leap Everyday CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF061","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420005-05","Aetna Leap Everyday CHI Health Omaha","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723522_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420005","Aetna Leap Everyday CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF061","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420005-06","Aetna Leap Everyday CHI Health Omaha","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723522_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420012","Aetna Leap Everyday Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF068","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420012-00","Aetna Leap Everyday Nebraska Health Network","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723625_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420012","Aetna Leap Everyday Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF068","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420012-01","Aetna Leap Everyday Nebraska Health Network","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723625_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420012","Aetna Leap Everyday Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF068","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420012-02","Aetna Leap Everyday Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723625_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420012","Aetna Leap Everyday Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF068","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420012-03","Aetna Leap Everyday Nebraska Health Network","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723625_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420012","Aetna Leap Everyday Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF068","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420012-04","Aetna Leap Everyday Nebraska Health Network","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723625_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420012","Aetna Leap Everyday Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF068","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420012-05","Aetna Leap Everyday Nebraska Health Network","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723625_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420012","Aetna Leap Everyday Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF068","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420012-06","Aetna Leap Everyday Nebraska Health Network","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723625_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420006","Aetna Leap Everyday Plus CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF062","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420006-00","Aetna Leap Everyday Plus CHI Health Omaha","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723529_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420006","Aetna Leap Everyday Plus CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF062","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420006-01","Aetna Leap Everyday Plus CHI Health Omaha","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723529_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420006","Aetna Leap Everyday Plus CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF062","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420006-02","Aetna Leap Everyday Plus CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723529_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420006","Aetna Leap Everyday Plus CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF062","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420006-03","Aetna Leap Everyday Plus CHI Health Omaha","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723529_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420006","Aetna Leap Everyday Plus CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF062","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420006-04","Aetna Leap Everyday Plus CHI Health Omaha","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723529_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420006","Aetna Leap Everyday Plus CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF062","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420006-05","Aetna Leap Everyday Plus CHI Health Omaha","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723529_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420006","Aetna Leap Everyday Plus CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF062","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420006-06","Aetna Leap Everyday Plus CHI Health Omaha","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723529_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420013","Aetna Leap Everyday Plus Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF069","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420013-00","Aetna Leap Everyday Plus Nebraska Health Network","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723632_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420013","Aetna Leap Everyday Plus Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF069","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420013-01","Aetna Leap Everyday Plus Nebraska Health Network","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723632_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420013","Aetna Leap Everyday Plus Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF069","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420013-02","Aetna Leap Everyday Plus Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723632_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420013","Aetna Leap Everyday Plus Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF069","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420013-03","Aetna Leap Everyday Plus Nebraska Health Network","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723632_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420013","Aetna Leap Everyday Plus Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF069","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420013-04","Aetna Leap Everyday Plus Nebraska Health Network","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723632_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420013","Aetna Leap Everyday Plus Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF069","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420013-05","Aetna Leap Everyday Plus Nebraska Health Network","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723632_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420013","Aetna Leap Everyday Plus Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF069","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420013-06","Aetna Leap Everyday Plus Nebraska Health Network","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723632_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420007","Aetna Leap Healthy Minds CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF063","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420007-00","Aetna Leap Healthy Minds CHI Health Omaha","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723536_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420007","Aetna Leap Healthy Minds CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF063","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420007-01","Aetna Leap Healthy Minds CHI Health Omaha","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723536_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420007","Aetna Leap Healthy Minds CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF063","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420007-02","Aetna Leap Healthy Minds CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723536_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420007","Aetna Leap Healthy Minds CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF063","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420007-03","Aetna Leap Healthy Minds CHI Health Omaha","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723536_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420007","Aetna Leap Healthy Minds CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF063","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420007-04","Aetna Leap Healthy Minds CHI Health Omaha","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723536_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420007","Aetna Leap Healthy Minds CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF063","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420007-05","Aetna Leap Healthy Minds CHI Health Omaha","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723536_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420007","Aetna Leap Healthy Minds CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF063","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420007-06","Aetna Leap Healthy Minds CHI Health Omaha","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723536_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420014","Aetna Leap Healthy Minds Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF070","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420014-00","Aetna Leap Healthy Minds Nebraska Health Network","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723639_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420014","Aetna Leap Healthy Minds Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF070","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420014-01","Aetna Leap Healthy Minds Nebraska Health Network","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723639_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420014","Aetna Leap Healthy Minds Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF070","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420014-02","Aetna Leap Healthy Minds Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723639_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420014","Aetna Leap Healthy Minds Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF070","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420014-03","Aetna Leap Healthy Minds Nebraska Health Network","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723639_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420014","Aetna Leap Healthy Minds Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF070","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420014-04","Aetna Leap Healthy Minds Nebraska Health Network","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723639_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420014","Aetna Leap Healthy Minds Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF070","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420014-05","Aetna Leap Healthy Minds Nebraska Health Network","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723639_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420014","Aetna Leap Healthy Minds Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF070","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420014-06","Aetna Leap Healthy Minds Nebraska Health Network","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723639_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420002","Aetna Leap Catastrophic CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF058","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420002-00","Aetna Leap Catastrophic CHI Health Omaha","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723558_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420002","Aetna Leap Catastrophic CHI Health Omaha","18973IA042",,"IAN009","IAS009","IAF058","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420002-01","Aetna Leap Catastrophic CHI Health Omaha","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723558_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400002","Aetna Leap Catastrophic Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF002","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400002-00","Aetna Leap Catastrophic Mercy Medical Center","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723099_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400002","Aetna Leap Catastrophic Mercy Medical Center","18973IA040",,"IAN008","IAS008","IAF002","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400002-01","Aetna Leap Catastrophic Mercy Medical Center","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723099_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400009","Aetna Leap Catastrophic MIPPA","18973IA040",,"IAN002","IAS002","IAF009","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400009-00","Aetna Leap Catastrophic MIPPA","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722516_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400009","Aetna Leap Catastrophic MIPPA","18973IA040",,"IAN002","IAS002","IAF009","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400009-01","Aetna Leap Catastrophic MIPPA","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_722516_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420009","Aetna Leap Catastrophic Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF065","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420009-00","Aetna Leap Catastrophic Nebraska Health Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723661_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0420009","Aetna Leap Catastrophic Nebraska Health Network","18973IA042",,"IAN010","IAS010","IAF065","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0420009-01","Aetna Leap Catastrophic Nebraska Health Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723661_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400016","Aetna Leap Catastrophic Patient Preferred","18973IA040",,"IAN003","IAS003","IAF016","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400016-00","Aetna Leap Catastrophic Patient Preferred","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723183_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400016","Aetna Leap Catastrophic Patient Preferred","18973IA040",,"IAN003","IAS003","IAF016","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400016-01","Aetna Leap Catastrophic Patient Preferred","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723183_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400023","Aetna Leap Catastrophic POS","18973IA040",,"IAN001","IAS001","IAF023","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400023-00","Aetna Leap Catastrophic POS","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723054_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400023","Aetna Leap Catastrophic POS","18973IA040",,"IAN001","IAS001","IAF023","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400023-01","Aetna Leap Catastrophic POS","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723054_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400030","Aetna Leap Catastrophic UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF030","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400030-00","Aetna Leap Catastrophic UnityPoint Health Cedar Rapids","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723265_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400030","Aetna Leap Catastrophic UnityPoint Health Cedar Rapids","18973IA040",,"IAN006","IAS006","IAF030","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400030-01","Aetna Leap Catastrophic UnityPoint Health Cedar Rapids","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723265_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400037","Aetna Leap Catastrophic UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF037","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400037-00","Aetna Leap Catastrophic UnityPoint Health Des Moines","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723138_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400037","Aetna Leap Catastrophic UnityPoint Health Des Moines","18973IA040",,"IAN004","IAS004","IAF037","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400037-01","Aetna Leap Catastrophic UnityPoint Health Des Moines","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723138_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400044","Aetna Leap Catastrophic UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF044","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400044-00","Aetna Leap Catastrophic UnityPoint Health Quad Cities","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723320_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400044","Aetna Leap Catastrophic UnityPoint Health Quad Cities","18973IA040",,"IAN005","IAS005","IAF044","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400044-01","Aetna Leap Catastrophic UnityPoint Health Quad Cities","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723320_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400051","Aetna Leap Catastrophic UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF051","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400051-00","Aetna Leap Catastrophic UnityPoint Health Waterloo","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723362_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","18973","SERFF","2016-08-26 03:12:28","Individual","No","42-1244752","18973IA0400051","Aetna Leap Catastrophic UnityPoint Health Waterloo","18973IA040",,"IAN007","IAS007","IAF051","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5756366232","18973IA0400051-01","Aetna Leap Catastrophic UnityPoint Health Waterloo","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/IA/SBC_2017_IA_723362_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_IA.html"
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070002","Platinum $500 - 20% $15 OV","27651IA007",,"IAN001","IAS001","IAF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070002-00","Platinum $500 - 20% $15 OV","Standard Platinum Off Exchange Plan",,"0.897733211517334","No","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$340","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070002","Platinum $500 - 20% $15 OV","27651IA007",,"IAN001","IAS001","IAF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070002-01","Platinum $500 - 20% $15 OV","Standard Platinum On Exchange Plan",,"0.897733211517334","No","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$340","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050001-03","Platinum $1000 - 0%","Limited Cost Sharing Plan Variation",,"0.914287745952606","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZD&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050002-00","Platinum $500 - 20%","Standard Platinum Off Exchange Plan",,"0.916639864444733","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2017&state=IA",
"2017","IA","25440","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","93-0242990","25440IA0040002","EHB High PPO","25440IA004",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","25440IA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IA","25440","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","93-0242990","25440IA0040001","EHB Low PPO","25440IA004",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","25440IA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IA","25440","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","93-0242990","25440IA0030002","EHB High Passive","25440IA003",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","25440IA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IA","25440","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","93-0242990","25440IA0030001","EHB Low Passive","25440IA003",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","25440IA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050004-02","Gold $3500 - 0%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZG&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050004-03","Gold $3500 - 0%","Limited Cost Sharing Plan Variation",,"0.79325944185257","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZH&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070008","Silver $3000 - 0%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070008-01","Silver $3000 - 0%","Standard Silver On Exchange Plan",,"0.706944227218628","No","Yes","No","100%",,"$5,080","$20","$0","$150","$3,000","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070009","Bronze $5500 - 10%","27651IA007",,"IAN001","IAS001","IAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070009-00","Bronze $5500 - 10%","Standard Bronze Off Exchange Plan",,"0.582977712154388","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050005","Silver $4000 - 10%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-00","Silver $4000 - 10%","Standard Silver Off Exchange Plan",,"0.69496476650238","No","Yes","No","100%",,"$6,000","$0","$0","$150","$4,000","$180","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0080001","Silver HSA $3000 - 20%","27651IA008",,"IAN001","IAS001","IAF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080001-00","Silver HSA $3000 - 20%","Standard Silver Off Exchange Plan",,"0.698762774467468","Yes","Yes","No","100%",,"$4,500","$0","$0","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6550 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050005","Silver $4000 - 10%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-04","Silver $4000 - 10%","73% AV Level Silver Plan",,"0.735266208648682","No","Yes","No","100%",,"$5,250","$0","$0","$150","$3,250","$230","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=9S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050001-00","Platinum $1000 - 0%","Standard Platinum Off Exchange Plan",,"0.914287745952606","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070001","Platinum $1000 - 0% $30 OV","27651IA007",,"IAN001","IAS001","IAF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070001-00","Platinum $1000 - 0% $30 OV","Standard Platinum Off Exchange Plan",,"0.918217182159424","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070001","Platinum $1000 - 0% $30 OV","27651IA007",,"IAN001","IAS001","IAF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070001-01","Platinum $1000 - 0% $30 OV","Standard Platinum On Exchange Plan",,"0.918217182159424","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050001-01","Platinum $1000 - 0%","Standard Platinum On Exchange Plan",,"0.914287745952606","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050001-02","Platinum $1000 - 0%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZC&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070003","Gold $2500 - 0%","27651IA007",,"IAN001","IAS001","IAF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070003-00","Gold $2500 - 0%","Standard Gold Off Exchange Plan",,"0.797847390174866","No","Yes","No","100%",,"$2,500","$0","$0","$150","$2,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070003","Gold $2500 - 0%","27651IA007",,"IAN001","IAS001","IAF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070003-01","Gold $2500 - 0%","Standard Gold On Exchange Plan",,"0.797847390174866","No","Yes","No","100%",,"$2,500","$0","$0","$150","$2,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050005","Silver $4000 - 10%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-01","Silver $4000 - 10%","Standard Silver On Exchange Plan",,"0.69496476650238","No","Yes","No","100%",,"$6,000","$0","$0","$150","$4,000","$180","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070009","Bronze $5500 - 10%","27651IA007",,"IAN001","IAS001","IAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070009-01","Bronze $5500 - 10%","Standard Bronze On Exchange Plan",,"0.582977712154388","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070010","Bronze $7000 - 0%","27651IA007",,"IAN001","IAS001","IAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070010-00","Bronze $7000 - 0%","Standard Bronze Off Exchange Plan",,"0.591358125209808","No","Yes","No","100%",,"$7,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050005","Silver $4000 - 10%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-02","Silver $4000 - 10%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZM&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050005","Silver $4000 - 10%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-03","Silver $4000 - 10%","Limited Cost Sharing Plan Variation",,"0.69496476650238","No","Yes","No","100%",,"$6,000","$0","$0","$150","$4,000","$180","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZN&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070010","Bronze $7000 - 0%","27651IA007",,"IAN001","IAS001","IAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070010-01","Bronze $7000 - 0%","Standard Bronze On Exchange Plan",,"0.591358125209808","No","Yes","No","100%",,"$7,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050002-01","Platinum $500 - 20%","Standard Platinum On Exchange Plan",,"0.916639864444733","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050002-02","Platinum $500 - 20%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZA&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070004","Gold $2000 - 20% $50 OV","27651IA007",,"IAN001","IAS001","IAF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070004-00","Gold $2000 - 20% $50 OV","Standard Gold Off Exchange Plan",,"0.784634828567505","No","Yes","No","100%",,"$3,500","$0","$0","$150","$2,000","$380","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070004","Gold $2000 - 20% $50 OV","27651IA007",,"IAN001","IAS001","IAF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070004-01","Gold $2000 - 20% $50 OV","Standard Gold On Exchange Plan",,"0.784634828567505","No","Yes","No","100%",,"$3,500","$0","$0","$150","$2,000","$380","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050002-03","Platinum $500 - 20%","Limited Cost Sharing Plan Variation",,"0.916639864444733","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZB&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070005","Silver $4250 - 20%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070005-00","Silver $4250 - 20%","Standard Silver Off Exchange Plan",,"0.6825932264328","No","Yes","No","100%",,"$5,250","$0","$0","$150","$4,250","$120","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050003","Gold $1750 - 30%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050003-00","Gold $1750 - 30%","Standard Gold Off Exchange Plan",,"0.814602613449097","No","Yes","No","100%",,"$3,250","$0","$0","$150","$1,750","$290","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050003","Gold $1750 - 30%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050003-01","Gold $1750 - 30%","Standard Gold On Exchange Plan",,"0.814602613449097","No","Yes","No","100%",,"$3,250","$0","$0","$150","$1,750","$290","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070005","Silver $4250 - 20%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070005-01","Silver $4250 - 20%","Standard Silver On Exchange Plan",,"0.6825932264328","No","Yes","No","100%",,"$5,250","$0","$0","$150","$4,250","$120","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070006","Silver $3500 - 30% $50 OV","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070006-00","Silver $3500 - 30% $50 OV","Standard Silver Off Exchange Plan",,"0.692190766334534","No","Yes","No","100%",,"$5,580","$20","$500","$150","$3,500","$220","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050003","Gold $1750 - 30%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050003-02","Gold $1750 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZE&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050003","Gold $1750 - 30%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050003-03","Gold $1750 - 30%","Limited Cost Sharing Plan Variation",,"0.814602613449097","No","Yes","No","100%",,"$3,250","$0","$0","$150","$1,750","$290","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZF&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070006","Silver $3500 - 30% $50 OV","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070006-01","Silver $3500 - 30% $50 OV","Standard Silver On Exchange Plan",,"0.692190766334534","No","Yes","No","100%",,"$5,580","$20","$500","$150","$3,500","$220","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070007","Silver $600 - 50%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070007-00","Silver $600 - 50%","Standard Silver Off Exchange Plan",,"0.71808660030365","No","Yes","No","100%",,"$1,200","$20","$2,060","$150","$600","$360","$1,090","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050004-00","Gold $3500 - 0%","Standard Gold Off Exchange Plan",,"0.79325944185257","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050004-01","Gold $3500 - 0%","Standard Gold On Exchange Plan",,"0.79325944185257","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070007","Silver $600 - 50%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070007-01","Silver $600 - 50%","Standard Silver On Exchange Plan",,"0.71808660030365","No","Yes","No","100%",,"$1,200","$20","$2,060","$150","$600","$360","$1,090","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0070008","Silver $3000 - 0%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070008-00","Silver $3000 - 0%","Standard Silver Off Exchange Plan",,"0.706944227218628","No","Yes","No","100%",,"$5,080","$20","$0","$150","$3,000","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050005","Silver $4000 - 10%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-05","Silver $4000 - 10%","87% AV Level Silver Plan",,"0.873995244503021","No","Yes","No","100%",,"$1,750","$0","$0","$150","$1,250","$260","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0080001","Silver HSA $3000 - 20%","27651IA008",,"IAN001","IAS001","IAF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080001-01","Silver HSA $3000 - 20%","Standard Silver On Exchange Plan",,"0.698762774467468","Yes","Yes","No","100%",,"$4,500","$0","$0","$150","$3,000","$0","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6550 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0080002","Bronze HSA $4400 - 50%","27651IA008",,"IAN001","IAS001","IAF010","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080002-00","Bronze HSA $4400 - 50%","Standard Bronze Off Exchange Plan",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050005","Silver $4000 - 10%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-06","Silver $4000 - 10%","94% AV Level Silver Plan",,"0.944267988204956","No","Yes","No","100%",,"$500","$0","$250","$150","$250","$200","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=7S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0080002","Bronze HSA $4400 - 50%","27651IA008",,"IAN001","IAS001","IAF010","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080002-01","Bronze HSA $4400 - 50%","Standard Bronze On Exchange Plan",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-00","Silver $2500 - 50%","Standard Silver Off Exchange Plan",,"0.718596160411835","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-01","Silver $2500 - 50%","Standard Silver On Exchange Plan",,"0.718596160411835","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0080003","Bronze HSA $5250 - 30%","27651IA008",,"IAN001","IAS001","IAF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080003-00","Bronze HSA $5250 - 30%","Standard Bronze Off Exchange Plan",,"0.617813110351563","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,250","$0","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$6550 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0080003","Bronze HSA $5250 - 30%","27651IA008",,"IAN001","IAS001","IAF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080003-01","Bronze HSA $5250 - 30%","Standard Bronze On Exchange Plan",,"0.617813110351563","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,250","$0","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$6550 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-02","Silver $2500 - 50%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZK&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-03","Silver $2500 - 50%","Limited Cost Sharing Plan Variation",,"0.718596160411835","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZL&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0080004","Bronze HSA $6550 - 0%","27651IA008",,"IAN001","IAS001","IAF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080004-00","Bronze HSA $6550 - 0%","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","No","39-1807071","27651IA0080004","Bronze HSA $6550 - 0%","27651IA008",,"IAN001","IAS001","IAF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9966",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080004-01","Bronze HSA $6550 - 0%","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-04","Silver $2500 - 50%","73% AV Level Silver Plan",,"0.739035427570343","No","Yes","No","100%",,"$4,580","$20","$1,070","$150","$2,500","$360","$310","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=6S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-05","Silver $2500 - 50%","87% AV Level Silver Plan",,"0.87041711807251","No","Yes","No","100%",,"$2,000","$0","$0","$150","$1,000","$290","$320","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=5S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-06","Silver HSA $2000 - 50%","94% AV Level Silver Plan",,"0.94882071018219","Yes","Yes","No","100%",,"$500","$0","$0","$150","$250","$0","$250","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S4&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-06","Silver $2500 - 50%","94% AV Level Silver Plan",,"0.944267988204956","No","Yes","No","100%",,"$500","$0","$250","$150","$250","$200","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=4S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-00","Silver $2500 - 20%","Standard Silver Off Exchange Plan",,"0.712406814098358","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-01","Silver $2500 - 20%","Standard Silver On Exchange Plan",,"0.712406814098358","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-02","Silver $2500 - 20%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZI&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-03","Silver $2500 - 20%","Limited Cost Sharing Plan Variation",,"0.712406814098358","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZJ&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050009","Bronze $5000 - 10%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050009-00","Bronze $5000 - 10%","Standard Bronze Off Exchange Plan",,"0.600622475147247","No","Yes","No","100%",,"$7,080","$20","$20","$150","$5,000","$80","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050009","Bronze $5000 - 10%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050009-01","Bronze $5000 - 10%","Standard Bronze On Exchange Plan",,"0.600622475147247","No","Yes","No","100%",,"$7,080","$20","$20","$150","$5,000","$80","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-04","Silver $2500 - 20%","73% AV Level Silver Plan",,"0.735912501811981","No","Yes","No","100%",,"$4,000","$0","$0","$150","$2,250","$270","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=3S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-05","Silver $2500 - 20%","87% AV Level Silver Plan",,"0.877321481704712","No","Yes","No","100%",,"$1,250","$0","$0","$150","$1,000","$80","$170","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=2S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-06","Silver $2500 - 20%","94% AV Level Silver Plan",,"0.946879625320435","No","Yes","No","100%",,"$500","$0","$0","$150","$250","$100","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=1S&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050008","Bronze $3750 - 50%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050008-00","Bronze $3750 - 50%","Standard Bronze Off Exchange Plan",,"0.612308979034424","No","Yes","No","100%",,"$5,830","$20","$710","$150","$3,750","$380","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050008","Bronze $3750 - 50%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050008-01","Bronze $3750 - 50%","Standard Bronze On Exchange Plan",,"0.612308979034424","No","Yes","No","100%",,"$5,830","$20","$710","$150","$3,750","$380","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050008","Bronze $3750 - 50%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050008-02","Bronze $3750 - 50%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZQ&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050008","Bronze $3750 - 50%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050008-03","Bronze $3750 - 50%","Limited Cost Sharing Plan Variation",,"0.612308979034424","No","Yes","No","100%",,"$5,830","$20","$710","$150","$3,750","$380","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZR&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050009","Bronze $5000 - 10%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050009-02","Bronze $5000 - 10%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZO&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050009","Bronze $5000 - 10%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050009-03","Bronze $5000 - 10%","Limited Cost Sharing Plan Variation",,"0.600622475147247","No","Yes","No","100%",,"$7,080","$20","$20","$150","$5,000","$80","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZP&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050010","Bronze $6500 - 10%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050010-00","Bronze $6500 - 10%","Standard Bronze Off Exchange Plan",,"0.581400454044342","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050010","Bronze $6500 - 10%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050010-01","Bronze $6500 - 10%","Standard Bronze On Exchange Plan",,"0.581400454044342","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050010","Bronze $6500 - 10%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050010-02","Bronze $6500 - 10%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZS&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050010","Bronze $6500 - 10%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050010-03","Bronze $6500 - 10%","Limited Cost Sharing Plan Variation",,"0.581400454044342","No","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZT&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060001","Silver HSA $4400 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-00","Silver HSA $4400 - 0%","Standard Silver Off Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$4,400","$0","$0","$150","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060001","Silver HSA $4400 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-01","Silver HSA $4400 - 0%","Standard Silver On Exchange Plan",,"0.680664837360382","Yes","Yes","No","100%",,"$4,400","$0","$0","$150","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060001","Silver HSA $4400 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-02","Silver HSA $4400 - 0%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZU&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060001","Silver HSA $4400 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-03","Silver HSA $4400 - 0%","Limited Cost Sharing Plan Variation",,"0.680664837360382","Yes","Yes","No","100%",,"$4,400","$0","$0","$150","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZV&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060001","Silver HSA $4400 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-04","Silver HSA $4400 - 0%","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,250","$0","$0","$150","$3,250","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$5700 per person","$6500 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$5700 per person","$6500 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S3&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060001","Silver HSA $4400 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-05","Silver HSA $4400 - 0%","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2350 per person","$2500 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S2&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060001","Silver HSA $4400 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-06","Silver HSA $4400 - 0%","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","0.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S1&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-00","Silver HSA $2000 - 50%","Standard Silver Off Exchange Plan",,"0.711624562740326","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-01","Silver HSA $2000 - 50%","Standard Silver On Exchange Plan",,"0.711624562740326","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-02","Silver HSA $2000 - 50%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZY&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-03","Silver HSA $2000 - 50%","Limited Cost Sharing Plan Variation",,"0.711624562740326","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=Z1&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-04","Silver HSA $2000 - 50%","73% AV Level Silver Plan",,"0.738714993000031","Yes","Yes","No","100%",,"$3,000","$0","$500","$150","$1,500","$0","$1,890","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$5700 per person","$7000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S6&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-05","Silver HSA $2000 - 50%","87% AV Level Silver Plan",,"0.879132032394409","Yes","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$0","$950","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2350 per person","$3000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","20.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S5&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060005","Bronze HSA $5750 - 20%","27651IA006",,"IAN002","IAS001","IAF009","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060005-01","Bronze HSA $5750 - 20%","Standard Bronze On Exchange Plan",,"0.615649044513702","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$6550 per person","$11500 per group","20.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060005","Bronze HSA $5750 - 20%","27651IA006",,"IAN002","IAS001","IAF009","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060005-02","Bronze HSA $5750 - 20%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YC&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060005","Bronze HSA $5750 - 20%","27651IA006",,"IAN002","IAS001","IAF009","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060005-03","Bronze HSA $5750 - 20%","Limited Cost Sharing Plan Variation",,"0.615649044513702","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$6550 per person","$11500 per group","20.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YD&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050014","Catastrophic $7150 - 0%","27651IA005",,"IAN002","IAS001","IAF012","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050014-00","Catastrophic $7150 - 0%","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0050014","Catastrophic $7150 - 0%","27651IA005",,"IAN002","IAS001","IAF012","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050014-01","Catastrophic $7150 - 0%","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2017&state=IA",
"2017","IA","74406","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","38-3988543","74406IA0060001","Wellmark Value Silver 4250","74406IA006",,"IAN001","IAS002","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No",,"http://www.wellmark.com","74406IA0060001-01","Wellmark Value Silver 4250","Standard Silver On Exchange Plan",,"0.690493166446686","Yes","Yes","No","100%",,"$4,250","$160","$990","$150","$20","$2,160","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=9IQ&d=ALI","https://www.wellmark.com/-/media/6A90C47AFE36427E85CE5CB6B6E0C93A.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","38-3988543","74406IA0070001","Wellmark Value Gold 2150","74406IA007",,"IAN001","IAS002","IAF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No",,"http://www.wellmark.com","74406IA0070001-00","Wellmark Value Gold 2150","Standard Gold Off Exchange Plan","78.05%","0.766292989253998","Yes","Yes","No","100%",,"$2,150","$140","$920","$150","$20","$1,650","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=9IR&d=AMI","https://www.wellmark.com/-/media/6A90C47AFE36427E85CE5CB6B6E0C93A.ashx"
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060003","Bronze HSA $4400 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060003-00","Bronze HSA $4400 - 50%","Standard Bronze Off Exchange Plan",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060003","Bronze HSA $4400 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060003-01","Bronze HSA $4400 - 50%","Standard Bronze On Exchange Plan",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060003","Bronze HSA $4400 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060003-02","Bronze HSA $4400 - 50%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YE&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060003","Bronze HSA $4400 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060003-03","Bronze HSA $4400 - 50%","Limited Cost Sharing Plan Variation",,"0.619763255119324","Yes","Yes","No","100%",,"$6,480","$0","$70","$150","$4,400","$0","$440","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$6550 per person","$8800 per group","50.00%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YF&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060004","Bronze HSA $6550 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060004-00","Bronze HSA $6550 - 0%","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060004","Bronze HSA $6550 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060004-01","Bronze HSA $6550 - 0%","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060004","Bronze HSA $6550 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060004-02","Bronze HSA $6550 - 0%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YA&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060004","Bronze HSA $6550 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060004-03","Bronze HSA $6550 - 0%","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YB&eff_date=01/01/2017&state=IA",
"2017","IA","27651","SERFF","2016-08-25 03:47:19","Individual","No","39-1807071","27651IA0060005","Bronze HSA $5750 - 20%","27651IA006",,"IAN002","IAS001","IAF009","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9973",,,"2017-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060005-00","Bronze HSA $5750 - 20%","Standard Bronze Off Exchange Plan",,"0.615649044513702","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$6550 per person","$11500 per group","20.00%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2017&state=IA",
"2017","IA","41482","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","13-5581829","41482IA0070001","EHB Basic Dental Plan (Low)","41482IA007",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","41482IA0070001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","52391","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","47-0098400","52391IA0040002","EHB High PPO","52391IA004",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","52391IA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0010001","Wellmark Synergy Bronze 6500","87928IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0010001-03","Wellmark Synergy Bronze 6500","Limited Cost Sharing Plan Variation",,"0.61035031080246","Yes","Yes","No","100%",,"$6,500","$20","$330","$150","$3,310","$1,250","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=AIG&d=AIV","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","37-1800647","87928IA0090001","Wellmark Synergy Gold 2150","87928IA009",,"IAN001","IAS002","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No",,"http://www.wellmark.com","87928IA0090001-01","Wellmark Synergy Gold 2150","Standard Gold On Exchange Plan",,"0.78184050321579","Yes","Yes","No","100%",,"$2,150","$140","$920","$150","$20","$1,650","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=9IN&d=AJI","https://www.wellmark.com/-/media/CD5ED83221DC4FDE8F622453F69A44F1.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0010001","Wellmark Value Bronze 7150","74406IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0010001-03","Wellmark Value Bronze 7150","Limited Cost Sharing Plan Variation","61.80%","0.631597757339478","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$3,310","$1,250","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CLI&d=BSI","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","52391","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","47-0098400","52391IA0040001","EHB Low PPO","52391IA004",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","52391IA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IA","52391","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","47-0098400","52391IA0030002","EHB High Passive","52391IA003",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","52391IA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IA","52391","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","47-0098400","52391IA0030001","EHB Low Passive","52391IA003",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","52391IA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IA","61284","SERFF","2016-08-25 03:47:19","Individual","Yes","75-1233841","61284IA0010007","Dentegra Dental PPO Pediatric Basic Plan","61284IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0010007-17"
"2017","IA","61284","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","75-1233841","61284IA0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","61284IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0020007-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0020007-17"
"2017","IA","61284","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","75-1233841","61284IA0020012","Dentegra Dental PPO for Small Businesses Family Preferred Plan","61284IA002",,"IAN001","IAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0020012-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0020012-17"
"2017","IA","61284","SERFF","2016-08-25 03:47:19","Individual","Yes","75-1233841","61284IA0010012","Dentegra Dental PPO Family Preferred Plan","61284IA001",,"IAN001","IAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0010012-17"
"2017","IA","61284","SERFF","2016-08-25 03:47:19","Individual","Yes","75-1233841","61284IA0010011","Dentegra Dental PPO Family Basic Plan","61284IA001",,"IAN001","IAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0010011-17"
"2017","IA","61284","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","75-1233841","61284IA0020011","Dentegra Dental PPO for Small Businesses Family Basic Plan","61284IA002",,"IAN001","IAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0020011-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0020011-17"
"2017","IA","63366","SERFF","2016-08-25 03:47:19","Individual","Yes","42-0959302","63366IA0020001","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://deltadentalia.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","63366IA0020001-01","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","Standard High On Exchange Plan","84.20%",,,,"Yes","42%","58%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010003","Delta Dental Premier® Plan A Plus - L","63366IA001","7790788992","IAN001","IAS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010003-00","Delta Dental Premier® Plan A Plus - L","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010004","Delta Dental Premier® Plan B Plus - H","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010004-00","Delta Dental Premier® Plan B Plus - H","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","Individual","Yes","42-0959302","63366IA0020003","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0020003-01","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","Standard High On Exchange Plan","84.20%",,,,"Yes","42%","58%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010005","Delta Dental Premier® Plan C Plus - H","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010005-00","Delta Dental Premier® Plan C Plus - H","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010008","Delta Dental Premier® Plan A Plus - LC","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement.","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010008-00","Delta Dental Premier® Plan A Plus - LC","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","Individual","Yes","42-0959302","63366IA0020002","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Major Dental Care and Orthodntia - Adult, non-medically necessary orthodontia - Child",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://deltadentalia.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","63366IA0020002-01","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","Standard Low On Exchange Plan","71.90%",,,,"Yes","33%","67%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010009","Delta Dental Premier® Plan B Plus - HC","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement.","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010009-00","Delta Dental Premier® Plan B Plus - HC","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","Individual","Yes","42-0959302","63366IA0020004","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Major Dental Care and Orthodntia - Adult, non-medically necessary orthodontia - Child",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0020004-01","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","Standard Low On Exchange Plan","71.90%",,,,"Yes","33%","67%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010010","Delta Dental Premier® Plan C Plus - HC","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement.","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010010-00","Delta Dental Premier® Plan C Plus - HC","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","Individual","Yes","42-0959302","63366IA0020006","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://deltadentalia.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","63366IA0020006-01","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","Standard High On Exchange Plan","84.20%",,,,"Yes","42%","58%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010012","Delta Dental PPO Plus Premier® Plan A Plus - L","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010012-00","Delta Dental PPO Plus Premier® Plan A Plus - L","Standard Low Off Exchange Plan","71.60%",,,,"Yes","50%","50%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010013","Delta Dental PPO Plus Premier® Plan B Plus - H","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010013-00","Delta Dental PPO Plus Premier® Plan B Plus - H","Standard High Off Exchange Plan","83.60%",,,,"Yes","50%","50%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","Individual","Yes","42-0959302","63366IA0020007","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0020007-00","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","Standard High Off Exchange Plan","84.20%",,,,"Yes","42%","58%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010014","Delta Dental PPO Plus Premier® Plan C Plus - H","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010014-00","Delta Dental PPO Plus Premier® Plan C Plus - H","Standard High Off Exchange Plan","83.60%",,,,"Yes","50%","50%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","Individual","Yes","42-0959302","63366IA0020005","Delta Dental PPO Plus Premier® Individual Comprehensive Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0020005-00","Delta Dental PPO Plus Premier® Individual Comprehensive Plus","Standard High Off Exchange Plan","84.20%",,,,"Yes","52%","48%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010016","Delta Dental PPO Plus Premier® Plan A Plus - LC","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010016-00","Delta Dental PPO Plus Premier® Plan A Plus - LC","Standard Low Off Exchange Plan","71.60%",,,,"Yes","54%","46%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010017","Delta Dental PPO Plus Premier® Plan B Plus - HC","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010017-00","Delta Dental PPO Plus Premier® Plan B Plus - HC","Standard High Off Exchange Plan","83.60%",,,,"Yes","50%","50%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010018","Delta Dental PPO Plus Premier® Plan C Plus - HC","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010018-00","Delta Dental PPO Plus Premier® Plan C Plus - HC","Standard High Off Exchange Plan","83.60%",,,,"Yes","67%","33%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010023","Delta Dental PPO Plus Premier® Employee Choice - Platinum Plus","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010023-00","Delta Dental PPO Plus Premier® Employee Choice - Platinum Plus","Standard High Off Exchange Plan","84.20%",,,,"Yes","29%","71%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010022","Delta Dental PPO Plus Premier® Employee Choice - Preferred Plus","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010022-00","Delta Dental PPO Plus Premier® Employee Choice - Preferred Plus","Standard High Off Exchange Plan","84.20%",,,,"Yes","42%","58%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","63366","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0959302","63366IA0010020","Delta Dental PPO Plus Premier® Employee Choice - Preventive Plus","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Adult extrations, oral surgery and orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Claims can be submitted for reinbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010020-00","Delta Dental PPO Plus Premier® Employee Choice - Preventive Plus","Standard Low Off Exchange Plan","71.90%",,,,"Yes","29%","71%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","71051","SERFF","2016-08-25 03:47:19","Individual","Yes","95-6042390","71051IA0020003","BESTOne Advantage Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010007","BESTDental Premium","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Premium_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010007","BESTDental Premium","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Premium_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","Individual","Yes","95-6042390","71051IA0020003","BESTOne Advantage Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","Individual","Yes","95-6042390","71051IA0020004","BESTOne Plus Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010008","BESTDental Standard - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Standard-H_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010008","BESTDental Standard - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Standard-H_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","Individual","Yes","95-6042390","71051IA0020004","BESTOne Plus Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010010","BESTDental Choice - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Choice-H_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010010","BESTDental Choice - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Choice-H_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","Individual","Yes","95-6042390","71051IA0020005","BESTOne Dental Plus - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020005-00","BESTOne Dental Plus - Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010009","BESTDental Standard - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Standard-L_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010009","BESTDental Standard - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Standard-L_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","Individual","Yes","95-6042390","71051IA0020005","BESTOne Dental Plus - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020005-01","BESTOne Dental Plus - Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","Individual","Yes","95-6042390","71051IA0020006","BESTOne Dental Basic - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020006-00","BESTOne Dental Basic - Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010011","BESTDental Choice - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Choice-L_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010011","BESTDental Choice - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Choice-L_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","Individual","Yes","95-6042390","71051IA0020006","BESTOne Dental Basic - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020006-01","BESTOne Dental Basic - Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010012","BESTDental Value","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Value_Plan.pdf"
"2017","IA","71051","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","95-6042390","71051IA0010012","BESTDental Value","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTDental_Value_Plan.pdf"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","38-3988543","74406IA0060001","Wellmark Value Silver 4250","74406IA006",,"IAN001","IAS002","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No",,"http://www.wellmark.com","74406IA0060001-00","Wellmark Value Silver 4250","Standard Silver Off Exchange Plan",,"0.690493166446686","Yes","Yes","No","100%",,"$4,250","$160","$990","$150","$20","$2,160","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=9IP&d=AKI","https://www.wellmark.com/-/media/6A90C47AFE36427E85CE5CB6B6E0C93A.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0010001","Wellmark Value Bronze 7150","74406IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0010001-00","Wellmark Value Bronze 7150","Standard Bronze Off Exchange Plan","61.80%","0.631597757339478","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$3,310","$1,250","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CI3&d=BI7","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0010001","Wellmark Value Bronze 7150","74406IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0010001-01","Wellmark Value Bronze 7150","Standard Bronze On Exchange Plan","61.80%","0.631597757339478","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$3,310","$1,250","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CI2&d=BI6","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0010001","Wellmark Value Bronze 7150","74406IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0010001-02","Wellmark Value Bronze 7150","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CNI&d=BUI","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0010001","Wellmark Synergy Bronze 6500","87928IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0010001-02","Wellmark Synergy Bronze 6500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=BIX&d=BI3","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","38-3988543","74406IA0070001","Wellmark Value Gold 2150","74406IA007",,"IAN001","IAS002","IAF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No",,"http://www.wellmark.com","74406IA0070001-01","Wellmark Value Gold 2150","Standard Gold On Exchange Plan","78.05%","0.766292989253998","Yes","Yes","No","100%",,"$2,150","$140","$920","$150","$20","$1,650","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=9IS&d=API","https://www.wellmark.com/-/media/6A90C47AFE36427E85CE5CB6B6E0C93A.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020001","Wellmark Value Silver 3200","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020001-00","Wellmark Value Silver 3200","Standard Silver Off Exchange Plan",,"0.717161476612091","Yes","Yes","No","100%",,"$3,200","$80","$1,060","$150","$20","$1,590","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CI6&d=BAI","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020001","Wellmark Value Silver 3200","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020001-01","Wellmark Value Silver 3200","Standard Silver On Exchange Plan",,"0.717161476612091","Yes","Yes","No","100%",,"$3,200","$80","$1,060","$150","$20","$1,590","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CI5&d=BI9","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020001","Wellmark Value Silver 3200","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020001-02","Wellmark Value Silver 3200","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CSI&d=BXI","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020001","Wellmark Value Silver 3200","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020001-03","Wellmark Value Silver 3200","Limited Cost Sharing Plan Variation",,"0.717161476612091","Yes","Yes","No","100%",,"$3,200","$80","$1,060","$150","$20","$1,590","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CMI&d=BTI","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020001","Wellmark Value Silver 3200","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020001-04","Wellmark Value Silver 3200","73% AV Level Silver Plan",,"0.738638699054718","Yes","Yes","No","100%",,"$3,200","$80","$1,060","$150","$20","$1,590","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CID&d=BIH","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020001","Wellmark Value Silver 3200","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020001-05","Wellmark Value Silver 3200","87% AV Level Silver Plan",,"0.863824665546417","Yes","Yes","No","100%",,"$1,250","$70","$550","$150","$20","$1,310","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CIE&d=B2I","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020001","Wellmark Value Silver 3200","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020001-06","Wellmark Value Silver 3200","94% AV Level Silver Plan",,"0.933904051780701","Yes","Yes","No","100%",,"$760","$40","$0","$150","$20","$780","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CIF&d=B3I","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020002","Wellmark Value Silver 4000","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020002-00","Wellmark Value Silver 4000","Standard Silver Off Exchange Plan","69.05%","0.699665665626526","Yes","Yes","No","100%",,"$4,000","$110","$820","$150","$20","$1,680","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CI8&d=BIC","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020002","Wellmark Value Silver 4000","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020002-01","Wellmark Value Silver 4000","Standard Silver On Exchange Plan","69.05%","0.699665665626526","Yes","Yes","No","100%",,"$4,000","$110","$820","$150","$20","$1,680","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CI7&d=BIB","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020002","Wellmark Value Silver 4000","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020002-02","Wellmark Value Silver 4000","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CPI&d=BVI","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020002","Wellmark Value Silver 4000","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020002-03","Wellmark Value Silver 4000","Limited Cost Sharing Plan Variation","69.05%","0.699665665626526","Yes","Yes","No","100%",,"$4,000","$110","$820","$150","$20","$1,680","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CTI&d=BYI","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020002","Wellmark Value Silver 4000","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020002-04","Wellmark Value Silver 4000","73% AV Level Silver Plan","73.00%","0.746724903583527","Yes","Yes","No","100%",,"$4,000","$80","$820","$150","$20","$1,590","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CIG&d=B4I","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020002","Wellmark Value Silver 4000","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020002-05","Wellmark Value Silver 4000","87% AV Level Silver Plan","86.22%","0.864419281482697","Yes","Yes","No","100%",,"$1,250","$70","$550","$150","$20","$1,310","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CIH&d=B5I","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0020002","Wellmark Value Silver 4000","74406IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0020002-06","Wellmark Value Silver 4000","94% AV Level Silver Plan","93.20%","0.933623790740967","Yes","Yes","No","100%",,"$760","$40","$0","$150","$20","$780","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=C2I&d=B6I","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0030001","Wellmark Value Gold 2000","74406IA003",,"IAN001","IAS003","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0030001-00","Wellmark Value Gold 2000","Standard Gold Off Exchange Plan",,"0.787313520908356","Yes","Yes","No","100%",,"$2,000","$70","$950","$150","$20","$1,310","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CIC&d=BIG","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0030001","Wellmark Value Gold 2000","74406IA003",,"IAN001","IAS003","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0030001-01","Wellmark Value Gold 2000","Standard Gold On Exchange Plan",,"0.787313520908356","Yes","Yes","No","100%",,"$2,000","$70","$950","$150","$20","$1,310","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CIB&d=BIF","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0030001","Wellmark Value Gold 2000","74406IA003",,"IAN001","IAS003","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0030001-02","Wellmark Value Gold 2000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CRI&d=BWI","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","74406","SERFF","2017-01-23 20:15:25","Individual","No","38-3988543","74406IA0030001","Wellmark Value Gold 2000","74406IA003",,"IAN001","IAS003","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","74406IA0030001-03","Wellmark Value Gold 2000","Limited Cost Sharing Plan Variation",,"0.787313520908356","Yes","Yes","No","100%",,"$2,000","$70","$950","$150","$20","$1,310","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=DXI&d=5IT","https://www.wellmark.com/-/media/BE9B82C2509D41F6AA4064721E05F28E.ashx"
"2017","IA","77847","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","57-0523959","77847IA0020001","Group Dental Policy","77847IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","77847IA0020001-00","Group Dental Policy","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060004","Sanford Simplicity $4,500","85930IA006",,"IAN001","IAS001","IAF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060004-00","Sanford Simplicity $4,500","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$3,600","$0","$400","$200","$4,500","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060004","Sanford Simplicity $4,500","85930IA006",,"IAN001","IAS001","IAF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060004-01","Sanford Simplicity $4,500","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$3,600","$0","$400","$200","$4,500","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060005","Sanford Simplicity $6,000","85930IA006",,"IAN001","IAS001","IAF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060005-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan",,"0.618333578109741","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060005","Sanford Simplicity $6,000","85930IA006",,"IAN001","IAS001","IAF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060005-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan",,"0.618333578109741","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060008","Sanford Simplicity $2,700","85930IA006",,"IAN001","IAS001","IAF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060008-00","Sanford Simplicity $2,700","Standard Silver Off Exchange Plan",,"0.697694897651672","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060008","Sanford Simplicity $2,700","85930IA006",,"IAN001","IAS001","IAF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060008-01","Sanford Simplicity $2,700","Standard Silver On Exchange Plan",,"0.697694897651672","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060003","Sanford Simplicity $3,500","85930IA006",,"IAN001","IAS001","IAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060003-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060003","Sanford Simplicity $3,500","85930IA006",,"IAN001","IAS001","IAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060003-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060007","Sanford Simplicity $1,250","85930IA006",,"IAN001","IAS001","IAF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060007-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.798427879810333","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$700","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-00","Medica Insure Silver H S A","Standard Silver Off Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-01","Medica Insure Silver H S A","Standard Silver On Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-02","Medica Insure Silver H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHIAZ&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-03","Medica Insure Silver H S A","Limited Cost Sharing Plan Variation",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHIAL&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-04","Medica Insure Silver H S A","73% AV Level Silver Plan",,"0.738642454147339","Yes","Yes","No","100%",,"$1,100","$0","$1,300","$1,000","$1,100","$0","$1,300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$3300 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHIA73&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-05","Medica Insure Silver H S A","87% AV Level Silver Plan",,"0.87436580657959","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHIA87&uid=FFM",
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060007","Sanford Simplicity $1,250","85930IA006",,"IAN001","IAS001","IAF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060007-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.798427879810333","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$700","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060001","Sanford Simplicity $500","85930IA006",,"IAN001","IAS001","IAF004","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060001-00","Sanford Simplicity $500","Standard Platinum Off Exchange Plan",,"0.904879629611969","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","85930","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","91-1842494","85930IA0060001","Sanford Simplicity $500","85930IA006",,"IAN001","IAS001","IAF004","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060001-01","Sanford Simplicity $500","Standard Platinum On Exchange Plan",,"0.904879629611969","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2017/sg_ia_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2017.pdf"
"2017","IA","86010","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-0883760","86010IA0040002","EHB High PPO","86010IA004",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86010IA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IA","86010","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-0883760","86010IA0040001","EHB Low PPO","86010IA004",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86010IA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IA","86010","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-0883760","86010IA0030002","EHB High Passive","86010IA003",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86010IA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IA","86010","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-0883760","86010IA0030001","EHB Low Passive","86010IA003",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86010IA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","37-1800647","87928IA0080001","Wellmark Synergy Silver 4250","87928IA008",,"IAN001","IAS002","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No",,"http://www.wellmark.com","87928IA0080001-00","Wellmark Synergy Silver 4250","Standard Silver Off Exchange Plan",,"0.690493166446686","Yes","Yes","No","100%",,"$4,250","$160","$990","$150","$20","$2,160","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=9IK&d=AEI","https://www.wellmark.com/-/media/CD5ED83221DC4FDE8F622453F69A44F1.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0010001","Wellmark Synergy Bronze 6500","87928IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0010001-00","Wellmark Synergy Bronze 6500","Standard Bronze Off Exchange Plan",,"0.61035031080246","Yes","Yes","No","100%",,"$6,500","$20","$330","$150","$3,310","$1,250","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=AIF&d=AIU","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0010001","Wellmark Synergy Bronze 6500","87928IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0010001-01","Wellmark Synergy Bronze 6500","Standard Bronze On Exchange Plan",,"0.61035031080246","Yes","Yes","No","100%",,"$6,500","$20","$330","$150","$3,310","$1,250","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=AIE&d=AIT","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","37-1800647","87928IA0080001","Wellmark Synergy Silver 4250","87928IA008",,"IAN001","IAS002","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No",,"http://www.wellmark.com","87928IA0080001-01","Wellmark Synergy Silver 4250","Standard Silver On Exchange Plan",,"0.690493166446686","Yes","Yes","No","100%",,"$4,250","$160","$990","$150","$20","$2,160","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=9IL&d=AGI","https://www.wellmark.com/-/media/CD5ED83221DC4FDE8F622453F69A44F1.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","37-1800647","87928IA0090001","Wellmark Synergy Gold 2150","87928IA009",,"IAN001","IAS002","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No",,"http://www.wellmark.com","87928IA0090001-00","Wellmark Synergy Gold 2150","Standard Gold Off Exchange Plan",,"0.78184050321579","Yes","Yes","No","100%",,"$2,150","$140","$920","$150","$20","$1,650","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=9IM&d=AHI","https://www.wellmark.com/-/media/CD5ED83221DC4FDE8F622453F69A44F1.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0020001","Wellmark Synergy Silver 3000","87928IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0020001-00","Wellmark Synergy Silver 3000","Standard Silver Off Exchange Plan","71.88%","0.726229012012482","Yes","Yes","No","100%",,"$3,000","$110","$1,120","$150","$20","$1,810","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=BIU&d=AIY","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0020001","Wellmark Synergy Silver 3000","87928IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0020001-01","Wellmark Synergy Silver 3000","Standard Silver On Exchange Plan","71.88%","0.726229012012482","Yes","Yes","No","100%",,"$3,000","$110","$1,120","$150","$20","$1,810","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=BIT&d=AIX","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0020001","Wellmark Synergy Silver 3000","87928IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0020001-02","Wellmark Synergy Silver 3000","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CEI&d=BKI","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0020001","Wellmark Synergy Silver 3000","87928IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0020001-03","Wellmark Synergy Silver 3000","Limited Cost Sharing Plan Variation","71.88%","0.726229012012482","Yes","Yes","No","100%",,"$3,000","$110","$1,120","$150","$20","$1,810","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=BIV&d=AIZ","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0020001","Wellmark Synergy Silver 3000","87928IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0020001-04","Wellmark Synergy Silver 3000","73% AV Level Silver Plan","73.88%","0.745771408081055","Yes","Yes","No","100%",,"$3,000","$110","$1,120","$150","$20","$1,810","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=BIW&d=BI2","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0020001","Wellmark Synergy Silver 3000","87928IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0020001-05","Wellmark Synergy Silver 3000","87% AV Level Silver Plan","86.02%","0.862776756286621","Yes","Yes","No","100%",,"$1,250","$60","$690","$150","$20","$1,090","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=BIY&d=BI4","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0020001","Wellmark Synergy Silver 3000","87928IA002",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0020001-06","Wellmark Synergy Silver 3000","94% AV Level Silver Plan","93.00%","0.931683838367462","Yes","Yes","No","100%",,"$810","$40","$0","$150","$20","$760","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CCI&d=BHI","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0030001","Wellmark Synergy Gold 2500","87928IA003",,"IAN001","IAS002","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0030001-00","Wellmark Synergy Gold 2500","Standard Gold Off Exchange Plan",,"0.784531772136688","Yes","Yes","No","100%",,"$2,500","$120","$420","$150","$20","$1,830","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CJI&d=BQI","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0030001","Wellmark Synergy Gold 2500","87928IA003",,"IAN001","IAS002","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0030001-01","Wellmark Synergy Gold 2500","Standard Gold On Exchange Plan",,"0.784531772136688","Yes","Yes","No","100%",,"$2,500","$120","$420","$150","$20","$1,830","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CHI&d=BNI","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0030001","Wellmark Synergy Gold 2500","87928IA003",,"IAN001","IAS002","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0030001-02","Wellmark Synergy Gold 2500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=BIZ&d=BI5","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","87928","SERFF","2017-01-23 20:15:25","Individual","No","37-1800647","87928IA0030001","Wellmark Synergy Gold 2500","87928IA003",,"IAN001","IAS002","IAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2017-01-01",,"Yes","Accidental injury and emergency services only","Yes","Accidental injury and emergency services only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.wellmark.com","87928IA0030001-03","Wellmark Synergy Gold 2500","Limited Cost Sharing Plan Variation",,"0.784531772136688","Yes","Yes","No","100%",,"$2,500","$120","$420","$150","$20","$1,830","$0","$160","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.wellmark.com/sbcfinder/sbc.aspx?yr=2017&h=CKI&d=BRI","https://www.wellmark.com/-/media/3A8E50E9BD4D4AEC92C869249B5AA80D.ashx"
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-01","Medica Insure Silver Copay","Standard Silver On Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-02","Medica Insure Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCIAZ&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS002","IAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010019-00","Medica Insure Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IGPCIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS002","IAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010019-01","Medica Insure Gold Copay Plus","Standard Gold On Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IGPCIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS002","IAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010019-02","Medica Insure Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IGPCIAZ&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS002","IAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010019-03","Medica Insure Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IGPCIAL&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-00","Medica Insure Silver Copay","Standard Silver Off Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-03","Medica Insure Silver Copay","Limited Cost Sharing Plan Variation",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCIAL&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-04","Medica Insure Silver Copay","73% AV Level Silver Plan",,"0.73963475227356","Yes","Yes","No","100%",,"$2,400","$10","$900","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCIA73&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-05","Medica Insure Silver Copay","87% AV Level Silver Plan",,"0.875553548336029","Yes","Yes","No","100%",,"$400","$10","$1,000","$1,000","$400","$400","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCIA87&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-06","Medica Insure Silver Copay","94% AV Level Silver Plan",,"0.934451282024384","Yes","Yes","No","100%",,"$100","$10","$300","$1,000","$100","$400","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCIA94&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-06","Medica Insure Silver H S A","94% AV Level Silver Plan",,"0.941599547863007","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHIA94&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010005-00","Medica Insure Bronze Copay","Standard Bronze Off Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBCIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010005-01","Medica Insure Bronze Copay","Standard Bronze On Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBCIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010005-02","Medica Insure Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBCIAZ&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010005-03","Medica Insure Bronze Copay","Limited Cost Sharing Plan Variation",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBCIAL&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze H S A","93078IA001",,"IAN001","IAS001","IAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010011-00","Medica Insure Bronze H S A","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBHIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze H S A","93078IA001",,"IAN001","IAS001","IAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010011-01","Medica Insure Bronze H S A","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBHIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze H S A","93078IA001",,"IAN001","IAS001","IAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010011-02","Medica Insure Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBHIAZ&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze H S A","93078IA001",,"IAN001","IAS001","IAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010011-03","Medica Insure Bronze H S A","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBHIAL&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010013","Medica Insure Catastrophic","93078IA001",,"IAN001","IAS001","IAF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010013-00","Medica Insure Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICIA&uid=FFM",
"2017","IA","93078","SERFF","2016-10-18 04:56:11","Individual","No","41-1490988","93078IA0010013","Medica Insure Catastrophic","93078IA001",,"IAN001","IAS001","IAF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010013-01","Medica Insure Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICIA&uid=FFM",
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310066","POS 5000a Elite Bronze","20129IL031","7740283974","ILN001","ILS001","ILF004","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310066-00","POS 5000a Elite Bronze","Standard Bronze Off Exchange Plan",,"0.61685973405838","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_5000a_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_5000a_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310066","POS 5000a Elite Bronze","20129IL031","7740283974","ILN001","ILS001","ILF004","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310066-01","POS 5000a Elite Bronze","Standard Bronze On Exchange Plan",,"0.61685973405838","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_5000a_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_5000a_Elite_Bronze.pdf"
"2017","IL","18715","SERFF","2016-11-22 20:15:54","Individual","Yes","75-1233841","18715IL0010010","Dentegra Dental PPO Pediatric Basic Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2107-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010010-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010010-17"
"2017","IL","18715","SERFF","2016-11-22 20:15:54","Individual","Yes","75-1233841","18715IL0010011","Dentegra Dental PPO Family Basic Plan","18715IL001",,"ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010011-17"
"2017","IL","18715","SERFF","2016-11-22 20:15:54","Individual","Yes","75-1233841","18715IL0010012","Dentegra Dental PPO Family Preferred Plan","18715IL001",,"ILN001","ILS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010012-17"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320051","HMO 4000 Elite Bronze","20129IL032","7740283974","ILN001","ILS001","ILF002","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320051-00","HMO 4000 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.618059635162354","Yes","Yes","No","100%",,"$4,000","$20","$1,400","$200","$4,000","$200","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_HMO_4000_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_HMO_4000_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320051","HMO 4000 Elite Bronze","20129IL032","7740283974","ILN001","ILS001","ILF002","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320051-01","HMO 4000 Elite Bronze","Standard Bronze On Exchange Plan",,"0.618059635162354","Yes","Yes","No","100%",,"$4,000","$20","$1,400","$200","$4,000","$200","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_HMO_4000_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_HMO_4000_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310065","POS 3750c Elite Bronze","20129IL031","7740283974","ILN001","ILS001","ILF019","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310065-00","POS 3750c Elite Bronze","Standard Bronze Off Exchange Plan",,"0.616886794567108","Yes","Yes","No","100%",,"$3,750","$0","$1,400","$200","$3,750","$0","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_3750c_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_3750c_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310065","POS 3750c Elite Bronze","20129IL031","7740283974","ILN001","ILS001","ILF019","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310065-01","POS 3750c Elite Bronze","Standard Bronze On Exchange Plan",,"0.616886794567108","Yes","Yes","No","100%",,"$3,750","$0","$1,400","$200","$3,750","$0","$600","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_3750c_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_3750c_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320052","HMO 4200 Elite Bronze","20129IL032","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320052-00","HMO 4200 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.613476395606995","Yes","Yes","No","100%",,"$4,200","$0","$1,300","$200","$4,200","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_HMO_4200_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_HMO_4200_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320052","HMO 4200 Elite Bronze","20129IL032","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320052-01","HMO 4200 Elite Bronze","Standard Bronze On Exchange Plan",,"0.613476395606995","Yes","Yes","No","100%",,"$4,200","$0","$1,300","$200","$4,200","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_HMO_4200_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_HMO_4200_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0280044","POS HSA 6550 Elite Bronze","20129IL028","7740283974","ILN001","ILS001","ILF001","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0280044-00","POS HSA 6550 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,975","$22975 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_HSA_6550_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_HSA_6550_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0280044","POS HSA 6550 Elite Bronze","20129IL028","7740283974","ILN001","ILS001","ILF001","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0280044-01","POS HSA 6550 Elite Bronze","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,975","$22975 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB__SBC_POS_HSA_6550_Elite_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_HSA_6550_Elite_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310068","POS 6000a Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF008","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310068-00","POS 6000a Elite Silver","Standard Silver Off Exchange Plan",,"0.706432700157166","No","Yes","No","100%",,"$4,200","$300","$0","$200","$700","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_6000a_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_6000a_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310068","POS 6000a Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF008","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310068-01","POS 6000a Elite Silver","Standard Silver On Exchange Plan",,"0.706432700157166","No","Yes","No","100%",,"$4,200","$300","$0","$200","$700","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_6000a_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_6000a_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0280045","POS HSA 6550 Methodist Bronze","20129IL028","7740283974","ILN002","ILS002","ILF001","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0280045-00","POS HSA 6550 Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,975","$22975 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_HSA_6550_Methodist_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_HSA_6550_Methodist_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0280045","POS HSA 6550 Methodist Bronze","20129IL028","7740283974","ILN002","ILS002","ILF001","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0280045-01","POS HSA 6550 Methodist Bronze","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,975","$22975 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_HSA_6550_Methodist_Bronze.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_HSA_6550_Methodist_Bronze.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310067","POS 2700 Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF020","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310067-00","POS 2700 Elite Silver","Standard Silver Off Exchange Plan",,"0.709729969501495","No","Yes","No","100%",,"$2,700","$20","$1,300","$200","$700","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group","$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$16200 per person","$16200 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_2700_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_2700_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310067","POS 2700 Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF020","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310067-01","POS 2700 Elite Silver","Standard Silver On Exchange Plan",,"0.709729969501495","No","Yes","No","100%",,"$2,700","$20","$1,300","$200","$700","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group","$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$16200 per person","$16200 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_2700_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_2700_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320053","HMO 3000a Elite Silver","20129IL032","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320053-00","HMO 3000a Elite Silver","Standard Silver Off Exchange Plan",,"0.708269476890564","No","Yes","No","100%",,"$3,000","$20","$1,200","$200","$700","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_HMO_3000a_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_HMO_3000a_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320053","HMO 3000a Elite Silver","20129IL032","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320053-01","HMO 3000a Elite Silver","Standard Silver On Exchange Plan",,"0.708269476890564","No","Yes","No","100%",,"$3,000","$20","$1,200","$200","$700","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_HMO_3000a_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_HMO_3000a_Elite_Silver.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-00","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140003-00.pdf","https://api.centene.com/Brochures/2017/27833IL0140003-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-01","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140003-01.pdf","https://api.centene.com/Brochures/2017/27833IL0140003-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-02","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140003-02.pdf","https://api.centene.com/Brochures/2017/27833IL0140003-02.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320054","HMO 3000a Methodist Silver","20129IL032","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320054-00","HMO 3000a Methodist Silver","Standard Silver Off Exchange Plan",,"0.708269476890564","No","Yes","No","100%",,"$3,000","$20","$1,200","$200","$700","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_HMO_3000a_Methodist_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_HMO_3000a_Methodist_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320054","HMO 3000a Methodist Silver","20129IL032","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320054-01","HMO 3000a Methodist Silver","Standard Silver On Exchange Plan",,"0.708269476890564","No","Yes","No","100%",,"$3,000","$20","$1,200","$200","$700","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_HMO_3000a_Methodist_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_HMO_3000a_Methodist_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0350028","PPO 3750 Elite Silver","20129IL035","7740283974","ILN001","ILS001","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0350028-00","PPO 3750 Elite Silver","Standard Silver Off Exchange Plan",,"0.70611172914505","No","Yes","No","100%",,"$3,750","$10","$600","$200","$700","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$39600 per group","$19,800","$19800 per person","$52800 per group","$3,750","$3750 per person","$6750 per group","20.00%",,,,,"$6,750","$6750 per person","$20250 per group","$10,500","$10500 per person","$27000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_PPO_3750_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_PPO_3750_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0350028","PPO 3750 Elite Silver","20129IL035","7740283974","ILN001","ILS001","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0350028-01","PPO 3750 Elite Silver","Standard Silver On Exchange Plan",,"0.70611172914505","No","Yes","No","100%",,"$3,750","$10","$600","$200","$700","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$39600 per group","$19,800","$19800 per person","$52800 per group","$3,750","$3750 per person","$6750 per group","20.00%",,,,,"$6,750","$6750 per person","$20250 per group","$10,500","$10500 per person","$27000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_PPO_3750_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_PPO_3750_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0350029","PPO 4500a Elite Silver","20129IL035","7740283974","ILN001","ILS001","ILF020","New","PPO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0350029-00","PPO 4500a Elite Silver","Standard Silver Off Exchange Plan",,"0.709293484687805","No","Yes","No","100%",,"$4,200","$300","$500","$200","$700","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$13200 per group",,,,"$15,000","$15000 per person","$45000 per group","$21,100","$21100 per person","$58200 per group","$4,500","$4500 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$38100 per group","$17,200","$17200 per person","$50800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_PPO_4500a_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_PPO_4500a_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0350029","PPO 4500a Elite Silver","20129IL035","7740283974","ILN001","ILS001","ILF020","New","PPO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0350029-01","PPO 4500a Elite Silver","Standard Silver On Exchange Plan",,"0.709293484687805","No","Yes","No","100%",,"$4,200","$300","$500","$200","$700","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$13200 per group",,,,"$15,000","$15000 per person","$45000 per group","$21,100","$21100 per person","$58200 per group","$4,500","$4500 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$38100 per group","$17,200","$17200 per person","$50800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_PPO_4500a_Elite_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_PPO_4500a_Elite_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310069","POS 6000a Methodist Silver","20129IL031","7740283974","ILN002","ILS002","ILF008","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310069-00","POS 6000a Methodist Silver","Standard Silver Off Exchange Plan",,"0.706432700157166","No","Yes","No","100%",,"$4,200","$300","$0","$200","$700","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_6000a_Methodist_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_6000a_Methodist_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310069","POS 6000a Methodist Silver","20129IL031","7740283974","ILN002","ILS002","ILF008","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310069-01","POS 6000a Methodist Silver","Standard Silver On Exchange Plan",,"0.706432700157166","No","Yes","No","100%",,"$4,200","$300","$0","$200","$700","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_6000a_Methodist_Silver.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_6000a_Methodist_Silver.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310070","POS 2000 Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF021","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310070-00","POS 2000 Elite Gold","Standard Gold Off Exchange Plan",,"0.795616209506989","No","Yes","No","100%",,"$2,000","$10","$700","$200","$700","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$28000 per group","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"$4,000","$4000 per person","$12000 per group","$6,000","$6000 per person","$16000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_2000_Elite_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_2000_Elite_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310070","POS 2000 Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF021","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310070-01","POS 2000 Elite Gold","Standard Gold On Exchange Plan",,"0.795616209506989","No","Yes","No","100%",,"$2,000","$10","$700","$200","$700","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$28000 per group","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"$4,000","$4000 per person","$12000 per group","$6,000","$6000 per person","$16000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_2000_Elite_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_2000_Elite_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320055","HMO 2000 Elite Gold","20129IL032","7740283974","ILN001","ILS001","ILF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320055-00","HMO 2000 Elite Gold","Standard Gold Off Exchange Plan",,"0.795504808425903","No","Yes","No","100%",,"$2,000","$20","$500","$200","$700","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_HMO_2000_Elite_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_HMO_2000_Elite_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0320055","HMO 2000 Elite Gold","20129IL032","7740283974","ILN001","ILS001","ILF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0320055-01","HMO 2000 Elite Gold","Standard Gold On Exchange Plan",,"0.795504808425903","No","Yes","No","100%",,"$2,000","$20","$500","$200","$700","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_HMO_2000_Elite_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_HMO_2000_Elite_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310071","POS 2750 Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF021","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310071-00","POS 2750 Elite Gold","Standard Gold Off Exchange Plan",,"0.790573477745056","No","Yes","No","100%",,"$2,750","$10","$400","$200","$700","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"$5,500","$5500 per person","$16500 per group","$8,250","$8250 per person","$22000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_2750_Elite_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_2750_Elite_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310071","POS 2750 Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF021","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310071-01","POS 2750 Elite Gold","Standard Gold On Exchange Plan",,"0.790573477745056","No","Yes","No","100%",,"$2,750","$10","$400","$200","$700","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"$5,500","$5500 per person","$16500 per group","$8,250","$8250 per person","$22000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_2750_Elite_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_2750_Elite_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310072","POS 2750 Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF021","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310072-00","POS 2750 Methodist Gold","Standard Gold Off Exchange Plan",,"0.790573477745056","No","Yes","No","100%",,"$2,750","$10","$400","$200","$700","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$31500 per group","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"$5,500","$5500 per person","$16500 per group","$8,250","$8250 per person","$22000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_POS_2750_Methodist_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_POS_2750_Methodist_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0310072","POS 2750 Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF021","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0310072-01","POS 2750 Methodist Gold","Standard Gold On Exchange Plan",,"0.790573477745056","No","Yes","No","100%",,"$2,750","$10","$400","$200","$700","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$31500 per group","$2,750","$2750 per person","$5500 per group","10.00%",,,,,"$5,500","$5500 per person","$16500 per group","$8,250","$8250 per person","$22000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_POS_2750_Methodist_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_POS_2750_Methodist_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0350030","PPO 3250b Elite Gold","20129IL035","7740283974","ILN001","ILS001","ILF008","New","PPO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0350030-00","PPO 3250b Elite Gold","Standard Gold Off Exchange Plan",,"0.797455608844757","No","Yes","No","100%",,"$3,250","$0","$0","$200","$700","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$12,000","$12000 per person","$24000 per group","$15,320","$15320 per person","$30500 per group","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$19500 per group","$9,750","$9750 per person","$26000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SBC_PPO_3250b_Elite_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_DIR_SOB_PPO_3250b_Elite_Gold.pdf"
"2017","IL","20129","SERFF","2016-10-13 03:13:09","SHOP (Small Group)","No","37-1260731","20129IL0350030","PPO 3250b Elite Gold","20129IL035","7740283974","ILN001","ILS001","ILF008","New","PPO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.995284611236375",,,"2017-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2016.pdf","20129IL0350030-01","PPO 3250b Elite Gold","Standard Gold On Exchange Plan",,"0.797455608844757","No","Yes","No","100%",,"$3,250","$0","$0","$200","$700","$700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$12,000","$12000 per person","$24000 per group","$15,320","$15320 per person","$30500 per group","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$19500 per group","$9,750","$9750 per person","$26000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SBC_PPO_3250b_Elite_Gold.pdf","https://www.healthalliance.org/docs/2017_IL_GRP_PUB_SOB_PPO_3250b_Elite_Gold.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-04","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140002-04.pdf","https://api.centene.com/Brochures/2017/27833IL0140002-04.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-05","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140002-05.pdf","https://api.centene.com/Brochures/2017/27833IL0140002-05.pdf"
"2017","IL","20545","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","57-0523959","20545IL0030001","Group Dental Policy","20545IL003",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","20545IL0030001-00","Group Dental Policy","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$100 per group",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140001-00","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","Standard Gold Off Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/27833IL0140001-00.pdf","https://api.centene.com/Brochures/2017/27833IL0140001-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140001-01","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","Standard Gold On Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/27833IL0140001-01.pdf","https://api.centene.com/Brochures/2017/27833IL0140001-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140001-02","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/27833IL0140001-02.pdf","https://api.centene.com/Brochures/2017/27833IL0140001-02.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140001-03","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/27833IL0140001-03.pdf","https://api.centene.com/Brochures/2017/27833IL0140001-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-00","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140002-00.pdf","https://api.centene.com/Brochures/2017/27833IL0140002-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-01","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140002-01.pdf","https://api.centene.com/Brochures/2017/27833IL0140002-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-02","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140002-02.pdf","https://api.centene.com/Brochures/2017/27833IL0140002-02.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-03","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140002-03.pdf","https://api.centene.com/Brochures/2017/27833IL0140002-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-06","Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140002-06.pdf","https://api.centene.com/Brochures/2017/27833IL0140002-06.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-03","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140003-03.pdf","https://api.centene.com/Brochures/2017/27833IL0140003-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-04","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140003-04.pdf","https://api.centene.com/Brochures/2017/27833IL0140003-04.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-05","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140003-05.pdf","https://api.centene.com/Brochures/2017/27833IL0140003-05.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-06","Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140003-06.pdf","https://api.centene.com/Brochures/2017/27833IL0140003-06.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140007-00","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140007-00.pdf","https://api.centene.com/Brochures/2017/27833IL0140007-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140007-01","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140007-01.pdf","https://api.centene.com/Brochures/2017/27833IL0140007-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140007-02","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140007-02.pdf","https://api.centene.com/Brochures/2017/27833IL0140007-02.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140007-03","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140007-03.pdf","https://api.centene.com/Brochures/2017/27833IL0140007-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140007-04","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140007-04.pdf","https://api.centene.com/Brochures/2017/27833IL0140007-04.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140007-05","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140007-05.pdf","https://api.centene.com/Brochures/2017/27833IL0140007-05.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140007-06","Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140007-06.pdf","https://api.centene.com/Brochures/2017/27833IL0140007-06.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF006","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140008-00","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140008-00.pdf","https://api.centene.com/Brochures/2017/27833IL0140008-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF006","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140008-01","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140008-01.pdf","https://api.centene.com/Brochures/2017/27833IL0140008-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF006","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140008-02","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140008-02.pdf","https://api.centene.com/Brochures/2017/27833IL0140008-02.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF006","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140008-03","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140008-03.pdf","https://api.centene.com/Brochures/2017/27833IL0140008-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF006","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140008-04","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$400","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140008-04.pdf","https://api.centene.com/Brochures/2017/27833IL0140008-04.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF006","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140008-05","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$900","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140008-05.pdf","https://api.centene.com/Brochures/2017/27833IL0140008-05.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF006","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140008-06","Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$300","$200","$250","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140008-06.pdf","https://api.centene.com/Brochures/2017/27833IL0140008-06.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140009-00","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140009-00.pdf","https://api.centene.com/Brochures/2017/27833IL0140009-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140009-01","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140009-01.pdf","https://api.centene.com/Brochures/2017/27833IL0140009-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140009-02","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140009-02.pdf","https://api.centene.com/Brochures/2017/27833IL0140009-02.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140009-03","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.680805623531342","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140009-03.pdf","https://api.centene.com/Brochures/2017/27833IL0140009-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140009-04","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","73% AV Level Silver Plan",,"0.732531428337097","Yes","Yes","No","100%",,"$5,200","$40","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140009-04.pdf","https://api.centene.com/Brochures/2017/27833IL0140009-04.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140009-05","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","87% AV Level Silver Plan",,"0.865934371948242","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140009-05.pdf","https://api.centene.com/Brochures/2017/27833IL0140009-05.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140009-06","Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network","94% AV Level Silver Plan",,"0.947982847690582","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0140009-06.pdf","https://api.centene.com/Brochures/2017/27833IL0140009-06.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9051",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-00","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150001-00.pdf","https://api.centene.com/Brochures/2017/27833IL0150001-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9051",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-01","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150001-01.pdf","https://api.centene.com/Brochures/2017/27833IL0150001-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9051",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-02","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150001-02.pdf","https://api.centene.com/Brochures/2017/27833IL0150001-02.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9051",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-03","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150001-03.pdf","https://api.centene.com/Brochures/2017/27833IL0150001-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9051",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-04","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150001-04.pdf","https://api.centene.com/Brochures/2017/27833IL0150001-04.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9051",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-05","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150001-05.pdf","https://api.centene.com/Brochures/2017/27833IL0150001-05.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9051",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-06","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150001-06.pdf","https://api.centene.com/Brochures/2017/27833IL0150001-06.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.908",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-00","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150002-00.pdf","https://api.centene.com/Brochures/2017/27833IL0150002-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.908",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-01","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150002-01.pdf","https://api.centene.com/Brochures/2017/27833IL0150002-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.908",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-02","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150002-02.pdf","https://api.centene.com/Brochures/2017/27833IL0150002-02.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.908",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-03","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150002-03.pdf","https://api.centene.com/Brochures/2017/27833IL0150002-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.908",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-04","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150002-04.pdf","https://api.centene.com/Brochures/2017/27833IL0150002-04.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.908",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-05","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150002-05.pdf","https://api.centene.com/Brochures/2017/27833IL0150002-05.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.908",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-06","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150002-06.pdf","https://api.centene.com/Brochures/2017/27833IL0150002-06.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.8949",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150004-00","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150004-00.pdf","https://api.centene.com/Brochures/2017/27833IL0150004-00.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.8949",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150004-01","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150004-01.pdf","https://api.centene.com/Brochures/2017/27833IL0150004-01.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.8949",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150004-02","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150004-02.pdf","https://api.centene.com/Brochures/2017/27833IL0150004-02.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.8949",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150004-03","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.695013582706451","Yes","Yes","No","100%",,"$3,000","$800","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150004-03.pdf","https://api.centene.com/Brochures/2017/27833IL0150004-03.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.8949",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150004-04","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","73% AV Level Silver Plan",,"0.73909205198288","Yes","Yes","No","100%",,"$1,250","$800","$0","$200","$1,250","$1,100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150004-04.pdf","https://api.centene.com/Brochures/2017/27833IL0150004-04.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.8949",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150004-05","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","87% AV Level Silver Plan",,"0.877092719078064","Yes","Yes","No","100%",,"$250","$200","$100","$200","$250","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150004-05.pdf","https://api.centene.com/Brochures/2017/27833IL0150004-05.pdf"
"2017","IL","27833","SERFF","2016-09-29 04:19:41","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.8949",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150004-06","Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network","94% AV Level Silver Plan",,"0.948654651641846","Yes","Yes","No","100%",,"$0","$50","$200","$200","$0","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$425 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/27833IL0150004-06.pdf","https://api.centene.com/Brochures/2017/27833IL0150004-06.pdf"
"2017","IL","30680","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","30680IL0040002","EHB High PPO","30680IL004",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IL","30680","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","30680IL0040001","EHB Low PPO","30680IL004",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820048","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS072","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998875071265258",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820048-00","Blue Precision Bronze HMO 008","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","30680","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","30680IL0030002","EHB High Passive","30680IL003",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IL","30680","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","30680IL0030001","EHB Low Passive","30680IL003",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","Yes","36-1236610","36096IL0830001","BlueCare Dental? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820033","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS012","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998884978518095",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820033-00","Blue Precision Bronze HMO 008","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810039","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS012","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810039-00","Blue Precision Bronze HMO? 103","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810039","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS012","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810039-01","Blue Precision Bronze HMO? 103","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820033","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS012","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998884978518095",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820033-01","Blue Precision Bronze HMO 008","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810055","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS032","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810055-03","Blue Precision Bronze HMO? 103","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820048","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS072","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998875071265258",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820048-01","Blue Precision Bronze HMO 008","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820053","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS082","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998954418242838",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820053-00","Blue Precision Bronze HMO 008","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","Yes","36-1236610","36096IL0830001","BlueCare Dental? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820044","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS022","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998873739805303",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820044-00","Blue Precision Bronze HMO 008","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810039","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS012","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810039-02","Blue Precision Bronze HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810039","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS012","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810039-03","Blue Precision Bronze HMO? 103","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820044","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS022","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998873739805303",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820044-01","Blue Precision Bronze HMO 008","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820045","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS032","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998885790434778",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820045-00","Blue Precision Bronze HMO 008","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810054","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS022","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810054-00","Blue Precision Bronze HMO? 103","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810054","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS022","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810054-01","Blue Precision Bronze HMO? 103","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820045","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS032","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998885790434778",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820045-01","Blue Precision Bronze HMO 008","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820046","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS042","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998878123039334",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820046-00","Blue Precision Bronze HMO 008","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810054","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS022","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810054-02","Blue Precision Bronze HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810054","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS022","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810054-03","Blue Precision Bronze HMO? 103","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820046","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS042","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998878123039334",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820046-01","Blue Precision Bronze HMO 008","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820047","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS052","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998914439015716",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820047-00","Blue Precision Bronze HMO 008","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810055","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS032","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810055-00","Blue Precision Bronze HMO? 103","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810055","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS032","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810055-01","Blue Precision Bronze HMO? 103","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820047","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS052","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998914439015716",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820047-01","Blue Precision Bronze HMO 008","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810055","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS032","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810055-02","Blue Precision Bronze HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810038-00","Blue Precision Silver HMO? 102","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810047","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810047-03","Blue Precision Gold HMO? 101","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950007","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950007-01","BlueCare Direct Gold? 101 with Advocate","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950007","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950007-02","BlueCare Direct Gold? 101 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960008","BlueCare Direct Gold 001 with Advocate","36096IL096",,"ILN013","ILS023","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999133432875012",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960008-01","BlueCare Direct Gold 001 with Advocate","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980001","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS011","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980001-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990115","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS071","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990115-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810056","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS042","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810056-00","Blue Precision Bronze HMO? 103","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810056","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS042","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810056-01","Blue Precision Bronze HMO? 103","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820053","Blue Precision Bronze HMO 008","36096IL082",,"ILN012","ILS082","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998954418242838",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820053-01","Blue Precision Bronze HMO 008","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820033-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810051-00","Blue Precision Silver HMO? 102","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000003","Blue FocusCare Silver? 103","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000003-06","Blue FocusCare Silver? 103","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820002","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS012","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999157102234836",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820002-01","Blue Precision Silver HMO 002","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950003","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950003-01","BlueCare Direct Bronze? 103 with Advocate","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950003","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950003-02","BlueCare Direct Bronze? 103 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810056","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS042","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810056-02","Blue Precision Bronze HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810056","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS042","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810056-03","Blue Precision Bronze HMO? 103","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810057","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS052","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810057-00","Blue Precision Bronze HMO? 103","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810057","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS052","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810057-01","Blue Precision Bronze HMO? 103","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810057","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS052","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810057-02","Blue Precision Bronze HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810057","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS052","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810057-03","Blue Precision Bronze HMO? 103","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810058","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS072","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810058-00","Blue Precision Bronze HMO? 103","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810058","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS072","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810058-01","Blue Precision Bronze HMO? 103","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810058","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS072","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810058-02","Blue Precision Bronze HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810058","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS072","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810058-03","Blue Precision Bronze HMO? 103","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810059","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS082","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810059-00","Blue Precision Bronze HMO? 103","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810059","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS082","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810059-01","Blue Precision Bronze HMO? 103","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810059","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS082","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810059-02","Blue Precision Bronze HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810059","Blue Precision Bronze HMO? 103","36096IL081",,"ILN002","ILS082","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810059-03","Blue Precision Bronze HMO? 103","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810039-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000004","Blue FocusCare Bronze? 104","36096IL100",,"ILN007","ILS017","ILF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000004-00","Blue FocusCare Bronze? 104","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000004","Blue FocusCare Bronze? 104","36096IL100",,"ILN007","ILS017","ILF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000004-01","Blue FocusCare Bronze? 104","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000004","Blue FocusCare Bronze? 104","36096IL100",,"ILN007","ILS017","ILF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000004-02","Blue FocusCare Bronze? 104","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000004-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000004","Blue FocusCare Bronze? 104","36096IL100",,"ILN007","ILS017","ILF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000004-03","Blue FocusCare Bronze? 104","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000004-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810038-01","Blue Precision Silver HMO? 102","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810038-02","Blue Precision Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810038-03","Blue Precision Silver HMO? 102","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810038-04","Blue Precision Silver HMO? 102","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810038-05","Blue Precision Silver HMO? 102","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810038-06","Blue Precision Silver HMO? 102","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810048-00","Blue Precision Silver HMO? 102","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810048-01","Blue Precision Silver HMO? 102","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810048-02","Blue Precision Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810048-03","Blue Precision Silver HMO? 102","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810048-04","Blue Precision Silver HMO? 102","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810048-05","Blue Precision Silver HMO? 102","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810048-06","Blue Precision Silver HMO? 102","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810049-00","Blue Precision Silver HMO? 102","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810049-01","Blue Precision Silver HMO? 102","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810049-02","Blue Precision Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810049-03","Blue Precision Silver HMO? 102","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810049-04","Blue Precision Silver HMO? 102","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810049-05","Blue Precision Silver HMO? 102","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810049-06","Blue Precision Silver HMO? 102","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810050-00","Blue Precision Silver HMO? 102","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810050-01","Blue Precision Silver HMO? 102","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810050-02","Blue Precision Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810050-03","Blue Precision Silver HMO? 102","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810050-04","Blue Precision Silver HMO? 102","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810050-05","Blue Precision Silver HMO? 102","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810050-06","Blue Precision Silver HMO? 102","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810051-01","Blue Precision Silver HMO? 102","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810051-02","Blue Precision Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810051-03","Blue Precision Silver HMO? 102","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810051-04","Blue Precision Silver HMO? 102","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810051-05","Blue Precision Silver HMO? 102","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810051-06","Blue Precision Silver HMO? 102","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810052-00","Blue Precision Silver HMO? 102","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810052-01","Blue Precision Silver HMO? 102","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810052-02","Blue Precision Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810052-03","Blue Precision Silver HMO? 102","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810052-04","Blue Precision Silver HMO? 102","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810052-05","Blue Precision Silver HMO? 102","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810052-06","Blue Precision Silver HMO? 102","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810053-00","Blue Precision Silver HMO? 102","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810053-01","Blue Precision Silver HMO? 102","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810053-02","Blue Precision Silver HMO? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810053-03","Blue Precision Silver HMO? 102","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810053-04","Blue Precision Silver HMO? 102","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810053-05","Blue Precision Silver HMO? 102","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810053-06","Blue Precision Silver HMO? 102","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810038-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000003","Blue FocusCare Silver? 103","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000003-00","Blue FocusCare Silver? 103","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000003","Blue FocusCare Silver? 103","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000003-01","Blue FocusCare Silver? 103","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000003","Blue FocusCare Silver? 103","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000003-02","Blue FocusCare Silver? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000003","Blue FocusCare Silver? 103","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000003-03","Blue FocusCare Silver? 103","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000003","Blue FocusCare Silver? 103","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000003-04","Blue FocusCare Silver? 103","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000003","Blue FocusCare Silver? 103","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000003-05","Blue FocusCare Silver? 103","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810037","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810037-00","Blue Precision Gold HMO? 101","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810037","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810037-01","Blue Precision Gold HMO? 101","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810037","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810037-02","Blue Precision Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810037","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS012","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810037-03","Blue Precision Gold HMO? 101","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810042","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810042-00","Blue Precision Gold HMO? 101","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810042","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810042-01","Blue Precision Gold HMO? 101","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810042","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810042-02","Blue Precision Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810042","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS022","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810042-03","Blue Precision Gold HMO? 101","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810043","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810043-00","Blue Precision Gold HMO? 101","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810043","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810043-01","Blue Precision Gold HMO? 101","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810043","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810043-02","Blue Precision Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810043","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS032","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810043-03","Blue Precision Gold HMO? 101","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810044","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810044-00","Blue Precision Gold HMO? 101","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810044","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810044-01","Blue Precision Gold HMO? 101","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810044","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810044-02","Blue Precision Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810044","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS042","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810044-03","Blue Precision Gold HMO? 101","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810045","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810045-00","Blue Precision Gold HMO? 101","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810045","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810045-01","Blue Precision Gold HMO? 101","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810045","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810045-02","Blue Precision Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810045","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS052","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810045-03","Blue Precision Gold HMO? 101","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810046","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810046-00","Blue Precision Gold HMO? 101","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810046","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810046-01","Blue Precision Gold HMO? 101","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810046","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810046-02","Blue Precision Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810046","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS072","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9994",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810046-03","Blue Precision Gold HMO? 101","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810047","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810047-00","Blue Precision Gold HMO? 101","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810047","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810047-01","Blue Precision Gold HMO? 101","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$900","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810047","Blue Precision Gold HMO? 101","36096IL081",,"ILN002","ILS082","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810047-02","Blue Precision Gold HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810037-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000001","Blue FocusCare Gold? 101","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000001-00","Blue FocusCare Gold? 101","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000001","Blue FocusCare Gold? 101","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000001-01","Blue FocusCare Gold? 101","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000001","Blue FocusCare Gold? 101","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000001-02","Blue FocusCare Gold? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000001","Blue FocusCare Gold? 101","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000001-03","Blue FocusCare Gold? 101","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810072","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS012","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810072-00","Blue Precision Silver HMO? 106","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960004","BlueCare Direct Bronze 004 with Advocate","36096IL096",,"ILN013","ILS013","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998761087242328",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960004-00","BlueCare Direct Bronze 004 with Advocate","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","Yes","36-1236610","36096IL0830003","BlueCare Dental 4 Kids? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","Yes","36-1236610","36096IL0830003","BlueCare Dental 4 Kids? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960004","BlueCare Direct Bronze 004 with Advocate","36096IL096",,"ILN013","ILS013","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998761087242328",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960004-01","BlueCare Direct Bronze 004 with Advocate","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810072","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS012","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810072-01","Blue Precision Silver HMO? 106","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810072","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS012","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810072-02","Blue Precision Silver HMO? 106","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960017","BlueCare Direct Bronze 004 with Advocate","36096IL096",,"ILN013","ILS023","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.99874859978367",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960017-00","BlueCare Direct Bronze 004 with Advocate","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960017","BlueCare Direct Bronze 004 with Advocate","36096IL096",,"ILN013","ILS023","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.99874859978367",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960017-01","BlueCare Direct Bronze 004 with Advocate","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810072","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS012","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810072-03","Blue Precision Silver HMO? 106","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810072","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS012","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810072-04","Blue Precision Silver HMO? 106","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960018","BlueCare Direct Bronze 004 with Advocate","36096IL096",,"ILN013","ILS033","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998761989371975",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960018-00","BlueCare Direct Bronze 004 with Advocate","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960018","BlueCare Direct Bronze 004 with Advocate","36096IL096",,"ILN013","ILS033","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998761989371975",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960018-01","BlueCare Direct Bronze 004 with Advocate","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810072","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS012","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810072-05","Blue Precision Silver HMO? 106","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810072","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS012","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810072-06","Blue Precision Silver HMO? 106","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960019","BlueCare Direct Bronze 004 with Advocate","36096IL096",,"ILN013","ILS043","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998753470043705",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960019-00","BlueCare Direct Bronze 004 with Advocate","Standard Bronze Off Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960019","BlueCare Direct Bronze 004 with Advocate","36096IL096",,"ILN013","ILS043","ILF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.998753470043705",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960019-01","BlueCare Direct Bronze 004 with Advocate","Standard Bronze On Exchange Plan","61.51%","0","Yes","Yes","No","100%",,"$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810073","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS022","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810073-00","Blue Precision Silver HMO? 106","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810073","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS022","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810073-01","Blue Precision Silver HMO? 106","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810073","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS022","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810073-02","Blue Precision Silver HMO? 106","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810073","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS022","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810073-03","Blue Precision Silver HMO? 106","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810073","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS022","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810073-04","Blue Precision Silver HMO? 106","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810073","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS022","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810073-05","Blue Precision Silver HMO? 106","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810073","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS022","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810073-06","Blue Precision Silver HMO? 106","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810074","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS032","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810074-00","Blue Precision Silver HMO? 106","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810074","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS032","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810074-01","Blue Precision Silver HMO? 106","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810074","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS032","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810074-02","Blue Precision Silver HMO? 106","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810074","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS032","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810074-03","Blue Precision Silver HMO? 106","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810074","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS032","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810074-04","Blue Precision Silver HMO? 106","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810074","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS032","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810074-05","Blue Precision Silver HMO? 106","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810074","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS032","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810074-06","Blue Precision Silver HMO? 106","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810075","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS042","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810075-00","Blue Precision Silver HMO? 106","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810075","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS042","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810075-01","Blue Precision Silver HMO? 106","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810075","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS042","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810075-02","Blue Precision Silver HMO? 106","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810075","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS042","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810075-03","Blue Precision Silver HMO? 106","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810075","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS042","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810075-04","Blue Precision Silver HMO? 106","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810075","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS042","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810075-05","Blue Precision Silver HMO? 106","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0810075","Blue Precision Silver HMO? 106","36096IL081",,"ILN002","ILS042","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9992",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0810075-06","Blue Precision Silver HMO? 106","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0810072-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000002","Blue FocusCare Silver? 102","36096IL100",,"ILN007","ILS017","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000002-00","Blue FocusCare Silver? 102","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000002","Blue FocusCare Silver? 102","36096IL100",,"ILN007","ILS017","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000002-01","Blue FocusCare Silver? 102","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000002","Blue FocusCare Silver? 102","36096IL100",,"ILN007","ILS017","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000002-02","Blue FocusCare Silver? 102","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000002","Blue FocusCare Silver? 102","36096IL100",,"ILN007","ILS017","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000002-03","Blue FocusCare Silver? 102","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000002","Blue FocusCare Silver? 102","36096IL100",,"ILN007","ILS017","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000002-04","Blue FocusCare Silver? 102","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000002","Blue FocusCare Silver? 102","36096IL100",,"ILN007","ILS017","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000002-05","Blue FocusCare Silver? 102","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL1000002","Blue FocusCare Silver? 102","36096IL100",,"ILN007","ILS017","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL1000002-06","Blue FocusCare Silver? 102","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL1000002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950003","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950003-00","BlueCare Direct Bronze? 103 with Advocate","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820002","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS012","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999157102234836",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820002-00","Blue Precision Silver HMO 002","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","Yes","36-1236610","36096IL0830002","BlueCare Dental? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","Yes","36-1236610","36096IL0830002","BlueCare Dental? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820011","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS022","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999148606357358",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820011-00","Blue Precision Silver HMO 002","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820011","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS022","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999148606357358",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820011-01","Blue Precision Silver HMO 002","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950003","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950003-03","BlueCare Direct Bronze? 103 with Advocate","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950011","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950011-00","BlueCare Direct Bronze? 103 with Advocate","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820012","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS032","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999157716001268",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820012-00","Blue Precision Silver HMO 002","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820012","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS032","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999157716001268",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820012-01","Blue Precision Silver HMO 002","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950011","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950011-01","BlueCare Direct Bronze? 103 with Advocate","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950011","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950011-02","BlueCare Direct Bronze? 103 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820013","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS042","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999151919852415",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820013-00","Blue Precision Silver HMO 002","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820013","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS042","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999151919852415",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820013-01","Blue Precision Silver HMO 002","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950011","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950011-03","BlueCare Direct Bronze? 103 with Advocate","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950012","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950012-00","BlueCare Direct Bronze? 103 with Advocate","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820014","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS052","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999179372826038",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820014-00","Blue Precision Silver HMO 002","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820014","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS052","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999179372826038",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820014-01","Blue Precision Silver HMO 002","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950012","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950012-01","BlueCare Direct Bronze? 103 with Advocate","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950012","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950012-02","BlueCare Direct Bronze? 103 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820015","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS072","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999149612871258",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820015-00","Blue Precision Silver HMO 002","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820015","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS072","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999149612871258",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820015-01","Blue Precision Silver HMO 002","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950012","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950012-03","BlueCare Direct Bronze? 103 with Advocate","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950013","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950013-00","BlueCare Direct Bronze? 103 with Advocate","Standard Bronze Off Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820049","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS082","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999209595025109",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820049-00","Blue Precision Silver HMO 002","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820049","Blue Precision Silver HMO 002","36096IL082",,"ILN012","ILS082","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999209595025109",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820049-01","Blue Precision Silver HMO 002","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950013","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950013-01","BlueCare Direct Bronze? 103 with Advocate","Standard Bronze On Exchange Plan","61.69%","0","Yes","Yes","No","100%",,"$7,100","$50","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950013","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950013-02","BlueCare Direct Bronze? 103 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820007","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS012","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999227872148921",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820007-00","Blue Precision Gold HMO 001","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820007","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS012","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999227872148921",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820007-01","Blue Precision Gold HMO 001","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950013","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950013-03","BlueCare Direct Bronze? 103 with Advocate","Limited Cost Sharing Plan Variation","61.69%","0","Yes","Yes","No","100%",,"$7,100","$100","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950002-00","BlueCare Direct Silver? 102 with Advocate","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820006","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS022","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999220089587511",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820006-00","Blue Precision Gold HMO 001","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820006","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS022","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999220089587511",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820006-01","Blue Precision Gold HMO 001","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950002-01","BlueCare Direct Silver? 102 with Advocate","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950002-02","BlueCare Direct Silver? 102 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820001","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS032","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999228434383366",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820001-00","Blue Precision Gold HMO 001","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820001","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS032","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999228434383366",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820001-01","Blue Precision Gold HMO 001","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950002-03","BlueCare Direct Silver? 102 with Advocate","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950002-04","BlueCare Direct Silver? 102 with Advocate","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820008","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS042","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999223124880667",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820008-00","Blue Precision Gold HMO 001","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820008","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS042","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999223124880667",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820008-01","Blue Precision Gold HMO 001","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950002-05","BlueCare Direct Silver? 102 with Advocate","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950002-06","BlueCare Direct Silver? 102 with Advocate","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820009","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS052","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999248272895533",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820009-00","Blue Precision Gold HMO 001","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820009","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS052","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999248272895533",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820009-01","Blue Precision Gold HMO 001","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950008-00","BlueCare Direct Silver? 102 with Advocate","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950008-01","BlueCare Direct Silver? 102 with Advocate","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820010","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS072","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999221011594244",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820010-00","Blue Precision Gold HMO 001","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820010","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS072","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999221011594244",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820010-01","Blue Precision Gold HMO 001","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950008-02","BlueCare Direct Silver? 102 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950008-03","BlueCare Direct Silver? 102 with Advocate","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820054","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS082","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999275957630964",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820054-00","Blue Precision Gold HMO 001","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0820054","Blue Precision Gold HMO 001","36096IL082",,"ILN012","ILS082","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for all specialist services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999275957630964",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0820054-01","Blue Precision Gold HMO 001","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0820001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950008-04","BlueCare Direct Silver? 102 with Advocate","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950008-05","BlueCare Direct Silver? 102 with Advocate","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950008-06","BlueCare Direct Silver? 102 with Advocate","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950009-00","BlueCare Direct Silver? 102 with Advocate","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950009-01","BlueCare Direct Silver? 102 with Advocate","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950009-02","BlueCare Direct Silver? 102 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950009-03","BlueCare Direct Silver? 102 with Advocate","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950009-04","BlueCare Direct Silver? 102 with Advocate","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950009-05","BlueCare Direct Silver? 102 with Advocate","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950009-06","BlueCare Direct Silver? 102 with Advocate","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950010-00","BlueCare Direct Silver? 102 with Advocate","Standard Silver Off Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950010-01","BlueCare Direct Silver? 102 with Advocate","Standard Silver On Exchange Plan","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950010-02","BlueCare Direct Silver? 102 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950010-03","BlueCare Direct Silver? 102 with Advocate","Limited Cost Sharing Plan Variation","71.45%","0","Yes","Yes","No","100%",,"$2,600","$900","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950010-04","BlueCare Direct Silver? 102 with Advocate","73% AV Level Silver Plan","73.53%","0","Yes","Yes","No","100%",,"$2,400","$1,100","$0","$200","$2,400","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950010-05","BlueCare Direct Silver? 102 with Advocate","87% AV Level Silver Plan","87.56%","0","Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950010-06","BlueCare Direct Silver? 102 with Advocate","94% AV Level Silver Plan","94.18%","0","Yes","Yes","No","100%",,"$200","$300","$0","$200","$200","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950001","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950001-00","BlueCare Direct Gold? 101 with Advocate","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950001","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950001-01","BlueCare Direct Gold? 101 with Advocate","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950001","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950001-02","BlueCare Direct Gold? 101 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950001","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS013","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950001-03","BlueCare Direct Gold? 101 with Advocate","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950005","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950005-00","BlueCare Direct Gold? 101 with Advocate","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950005","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950005-01","BlueCare Direct Gold? 101 with Advocate","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950005","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950005-02","BlueCare Direct Gold? 101 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950005","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS023","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950005-03","BlueCare Direct Gold? 101 with Advocate","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950006","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950006-00","BlueCare Direct Gold? 101 with Advocate","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950006","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950006-01","BlueCare Direct Gold? 101 with Advocate","Standard Gold On Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950006","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950006-02","BlueCare Direct Gold? 101 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950006","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS033","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950006-03","BlueCare Direct Gold? 101 with Advocate","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950007","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950007-00","BlueCare Direct Gold? 101 with Advocate","Standard Gold Off Exchange Plan","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950007","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS043","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9993",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950007-03","BlueCare Direct Gold? 101 with Advocate","Limited Cost Sharing Plan Variation","80.17%","0","Yes","Yes","No","100%",,"$1,800","$800","$0","$200","$1,800","$30","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950001-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950014","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS013","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950014-00","BlueCare Direct Silver? 104 with Advocate","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950015","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS023","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950015-02","BlueCare Direct Silver? 104 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770001","Blue PPO Gold 001","36096IL077",,"ILN014","ILS001","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770001-01","Blue PPO Gold 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990110","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS021","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990110-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960002","BlueCare Direct Silver 002 with Advocate","36096IL096",,"ILN013","ILS013","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999063446927596",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960002-00","BlueCare Direct Silver 002 with Advocate","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","Yes","36-1236610","36096IL0830004","BlueCare Dental 4 Kids? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","Yes","36-1236610","36096IL0830004","BlueCare Dental 4 Kids? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960002","BlueCare Direct Silver 002 with Advocate","36096IL096",,"ILN013","ILS013","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999063446927596",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960002-01","BlueCare Direct Silver 002 with Advocate","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950014","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS013","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950014-01","BlueCare Direct Silver? 104 with Advocate","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950014","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS013","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950014-02","BlueCare Direct Silver? 104 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960011","BlueCare Direct Silver 002 with Advocate","36096IL096",,"ILN013","ILS023","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999054007063731",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960011-00","BlueCare Direct Silver 002 with Advocate","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960011","BlueCare Direct Silver 002 with Advocate","36096IL096",,"ILN013","ILS023","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999054007063731",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960011-01","BlueCare Direct Silver 002 with Advocate","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950014","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS013","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950014-03","BlueCare Direct Silver? 104 with Advocate","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950014","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS013","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950014-04","BlueCare Direct Silver? 104 with Advocate","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960012","BlueCare Direct Silver 002 with Advocate","36096IL096",,"ILN013","ILS033","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999064128890298",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960012-00","BlueCare Direct Silver 002 with Advocate","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960012","BlueCare Direct Silver 002 with Advocate","36096IL096",,"ILN013","ILS033","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999064128890298",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960012-01","BlueCare Direct Silver 002 with Advocate","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950014","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS013","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950014-05","BlueCare Direct Silver? 104 with Advocate","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950014","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS013","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950014-06","BlueCare Direct Silver? 104 with Advocate","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960013","BlueCare Direct Silver 002 with Advocate","36096IL096",,"ILN013","ILS043","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999057688724906",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960013-00","BlueCare Direct Silver 002 with Advocate","Standard Silver Off Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960013","BlueCare Direct Silver 002 with Advocate","36096IL096",,"ILN013","ILS043","ILF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999057688724906",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960013-01","BlueCare Direct Silver 002 with Advocate","Standard Silver On Exchange Plan","71.64%","0","No","Yes","No","100%",,"$5,000","$300","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950015","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS023","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950015-00","BlueCare Direct Silver? 104 with Advocate","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950015","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS023","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950015-01","BlueCare Direct Silver? 104 with Advocate","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960001","BlueCare Direct Gold 001 with Advocate","36096IL096",,"ILN013","ILS013","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999142080165468",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960001-00","BlueCare Direct Gold 001 with Advocate","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960001","BlueCare Direct Gold 001 with Advocate","36096IL096",,"ILN013","ILS013","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999142080165468",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960001-01","BlueCare Direct Gold 001 with Advocate","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950015","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS023","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950015-03","BlueCare Direct Silver? 104 with Advocate","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960008","BlueCare Direct Gold 001 with Advocate","36096IL096",,"ILN013","ILS023","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999133432875012",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960008-00","BlueCare Direct Gold 001 with Advocate","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950015","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS023","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950015-04","BlueCare Direct Silver? 104 with Advocate","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950015","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS023","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950015-05","BlueCare Direct Silver? 104 with Advocate","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960009","BlueCare Direct Gold 001 with Advocate","36096IL096",,"ILN013","ILS033","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999142704870406",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960009-00","BlueCare Direct Gold 001 with Advocate","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960009","BlueCare Direct Gold 001 with Advocate","36096IL096",,"ILN013","ILS033","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999142704870406",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960009-01","BlueCare Direct Gold 001 with Advocate","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950015","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS023","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950015-06","BlueCare Direct Silver? 104 with Advocate","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950016","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS033","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950016-00","BlueCare Direct Silver? 104 with Advocate","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960010","BlueCare Direct Gold 001 with Advocate","36096IL096",,"ILN013","ILS043","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999136805422963",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960010-00","BlueCare Direct Gold 001 with Advocate","Standard Gold Off Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0960010","BlueCare Direct Gold 001 with Advocate","36096IL096",,"ILN013","ILS043","ILF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999136805422963",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0960010-01","BlueCare Direct Gold 001 with Advocate","Standard Gold On Exchange Plan","80.89%","0","No","Yes","No","100%",,"$2,500","$200","$800","$200","$2,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0960001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950016","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS033","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950016-01","BlueCare Direct Silver? 104 with Advocate","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950016","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS033","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950016-02","BlueCare Direct Silver? 104 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950016","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS033","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950016-03","BlueCare Direct Silver? 104 with Advocate","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950016","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS033","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950016-04","BlueCare Direct Silver? 104 with Advocate","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950016","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS033","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950016-05","BlueCare Direct Silver? 104 with Advocate","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950016","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS033","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950016-06","BlueCare Direct Silver? 104 with Advocate","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950017","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS043","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950017-00","BlueCare Direct Silver? 104 with Advocate","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950017","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS043","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950017-01","BlueCare Direct Silver? 104 with Advocate","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950017","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS043","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950017-02","BlueCare Direct Silver? 104 with Advocate","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950017","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS043","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950017-03","BlueCare Direct Silver? 104 with Advocate","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","No","100%",,"$5,500","$500","$500","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950017","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS043","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950017-04","BlueCare Direct Silver? 104 with Advocate","73% AV Level Silver Plan","73.12%","0","Yes","Yes","No","100%",,"$4,000","$500","$1,000","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950017","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS043","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950017-05","BlueCare Direct Silver? 104 with Advocate","87% AV Level Silver Plan","87.09%","0","Yes","Yes","No","100%",,"$800","$200","$900","$200","$800","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0950017","BlueCare Direct Silver? 104 with Advocate","36096IL095",,"ILN003","ILS043","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9991",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0950017-06","BlueCare Direct Silver? 104 with Advocate","94% AV Level Silver Plan","94.68%","0.946848392486572","Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$10","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0950014-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990106","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS011","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990106-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770001","Blue PPO Gold 001","36096IL077",,"ILN014","ILS001","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770001-00","Blue PPO Gold 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990106","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS011","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990106-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990106","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS011","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990106-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980001","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS011","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980001-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990106","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS011","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990106-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990106","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS011","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990106-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980026","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS021","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980026-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980026","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS021","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980026-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990106","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS011","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990106-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990106","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS011","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990106-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980027","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS031","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980027-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980027","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS031","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980027-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990110","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS021","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990110-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990110","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS021","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990110-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980028","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS041","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980028-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980028","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS041","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980028-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990110","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS021","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990110-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990110","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS021","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990110-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980029","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS051","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980029-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980029","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS051","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980029-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990110","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS021","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990110-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990110","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS021","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990110-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980030","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS061","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980030-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980030","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS061","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980030-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990111","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS031","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990111-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980031","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS071","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980031-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990112","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS041","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990112-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980036","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS121","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980036-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980036","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS121","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980036-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990115","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS071","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990115-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990116","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS081","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990116-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980031","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS071","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980031-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990111","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS031","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990111-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990111","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS031","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990111-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980032","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS081","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980032-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980032","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS081","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980032-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990111","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS031","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990111-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990111","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS031","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990111-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980033","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS091","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980033-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980033","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS091","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980033-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990111","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS031","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990111-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990111","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS031","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990111-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980034","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS101","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980034-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980034","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS101","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980034-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990112","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS041","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990112-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990112","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS041","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990112-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980035","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS111","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980035-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980035","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS111","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980035-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990112","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS041","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990112-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990112","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS041","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990112-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990112","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS041","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990112-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980037","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS131","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980037-00","Blue Choice Preferred Gold PPO 001","Standard Gold Off Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980037","Blue Choice Preferred Gold PPO 001","36096IL098",,"ILN011","ILS131","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980037-01","Blue Choice Preferred Gold PPO 001","Standard Gold On Exchange Plan","79.47%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0.00%","$3,250","$3250 per person","$9750 per group","0.00%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980001-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990112","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS041","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990112-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990113","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS051","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990113-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990113","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS051","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990113-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990120","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS121","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990120-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990120","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS121","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990120-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990120","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS121","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990120-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990120","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS121","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990120-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990121","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS131","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990121-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990002-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990113","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS051","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990113-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990113","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS051","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990113-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990113","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS051","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990113-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990113","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS051","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990113-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990113","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS051","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990113-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990114","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS061","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990114-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990114","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS061","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990114-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990114","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS061","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990114-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990114","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS061","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990114-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990114","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS061","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990114-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990114","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS061","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990114-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990114","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS061","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990114-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990115","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS071","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990115-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990115","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS071","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990115-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990115","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS071","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990115-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990115","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS071","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990115-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990115","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS071","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990115-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990116","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS081","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990116-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990116","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS081","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990116-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990116","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS081","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990116-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990119","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS111","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990119-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990119","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS111","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990119-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990119","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS111","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990119-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990107","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990107-00","Blue Choice Preferred Bronze PPO? 108","Standard Bronze Off Exchange Plan","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980038","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS021","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980038-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990116","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS081","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990116-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990116","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS081","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990116-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990116","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS081","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990116-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990117","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS091","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990117-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990117","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS091","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990117-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990117","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS091","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990117-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990117","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS091","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990117-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990117","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS091","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990117-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990117","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS091","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990117-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990117","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS091","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990117-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990118","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS101","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990118-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990118","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS101","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990118-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990118","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS101","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990118-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990118","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS101","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990118-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990118","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS101","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990118-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990118","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS101","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990118-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990118","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS101","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990118-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990119","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS111","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990119-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990119","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS111","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990119-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990119","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS111","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990119-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990119","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS111","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990119-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990120","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS121","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990120-00","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990120","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS121","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990120-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990120","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS121","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990120-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990121","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS131","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990121-01","Blue Choice Preferred Silver PPO? 109 - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990121","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS131","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990121-02","Blue Choice Preferred Silver PPO? 109 - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990121","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS131","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990121-03","Blue Choice Preferred Silver PPO? 109 - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990121","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS131","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990121-04","Blue Choice Preferred Silver PPO? 109 - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990121","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS131","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990121-05","Blue Choice Preferred Silver PPO? 109 - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990121","Blue Choice Preferred Silver PPO? 109 - Standardized","36096IL099",,"ILN001","ILS131","ILF010","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990121-06","Blue Choice Preferred Silver PPO? 109 - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990106-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990105","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990105-00","Blue Choice Preferred Bronze PPO? 108","Standard Bronze Off Exchange Plan","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770002","Blue PPO Gold 002","36096IL077",,"ILN014","ILS001","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770002-00","Blue PPO Gold 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770002","Blue PPO Gold 002","36096IL077",,"ILN014","ILS001","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770002-01","Blue PPO Gold 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990105","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990105-01","Blue Choice Preferred Bronze PPO? 108","Standard Bronze On Exchange Plan","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990105","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990105-02","Blue Choice Preferred Bronze PPO? 108","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980002","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS011","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980002-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980002","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS011","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980002-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990105","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990105-03","Blue Choice Preferred Bronze PPO? 108","Limited Cost Sharing Plan Variation","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980038","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS021","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980038-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990107","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990107-01","Blue Choice Preferred Bronze PPO? 108","Standard Bronze On Exchange Plan","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990107","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990107-02","Blue Choice Preferred Bronze PPO? 108","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980039","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS031","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980039-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980039","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS031","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980039-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990107","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990107-03","Blue Choice Preferred Bronze PPO? 108","Limited Cost Sharing Plan Variation","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990108","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990108-00","Blue Choice Preferred Bronze PPO? 108","Standard Bronze Off Exchange Plan","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980040","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS041","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980040-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980040","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS041","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980040-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990108","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990108-01","Blue Choice Preferred Bronze PPO? 108","Standard Bronze On Exchange Plan","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990108","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990108-02","Blue Choice Preferred Bronze PPO? 108","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980041","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS051","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980041-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980041","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS051","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980041-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990108","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990108-03","Blue Choice Preferred Bronze PPO? 108","Limited Cost Sharing Plan Variation","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990109","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990109-00","Blue Choice Preferred Bronze PPO? 108","Standard Bronze Off Exchange Plan","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980042","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS061","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980042-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980042","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS061","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980042-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990109","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990109-01","Blue Choice Preferred Bronze PPO? 108","Standard Bronze On Exchange Plan","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990109","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990109-02","Blue Choice Preferred Bronze PPO? 108","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980043","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS071","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980043-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980043","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS071","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980043-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990109","Blue Choice Preferred Bronze PPO? 108","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990109-03","Blue Choice Preferred Bronze PPO? 108","Limited Cost Sharing Plan Variation","59.07%",,"Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990105-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990002-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980044","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS081","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980044-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980044","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS081","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980044-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990002-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990002-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990033-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990033-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990033-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990037-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990037-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980045","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS091","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980045-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980045","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS091","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980045-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990002-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980046","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS101","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980046-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980046","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS101","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980046-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990002-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990002-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990039-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990039-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990039-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990039-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980047","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS111","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980047-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980047","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS111","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980047-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990033-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990033-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980048","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS121","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980048-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980048","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS121","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980048-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990033-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990033-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980049","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS131","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980049-00","Blue Choice Preferred Gold PPO 002","Standard Gold Off Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980049","Blue Choice Preferred Gold PPO 002","36096IL098",,"ILN011","ILS131","ILF016","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980049-01","Blue Choice Preferred Gold PPO 002","Standard Gold On Exchange Plan","81.11%","0","No","Yes","Yes","60%","40%","$1,500","$200","$1,000","$200","$1,500","$40","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20.00%","$1,500","$1500 per person","$4000 per group","20.00%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990034-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990034-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990034-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990034-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990034-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990034-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990034-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990035-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990035-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990035-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990035-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990035-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990035-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990035-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990036-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990036-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990036-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990036-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990036-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990036-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990036-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990037-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990037-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990037-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990037-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990037-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990038-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990038-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990040-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990041-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990041-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990044-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990038-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990038-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990038-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990038-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990038-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990039-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990039-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990039-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980051","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS031","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980051-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980051","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS031","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980051-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990011","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS041","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990011-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990012","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS051","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990012-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980052","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS041","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980052-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990045-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980064","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS041","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980064-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990040-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990040-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990040-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990040-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990040-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990040-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990041-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990041-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990041-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990041-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990041-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990042-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990042-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990042-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990042-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990042-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990042-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990042-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990043-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990043-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990043-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990043-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990043-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990043-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990043-06","Blue Choice Preferred Silver PPO? 102","94% AV Level Silver Plan","93.72%",,"Yes","Yes","Yes","60%","40%","$0","$500","$200","$200","$0","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990044-00","Blue Choice Preferred Silver PPO? 102","Standard Silver Off Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990044-01","Blue Choice Preferred Silver PPO? 102","Standard Silver On Exchange Plan","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990044-02","Blue Choice Preferred Silver PPO? 102","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990044-03","Blue Choice Preferred Silver PPO? 102","Limited Cost Sharing Plan Variation","70.41%",,"Yes","Yes","Yes","60%","40%","$3,000","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","30.00%","$3,000","$3000 per person","$9000 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990044-04","Blue Choice Preferred Silver PPO? 102","73% AV Level Silver Plan","73.35%",,"Yes","Yes","Yes","60%","40%","$2,900","$500","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$8700 per group","30.00%","$2,900","$2900 per person","$8700 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990044-05","Blue Choice Preferred Silver PPO? 102","87% AV Level Silver Plan","87.13%",,"Yes","Yes","Yes","60%","40%","$200","$500","$1,300","$200","$200","$100","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30.00%","$200","$200 per person","$600 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990002-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990012","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS051","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990012-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990013","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS061","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990013-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980059","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS111","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980059-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980059","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS111","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980059-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990019","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS121","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990019-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990008","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS011","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990008-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770003","Blue PPO Silver 003","36096IL077",,"ILN014","ILS001","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770003-00","Blue PPO Silver 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770003","Blue PPO Silver 003","36096IL077",,"ILN014","ILS001","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770003-01","Blue PPO Silver 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990008","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS011","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990008-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990009","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS021","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990009-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980003","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS011","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980003-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980003","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS011","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980003-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990009","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS021","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990009-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990010","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS031","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990010-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980050","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS021","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980050-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980050","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS021","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980050-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990010","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS031","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990010-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990011","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS041","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990011-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980052","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS041","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980052-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980053","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS051","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980053-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980053","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS051","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980053-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990013","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS061","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990013-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990014","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS071","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990014-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980054","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS061","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980054-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980054","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS061","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980054-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990014","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS071","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990014-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990015","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS081","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990015-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980055","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS071","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980055-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980055","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS071","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980055-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990015","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS081","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990015-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990016","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS091","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990016-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980056","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS081","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980056-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980056","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS081","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980056-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990016","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS091","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990016-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990017","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS101","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990017-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980057","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS091","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980057-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980057","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS091","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980057-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990017","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS101","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990017-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990018","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS111","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990018-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980058","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS101","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980058-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980058","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS101","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980058-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990018","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS111","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990018-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990019","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS121","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990019-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990020","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS131","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990020-00","Blue Choice Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980060","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS121","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980060-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980060","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS121","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980060-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990020","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS131","ILF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990020-01","Blue Choice Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980061","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS131","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980061-00","Blue Choice Preferred Silver PPO 003","Standard Silver Off Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980061","Blue Choice Preferred Silver PPO 003","36096IL098",,"ILN011","ILS131","ILF016","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980061-01","Blue Choice Preferred Silver PPO 003","Standard Silver On Exchange Plan","69.83%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0.00%","$6,000","$6000 per person","$12700 per group","0.00%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770004","Blue PPO Silver 004","36096IL077",,"ILN014","ILS001","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770004-00","Blue PPO Silver 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990003-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990003-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770004","Blue PPO Silver 004","36096IL077",,"ILN014","ILS001","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770004-01","Blue PPO Silver 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980004","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS011","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980004-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990003-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990003-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980004","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS011","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980004-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980062","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS021","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980062-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990003-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990003-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980062","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS021","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980062-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980063","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS031","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980063-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS011","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990003-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990045-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980063","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS031","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980063-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980064","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS041","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980064-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990045-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980065","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS051","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980065-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990049-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990049-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990049-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990049-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990050-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990050-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990050-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990053-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990053-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990056-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990056-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990045-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990045-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980065","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS051","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980065-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980066","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS061","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980066-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990045-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS021","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990045-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980066","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS061","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980066-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980067","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS071","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980067-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990046-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990046-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980067","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS071","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980067-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980068","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS081","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980068-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990046-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990046-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980068","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS081","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980068-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980069","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS091","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980069-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990046-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990046-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980069","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS091","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980069-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980070","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS101","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980070-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS031","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990046-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990047-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980070","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS101","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980070-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980071","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS111","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980071-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990047-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990047-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980071","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS111","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980071-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980072","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS121","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980072-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990047-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990047-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980072","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS121","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980072-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980073","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS131","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980073-00","Blue Choice Preferred Silver PPO 004","Standard Silver Off Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990047-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS041","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990047-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980073","Blue Choice Preferred Silver PPO 004","36096IL098",,"ILN011","ILS131","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980073-01","Blue Choice Preferred Silver PPO 004","Standard Silver On Exchange Plan","71.60%","0","No","Yes","Yes","60%","40%","$3,000","$300","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980004-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990048-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990048-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990048-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990048-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990048-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990048-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS051","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990048-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990049-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990049-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS061","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990049-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990050-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990050-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990050-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS071","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990050-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990051-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990051-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990051-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990051-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990051-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990051-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS081","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990051-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990052-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990052-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990052-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990052-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990052-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990052-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS091","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990052-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990053-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990053-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990053-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990053-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS101","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990053-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990054-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990054-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990054-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990054-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990054-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990054-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS111","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990054-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990055-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990055-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990055-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990055-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990055-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990055-05","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","87% AV Level Silver Plan","87.59%","0.875936567783356","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$4500 per group","$1,800","$1800 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%","$500","$500 per person","$1500 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-05.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS121","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990055-06","Blue Choice Preferred Silver PPO? 103 - Five $0 PCP Visits","94% AV Level Silver Plan","94.13%","0.941311955451965","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-06.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990056-00","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990056-01","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Standard Silver On Exchange Plan","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990056-02","Blue Choice Preferred Silver PPO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990056-03","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","71.00%","0","Yes","Yes","Yes","60%","40%","$3,300","$400","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20.00%","$3,250","$3250 per person","$9750 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS131","ILF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990056-04","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","73% AV Level Silver Plan","73.50%","0","Yes","Yes","Yes","60%","40%","$3,000","$400","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10900 per group","$5,300","$5300 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20.00%","$3,000","$3000 per person","$9000 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990003-04.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990007","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS011","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990007-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990094","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS031","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990094-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990094","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS031","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990094-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980101","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS051","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980101-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980107","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS111","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980107-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990097","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS061","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990097-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990098","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS071","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990098-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980108","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS121","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980108-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770020","Blue PPO Silver 020","36096IL077",,"ILN014","ILS001","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770020-00","Blue PPO Silver 020","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770020-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770020","Blue PPO Silver 020","36096IL077",,"ILN014","ILS001","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770020-01","Blue PPO Silver 020","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770020-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990007","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS011","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990007-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990007","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS011","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990007-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990098","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS071","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990098-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990099","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS081","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990099-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990099","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS081","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990099-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980008","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS011","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980008-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980008","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS011","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980008-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990007","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS011","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990007-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990093","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS021","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990093-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980098","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS021","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980098-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980098","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS021","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980098-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990093","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS021","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990093-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990093","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS021","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990093-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980099","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS031","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980099-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980099","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS031","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980099-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990093","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS021","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990093-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990094","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS031","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990094-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980100","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS041","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980100-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980100","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS041","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980100-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980101","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS051","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980101-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990094","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS031","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990094-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990095","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS041","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990095-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980102","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS061","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980102-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980102","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS061","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980102-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990095","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS041","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990095-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990095","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS041","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990095-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980103","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS071","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980103-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980103","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS071","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980103-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990095","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS041","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990095-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990096","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS051","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990096-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980104","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS081","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980104-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980104","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS081","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980104-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990096","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS051","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990096-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990096","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS051","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990096-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980105","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS091","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980105-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980105","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS091","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980105-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990096","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS051","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990096-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990097","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS061","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990097-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980106","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS101","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980106-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980106","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS101","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980106-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990097","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS061","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990097-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990097","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS061","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990097-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980107","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS111","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980107-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980108","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS121","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980108-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990098","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS071","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990098-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990102","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS111","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990102-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990102","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS111","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990102-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990103","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS121","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990103-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990070","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS031","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990070-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980076","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS041","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980076-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980083","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS111","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980083-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990098","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS071","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990098-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980109","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS131","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980109-00","Blue Choice Preferred Silver PPO 008","Standard Silver Off Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980109","Blue Choice Preferred Silver PPO 008","36096IL098",,"ILN011","ILS131","ILF015","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980109-01","Blue Choice Preferred Silver PPO 008","Standard Silver On Exchange Plan","71.59%","0","No","Yes","Yes","60%","40%","$2,400","$400","$1,400","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","$6,950","$6950 per person","$13900 per group","$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$7050 per group","30.00%","$2,350","$2350 per person","$7050 per group","30.00%","$4,700","$4700 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980008-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990099","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS081","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990099-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990099","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS081","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990099-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990072","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS051","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990072-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980080","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS081","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980080-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980081","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS091","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980081-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990072","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS051","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990072-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990072","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS051","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990072-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980147","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS031","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980147-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990100","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS091","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990100-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990100","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS091","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990100-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990100","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS091","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990100-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990100","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS091","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990100-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990101","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS101","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990101-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990101","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS101","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990101-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990101","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS101","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990101-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990101","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS101","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990101-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990102","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS111","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990102-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990102","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS111","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990102-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990103","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS121","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990103-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990103","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS121","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990103-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990103","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS121","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990103-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990104","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS131","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990104-00","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990104","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS131","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990104-01","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990104","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS131","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990104-02","Blue Choice Preferred Bronze PPO? 107","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990104","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS131","ILF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990104-03","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.61%","0","Yes","Yes","Yes","60%","40%","$6,800","$400","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$14300 per group","20.00%","$6,750","$6750 per person","$14300 per group","20.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990007-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770006","Blue PPO Bronze 006","36096IL077",,"ILN014","ILS001","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770006-00","Blue PPO Bronze 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990005","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS011","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990005-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990005","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS011","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990005-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770006","Blue PPO Bronze 006","36096IL077",,"ILN014","ILS001","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770006-01","Blue PPO Bronze 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980006","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS011","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980006-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990005","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS011","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990005-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990005","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS011","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990005-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980006","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS011","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980006-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980074","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS021","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980074-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990069","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS021","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990069-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990069","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS021","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990069-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980074","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS021","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980074-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980075","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS031","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980075-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990069","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS021","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990069-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990069","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS021","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990069-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980075","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS031","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980075-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980076","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS041","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980076-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990070","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS031","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990070-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980077","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS051","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980077-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990070","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS031","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990070-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990070","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS031","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990070-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980077","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS051","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980077-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980078","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS061","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980078-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990071","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS041","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990071-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990071","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS041","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990071-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980078","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS061","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980078-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980079","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS071","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980079-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990071","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS041","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990071-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990071","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS041","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990071-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980079","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS071","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980079-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980080","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS081","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980080-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990072","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS051","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990072-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980081","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS091","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980081-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980082","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS101","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980082-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990073","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS061","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990073-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990073","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS061","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990073-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980082","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS101","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980082-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990073","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS061","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990073-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990073","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS061","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990073-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990077","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS101","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990077-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990077","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS101","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990077-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990077","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS101","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990077-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980150","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS061","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980150-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980150","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS061","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980150-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980151","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS071","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980151-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980083","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS111","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980083-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980084","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS121","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980084-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990074","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS071","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990074-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990074","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS071","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990074-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980084","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS121","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980084-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980085","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS131","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980085-00","Blue Choice Preferred Bronze PPO 006","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990074","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS071","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990074-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990074","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS071","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990074-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980085","Blue Choice Preferred Bronze PPO 006","36096IL098",,"ILN011","ILS131","ILF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980085-01","Blue Choice Preferred Bronze PPO 006","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","Yes","60%","40%","$6,400","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","$6,400","$6400 per person","$13100 per group","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$13100 per group","0.00%","$6,400","$6400 per person","$13100 per group","0.00%","$12,800","$12800 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990075","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS081","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990075-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990075","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS081","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990075-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990075","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS081","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990075-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990075","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS081","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990075-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990076","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS091","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990076-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990076","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS091","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990076-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990076","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS091","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990076-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990076","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS091","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990076-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990077","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS101","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990077-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990078","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS111","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990078-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990078","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS111","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990078-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990078","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS111","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990078-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990078","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS111","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990078-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990079","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS121","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990079-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990079","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS121","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990079-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990079","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS121","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990079-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990079","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS121","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990079-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990080","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS131","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990080-00","Blue Choice Preferred Bronze PPO? 105","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770032","Blue PPO Bronze 032","36096IL077",,"ILN014","ILS001","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770032-00","Blue PPO Bronze 032","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770032-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0770032","Blue PPO Bronze 032","36096IL077",,"ILN014","ILS001","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0770032-01","Blue PPO Bronze 032","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0770032-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990080","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS131","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990080-01","Blue Choice Preferred Bronze PPO? 105","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990080","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS131","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990080-02","Blue Choice Preferred Bronze PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980022","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS011","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980022-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980022","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS011","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980022-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990080","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS131","ILF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990080-03","Blue Choice Preferred Bronze PPO? 105","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990005-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980146","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS021","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980146-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980146","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS021","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980146-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980147","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS031","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980147-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980148","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS041","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980148-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980148","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS041","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980148-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980149","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS051","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980149-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990088","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS091","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990088-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990088","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS091","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990088-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990088","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS091","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990088-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990089","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS101","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990089-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980149","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS051","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980149-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980151","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS071","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980151-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980152","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS081","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980152-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980152","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS081","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980152-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990082","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS031","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990082-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990082","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS031","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990082-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990082","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS031","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990082-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990089","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS101","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990089-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990089","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS101","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990089-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980153","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS091","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980153-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980153","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS091","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980153-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980154","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS101","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980154-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980154","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS101","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980154-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980155","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS111","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980155-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980155","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS111","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980155-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980156","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS121","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980156-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980156","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS121","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980156-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980157","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS131","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980157-00","Blue Choice Preferred Bronze PPO 022","Standard Bronze Off Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","SHOP (Small Group)","No","36-1236610","36096IL0980157","Blue Choice Preferred Bronze PPO 022","36096IL098",,"ILN011","ILS131","ILF014","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0980157-01","Blue Choice Preferred Bronze PPO 022","Standard Bronze On Exchange Plan",,"0.617360830307007","Yes","Yes","Yes","60%","40%","$5,900","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$12900 per group","20.00%","$5,900","$5900 per person","$12900 per group","20.00%","$11,800","$11800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0980022-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990006","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS011","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990006-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990006","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS011","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990006-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990006","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS011","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990006-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990006","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS011","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990006-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990081","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS021","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990081-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990081","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS021","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990081-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990081","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS021","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990081-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990081","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS021","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990081-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990082","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS031","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990082-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990083","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS041","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990083-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990083","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS041","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990083-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990083","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS041","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990083-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990083","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS041","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990083-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990084","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS051","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990084-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990084","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS051","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990084-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990084","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS051","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990084-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990084","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS051","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990084-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990085","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS061","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990085-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990085","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS061","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990085-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990085","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS061","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990085-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990085","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS061","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990085-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990086","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS071","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990086-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990086","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS071","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990086-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990086","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS071","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990086-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990086","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS071","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990086-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990087","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS081","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990087-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990087","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS081","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990087-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990087","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS081","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990087-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990087","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS081","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990087-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990088","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS091","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990088-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990089","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS101","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990089-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040002","Cigna Connect 6250","53882IL004",,"ILN001","ILS001","ILF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040002-00","Cigna Connect 6250","Standard Bronze Off Exchange Plan","60.13%","0.616369545459747","Yes","Yes","No","100%",,"$5,730","$1,590","$0","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894588-sbc-cigna-connect-6250-bronze-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894589-sob-cigna-connect-6250-bronze-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040002","Cigna Connect 6250","53882IL004",,"ILN001","ILS001","ILF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040002-01","Cigna Connect 6250","Standard Bronze On Exchange Plan","60.13%","0.616369545459747","Yes","Yes","No","100%",,"$5,730","$1,590","$0","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894588-sbc-cigna-connect-6250-bronze-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894589-sob-cigna-connect-6250-bronze-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040002","Cigna Connect 6250","53882IL004",,"ILN001","ILS001","ILF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894596-sbc-cigna-connect-0-naan-plan-300b-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894597-sob-cigna-connect-0-naan-plan-300b-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040002","Cigna Connect 6250","53882IL004",,"ILN001","ILS001","ILF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040002-03","Cigna Connect 6250-1","Limited Cost Sharing Plan Variation","60.13%","0.616369545459747","Yes","Yes","No","100%",,"$5,730","$1,590","$0","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894590-sbc-cigna-connect-6250-1-bronze-300a-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894591-sob-cigna-connect-6250-1-bronze-300a-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040004","Cigna Connect 2750","53882IL004",,"ILN001","ILS001","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040004-00","Cigna Connect 2750","Standard Silver Off Exchange Plan",,"0.684606611728668","Yes","Yes","No","100%",,"$2,750","$0","$700","$30","$2,750","$0","$340","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894598-sbc-cigna-connect-2750-silver-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894599-sob-cigna-connect-2750-silver-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040004","Cigna Connect 2750","53882IL004",,"ILN001","ILS001","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040004-01","Cigna Connect 2750","Standard Silver On Exchange Plan",,"0.684606611728668","Yes","Yes","No","100%",,"$2,750","$0","$700","$30","$2,750","$0","$340","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894598-sbc-cigna-connect-2750-silver-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894599-sob-cigna-connect-2750-silver-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040004","Cigna Connect 2750","53882IL004",,"ILN001","ILS001","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040004-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894596-sbc-cigna-connect-0-naan-plan-300b-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894597-sob-cigna-connect-0-naan-plan-300b-chicago-il.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990090","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS111","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990090-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990090","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS111","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990090-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990090","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS111","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990090-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990090","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS111","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990090-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990091","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS121","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990091-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990091","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS121","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990091-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990091","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS121","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990091-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990091","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS121","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990091-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990092","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS131","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990092-00","Blue Choice Preferred Bronze PPO? 106","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-00.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990092","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS131","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990092-01","Blue Choice Preferred Bronze PPO? 106","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-01.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990092","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS131","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990092-02","Blue Choice Preferred Bronze PPO? 106","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-02.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","36096","SERFF","2017-01-31 20:15:24","Individual","No","36-1236610","36096IL0990092","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS131","ILF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_IL_5T_EX.pdf","36096IL0990092-03","Blue Choice Preferred Bronze PPO? 106","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13100 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/static/il/pdf/sbc/2017/36096IL0990006-03.pdf","http://www.bcbsil.com/static/il/pdf/brochure/2017/il-plan-overview.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040004","Cigna Connect 2750","53882IL004",,"ILN001","ILS001","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040004-05","Cigna Connect 700-3","87% AV Level Silver Plan",,"0.861850678920746","Yes","Yes","No","100%",,"$700","$0","$1,010","$30","$700","$0","$650","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894616-sbc-cigna-connect-700-3-silver-150-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894617-sob-cigna-connect-700-3-silver-150-chicago-il.pdf"
"2017","IL","39096","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","44-0308260","39096IL0010001","KCL EHB Low PPO","39096IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","39096IL0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IL","39096","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","44-0308260","39096IL0010003","KCL EHB Low MAC","39096IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","39096IL0010003-00","KCL EHB Low MAC","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IL","39096","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","44-0308260","39096IL0010002","KCL EHB High PPO","39096IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","39096IL0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IL","39096","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","44-0308260","39096IL0010004","KCL EHB High MAC","39096IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","39096IL0010004-00","KCL EHB High MAC","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IL","40653","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","42-0127290","40653IL0050001","Principal Plan Dental 70","40653IL005",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Child-Only",,,,,"0.81","Estimated Rate","2017-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","40653IL0050001-00","Principal Plan Dental 70","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IL","45634","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","59-0397210","45634IL0020003","DentaQuest PPO Family High","45634IL002",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0020003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","Individual","Yes","59-0397210","45634IL0010001","DentaQuest PPO  Pediatric High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","Individual","Yes","59-0397210","45634IL0010001","DentaQuest PPO  Pediatric High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","59-0397210","45634IL0020003","DentaQuest PPO Family High","45634IL002",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0020003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","59-0397210","45634IL0020004","DentaQuest PPO Family Low","45634IL002",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0020004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","59-0397210","45634IL0020004","DentaQuest PPO Family Low","45634IL002",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0020004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","59-0397210","45634IL0020005","DentaQuest PPO Family Preventative","45634IL002",,"ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0020005-00","DentaQuest PPO Family Preventative","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","Individual","Yes","59-0397210","45634IL0010003","DentaQuest PPO Family High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","Individual","Yes","59-0397210","45634IL0010003","DentaQuest PPO Family High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","59-0397210","45634IL0020005","DentaQuest PPO Family Preventative","45634IL002",,"ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0020005-01","DentaQuest PPO Family Preventative","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","Individual","Yes","59-0397210","45634IL0010004","DentaQuest PPO Family Low","45634IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","Individual","Yes","59-0397210","45634IL0010004","DentaQuest PPO Family Low","45634IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","Individual","Yes","59-0397210","45634IL0010005","DentaQuest PPO Family Preventative","45634IL001",,"ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010005-00","DentaQuest PPO Family Preventative","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","45634","SERFF","2016-11-16 22:15:47","Individual","Yes","59-0397210","45634IL0010005","DentaQuest PPO Family Preventative","45634IL001",,"ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010005-01","DentaQuest PPO Family Preventative","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2017","IL","52129","SERFF","2016-08-24 05:44:16","Individual","Yes","59-1031071","52129IL0030001","Cigna Dental Pediatric","52129IL003","7730182962","ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","52129IL0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-il"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040001","Cigna Connect HSA 5500","53882IL004",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040001-00","Cigna Connect HSA 5500","Standard Bronze Off Exchange Plan",,"0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$950","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894584-sbc-cigna-connect-hsa-5500-bronze-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894585-sob-cigna-connect-hsa-5500-bronze-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040001","Cigna Connect HSA 5500","53882IL004",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040001-01","Cigna Connect HSA 5500","Standard Bronze On Exchange Plan",,"0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$950","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894584-sbc-cigna-connect-hsa-5500-bronze-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894585-sob-cigna-connect-hsa-5500-bronze-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040001","Cigna Connect HSA 5500","53882IL004",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040001-02","Cigna Connect HSA-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894596-sbc-cigna-connect-0-naan-plan-300b-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894597-sob-cigna-connect-0-naan-plan-300b-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040001","Cigna Connect HSA 5500","53882IL004",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040001-03","Cigna Connect HSA 5500-1","Limited Cost Sharing Plan Variation",,"0.613475739955902","Yes","Yes","No","100%",,"$5,500","$0","$950","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894586-sbc-cigna-connect-hsa-5500-1-bronze-300a-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894587-sob-cigna-connect-hsa-5500-1-bronze-300a-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040004","Cigna Connect 2750","53882IL004",,"ILN001","ILS001","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040004-03","Cigna Connect 2750-1","Limited Cost Sharing Plan Variation",,"0.684606611728668","Yes","Yes","No","100%",,"$2,750","$0","$700","$30","$2,750","$0","$340","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894600-sbc-cigna-connect-2750-1-silver-300a-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894601-sob-cigna-connect-2750-1-silver-300a-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040004","Cigna Connect 2750","53882IL004",,"ILN001","ILS001","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040004-04","Cigna Connect 2200-2","73% AV Level Silver Plan",,"0.720408797264099","Yes","Yes","No","100%",,"$2,200","$0","$780","$30","$2,200","$0","$420","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894614-sbc-cigna-connect-2200-2-silver-200-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894615-sob-cigna-connect-2200-2-silver-200-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040004","Cigna Connect 2750","53882IL004",,"ILN001","ILS001","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040004-06","Cigna Connect 150-4","94% AV Level Silver Plan",,"0.944472074508667","Yes","Yes","No","100%",,"$150","$0","$360","$30","$150","$0","$240","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894618-sbc-cigna-connect-150-4-silver-100-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894619-sob-cigna-connect-150-4-silver-100-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040006","Cigna Connect 2500","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-00","Cigna Connect 2500","Standard Silver Off Exchange Plan","69.35%","0.698289692401886","Yes","Yes","No","100%",,"$2,500","$20","$1,460","$30","$2,500","$340","$90","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894602-sbc-cigna-connect-2500-silver-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894603-sob-cigna-connect-2500-silver-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040006","Cigna Connect 2500","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-01","Cigna Connect 2500","Standard Silver On Exchange Plan","69.35%","0.698289692401886","Yes","Yes","No","100%",,"$2,500","$20","$1,460","$30","$2,500","$340","$90","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894602-sbc-cigna-connect-2500-silver-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894603-sob-cigna-connect-2500-silver-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040006","Cigna Connect 2500","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894596-sbc-cigna-connect-0-naan-plan-300b-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894597-sob-cigna-connect-0-naan-plan-300b-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040006","Cigna Connect 2500","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-03","Cigna Connect 2500-1","Limited Cost Sharing Plan Variation","69.35%","0.698289692401886","Yes","Yes","No","100%",,"$2,500","$20","$1,460","$30","$2,500","$340","$90","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894604-sbc-cigna-connect-2500-1-silver-300a-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894605-sob-cigna-connect-2500-1-silver-300a-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040006","Cigna Connect 2500","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-04","Cigna Connect 2000-2","73% AV Level Silver Plan","72.90%","0.732837557792664","Yes","Yes","No","100%",,"$2,000","$20","$1,610","$30","$2,000","$410","$90","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894620-sbc-cigna-connect-2000-2-silver-200-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894621-sob-cigna-connect-2000-2-silver-200-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040006","Cigna Connect 2500","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-05","Cigna Connect 500-3","87% AV Level Silver Plan","87.24%","0.872754752635956","Yes","Yes","No","100%",,"$500","$30","$1,020","$30","$500","$500","$100","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894622-sbc-cigna-connect-500-3-silver-150-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894623-sob-cigna-connect-500-3-silver-150-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040006","Cigna Connect 2500","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-06","Cigna Connect 75-4","94% AV Level Silver Plan","93.05%","0.929417848587036","Yes","Yes","No","100%",,"$80","$30","$720","$30","$80","$340","$70","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894624-sbc-cigna-connect-75-4-silver-100-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894625-sob-cigna-connect-75-4-silver-100-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040008","Cigna Connect 1200","53882IL004",,"ILN001","ILS001","ILF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040008-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.13%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894638-sbc-cigna-connect-1200-gold-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894639-sob-cigna-connect-1200-gold-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040008","Cigna Connect 1200","53882IL004",,"ILN001","ILS001","ILF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040008-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.13%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894638-sbc-cigna-connect-1200-gold-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894639-sob-cigna-connect-1200-gold-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040008","Cigna Connect 1200","53882IL004",,"ILN001","ILS001","ILF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040008-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894596-sbc-cigna-connect-0-naan-plan-300b-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894597-sob-cigna-connect-0-naan-plan-300b-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040008","Cigna Connect 1200","53882IL004",,"ILN001","ILS001","ILF005","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040008-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.13%","0.784533441066742","Yes","Yes","No","100%",,"$1,200","$60","$1,210","$30","$140","$680","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894640-sbc-cigna-connect-1200-1-gold-300a-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894641-sob-cigna-connect-1200-1-gold-300a-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040003","Cigna US-IL Connect 6650","53882IL004",,"ILN001","ILS001","ILF006","New","HMO","Bronze","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040003-00","Cigna US-IL Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894592-sbc-cigna-us-il-connect-6650-bronze-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894593-sob-cigna-us-il-connect-6650-bronze-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040003","Cigna US-IL Connect 6650","53882IL004",,"ILN001","ILS001","ILF006","New","HMO","Bronze","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040003-01","Cigna US-IL Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894592-sbc-cigna-us-il-connect-6650-bronze-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894593-sob-cigna-us-il-connect-6650-bronze-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040003","Cigna US-IL Connect 6650","53882IL004",,"ILN001","ILS001","ILF006","New","HMO","Bronze","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040003-02","Cigna US-IL Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894596-sbc-cigna-connect-0-naan-plan-300b-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894597-sob-cigna-connect-0-naan-plan-300b-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040003","Cigna US-IL Connect 6650","53882IL004",,"ILN001","ILS001","ILF006","New","HMO","Bronze","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040003-03","Cigna US-IL Connect 6650-1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894594-sbc-cigna-us-il-connect-6650-1-bronze-300a-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894595-sob-cigna-us-il-connect-6650-1-bronze-300a-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040007","Cigna US-IL Connect 3500","53882IL004",,"ILN001","ILS001","ILF007","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040007-00","Cigna US-IL Connect 3500","Standard Silver Off Exchange Plan","70.78%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$110","$750","$30","$140","$1,160","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894610-sbc-cigna-us-il-connect-3500-silver-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894611-sob-cigna-us-il-connect-3500-silver-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040007","Cigna US-IL Connect 3500","53882IL004",,"ILN001","ILS001","ILF007","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040007-01","Cigna US-IL Connect 3500","Standard Silver On Exchange Plan","70.78%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$110","$750","$30","$140","$1,160","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894610-sbc-cigna-us-il-connect-3500-silver-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894611-sob-cigna-us-il-connect-3500-silver-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040007","Cigna US-IL Connect 3500","53882IL004",,"ILN001","ILS001","ILF007","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040007-02","Cigna US-IL Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894596-sbc-cigna-connect-0-naan-plan-300b-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894597-sob-cigna-connect-0-naan-plan-300b-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040007","Cigna US-IL Connect 3500","53882IL004",,"ILN001","ILS001","ILF007","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040007-03","Cigna US-IL Connect 3500-1","Limited Cost Sharing Plan Variation","70.78%","0.706332862377167","Yes","Yes","No","100%",,"$3,500","$110","$750","$30","$140","$1,160","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894612-sbc-cigna-us-il-connect-3500-1-silver-300a-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894613-sob-cigna-us-il-connect-3500-1-silver-300a-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040007","Cigna US-IL Connect 3500","53882IL004",,"ILN001","ILS001","ILF007","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040007-04","Cigna US-IL Connect 3000-2","73% AV Level Silver Plan","73.60%","0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894632-sbc-cigna-us-il-connect-3000-2-silver-200-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894633-sob-cigna-us-il-connect-3000-2-silver-200-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040007","Cigna US-IL Connect 3500","53882IL004",,"ILN001","ILS001","ILF007","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040007-05","Cigna US-IL Connect 700-3","87% AV Level Silver Plan","87.51%","0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894634-sbc-cigna-us-il-connect-700-3-silver-150-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894635-sob-cigna-us-il-connect-700-3-silver-150-chicago-il.pdf"
"2017","IL","53882","SERFF","2016-08-25 03:47:19","Individual","No","36-3385638","53882IL0040007","Cigna US-IL Connect 3500","53882IL004",,"ILN001","ILS001","ILF007","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040007-06","Cigna US-IL Connect 250-4","94% AV Level Silver Plan","94.32%","0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$350","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894636-sbc-cigna-us-il-connect-250-4-silver-100-chicago-il.pdf","http://www.cigna.com/assets/docs/individual-and-families/2017/medical/il/894637-sob-cigna-us-il-connect-250-4-silver-100-chicago-il.pdf"
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380027","Humana Bronze 6150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380027-00","Humana Bronze 6150/Illinois HMOx","Standard Bronze Off Exchange Plan",,"0.602655231952667","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845102",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380025","Humana Basic 7150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","58288IL0380025-00","Humana Basic 7150/Illinois HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2844829",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380025","Humana Basic 7150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","58288IL0380025-01","Humana Basic 7150/Illinois HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2844829",
"2017","IL","60600","SERFF","2016-08-24 05:44:16","Individual","Yes","36-2612058","60600IL0010003","Delta Dental Individual Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010003-01","Delta Dental Individual Preferred Plan","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2017","IL","68303","SERFF","2016-08-24 05:44:16","Individual","Yes","39-1263473","68303IL0690001","Humana Dental Smart Choice","68303IL069",,"ILN002","ILS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","68303IL0690001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857023"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","80-0968685","27811KS0020001","BlueCare Solutions GoldSHOP","27811KS002",,"KSN001","KSS001","KSF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.991435037029664",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0020001-01","BlueCare Solutions GoldSHOP","Standard Gold On Exchange Plan","78.69%","0.78690367937088","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$200","$500","$1,300","$0","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0020001-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0020001-01"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010009","BlueCare Solutions Gold","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010009-00","BlueCare Solutions Gold","Standard Gold Off Exchange Plan","79.72%","0.797174870967865","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$200","$500","$1,500","$0","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010009-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010009-00"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010009","BlueCare Solutions Gold","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010009-01","BlueCare Solutions Gold","Standard Gold On Exchange Plan","79.72%","0.797174870967865","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$200","$500","$1,500","$0","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010009-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010009-01"
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380026","Humana Bronze 4800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","58288IL0380026-00","Humana Bronze 4800/Illinois HMOx","Standard Bronze Off Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2844972",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380026","Humana Bronze 4800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","58288IL0380026-01","Humana Bronze 4800/Illinois HMOx","Standard Bronze On Exchange Plan",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2844972",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380026","Humana Bronze 4800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","58288IL0380026-02","Humana Bronze 4800/Illinois HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2844998",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380026","Humana Bronze 4800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF002","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","58288IL0380026-03","Humana Bronze 4800/Illinois HMOx","Limited Cost Sharing Plan Variation",,"0.617141127586365","Yes","Yes","No","100%",,"$4,800","$0","$1,200","$30","$4,800","$0","$300","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845011",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380027","Humana Bronze 6150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380027-01","Humana Bronze 6150/Illinois HMOx","Standard Bronze On Exchange Plan",,"0.602655231952667","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845102",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380027","Humana Bronze 6150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380027-02","Humana Bronze 6150/Illinois HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845115",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380027","Humana Bronze 6150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380027-03","Humana Bronze 6150/Illinois HMOx","Limited Cost Sharing Plan Variation",,"0.602655231952667","No","Yes","Yes","97%","3%","$6,150","$20","$200","$30","$2,100","$700","$0","$100","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","20.00%","$6,150","$6150 per person","$12300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845141",
"2017","IL","68303","SERFF","2016-08-24 05:44:16","Individual","Yes","39-1263473","68303IL0690001","Humana Dental Smart Choice","68303IL069",,"ILN002","ILS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","68303IL0690001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857023"
"2017","IL","75159","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","47-0098400","75159IL0040002","EHB High PPO","75159IL004",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380028","Humana Silver 4150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380028-00","Humana Silver 4150/Illinois HMOx","Standard Silver Off Exchange Plan",,"0.681158185005188","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845323",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380028","Humana Silver 4150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380028-01","Humana Silver 4150/Illinois HMOx","Standard Silver On Exchange Plan",,"0.681158185005188","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845323",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380028","Humana Silver 4150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380028-02","Humana Silver 4150/Illinois HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845336",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380028","Humana Silver 4150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380028-03","Humana Silver 4150/Illinois HMOx","Limited Cost Sharing Plan Variation",,"0.681158185005188","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845349",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380028","Humana Silver 4150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380028-04","Humana Silver 3500/Illinois HMOx","73% AV Level Silver Plan",,"0.722137033939362","No","Yes","Yes","97%","3%","$3,500","$10","$800","$30","$3,200","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%","$3,500","$3500 per person","$7000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845258",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380028","Humana Silver 4150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380028-05","Humana Silver 900/Illinois HMOx","87% AV Level Silver Plan",,"0.865757286548615","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845388",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380028","Humana Silver 4150/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380028-06","Humana Silver 250/Illinois HMOx","94% AV Level Silver Plan",,"0.933465957641602","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845232",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380049","Humana Gold 1400/Illinois HMOx","58288IL038",,"ILN002","ILS004","ILF005","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380049-00","Humana Gold 1400/Illinois HMOx","Standard Gold Off Exchange Plan",,"0.790098428726196","No","Yes","Yes","97%","3%","$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845167",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380049","Humana Gold 1400/Illinois HMOx","58288IL038",,"ILN002","ILS004","ILF005","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380049-01","Humana Gold 1400/Illinois HMOx","Standard Gold On Exchange Plan",,"0.790098428726196","No","Yes","Yes","97%","3%","$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845167",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380049","Humana Gold 1400/Illinois HMOx","58288IL038",,"ILN002","ILS004","ILF005","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380049-02","Humana Gold 1400/Illinois HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845180",
"2017","IL","58288","SERFF","2017-01-22 20:15:32","Individual","No","61-1013183","58288IL0380049","Humana Gold 1400/Illinois HMOx","58288IL038",,"ILN002","ILS004","ILF005","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","58288IL0380049-03","Humana Gold 1400/Illinois HMOx","Limited Cost Sharing Plan Variation",,"0.790098428726196","No","Yes","Yes","97%","3%","$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845193",
"2017","IL","59928","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-0883760","59928IL0040002","EHB High PPO","59928IL004",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IL","59928","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-0883760","59928IL0040001","EHB Low PPO","59928IL004",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IL","59928","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-0883760","59928IL0030002","EHB High Passive","59928IL003",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IL","59928","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","36-0883760","59928IL0030001","EHB Low Passive","59928IL003",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","IL","60600","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-2612058","60600IL0030002","Delta Dental Individual Kids Preferred Plan","60600IL003",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must see a Delta Dental PPO Provider","Yes",,"","60600IL0030002-00","Delta Dental Individual Kids Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IL","60600","SERFF","2016-08-24 05:44:16","Individual","Yes","36-2612058","60600IL0010002","Delta Dental Individual Kids Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010002-00","Delta Dental Individual Kids Basic Plan","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2017","IL","60600","SERFF","2016-08-24 05:44:16","Individual","Yes","36-2612058","60600IL0010002","Delta Dental Individual Kids Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010002-01","Delta Dental Individual Kids Basic Plan","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2017","IL","60600","SERFF","2016-08-24 05:44:16","Individual","Yes","36-2612058","60600IL0010001","Delta Dental Individual Kids Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010001-00","Delta Dental Individual Kids Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2017","IL","60600","SERFF","2016-08-24 05:44:16","Individual","Yes","36-2612058","60600IL0010001","Delta Dental Individual Kids Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010001-01","Delta Dental Individual Kids Preferred Plan","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2017","IL","60600","SERFF","2016-08-24 05:44:16","Individual","Yes","36-2612058","60600IL0010004","Delta Dental Individual Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010004-00","Delta Dental Individual Basic Plan","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2017","IL","60600","SERFF","2016-08-24 05:44:16","Individual","Yes","36-2612058","60600IL0010004","Delta Dental Individual Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010004-01","Delta Dental Individual Basic Plan","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2017","IL","60600","SERFF","2016-08-24 05:44:16","Individual","Yes","36-2612058","60600IL0010003","Delta Dental Individual Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010003-00","Delta Dental Individual Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2017","IL","75159","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","47-0098400","75159IL0040001","EHB Low PPO","75159IL004",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IL","75159","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","47-0098400","75159IL0030002","EHB High Passive","75159IL003",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IL","75159","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","47-0098400","75159IL0030001","EHB Low Passive","75159IL003",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","Individual","Yes","31-1185262","80839IL0010001","Illinois DentaTrust - PPO Pediatric High Option","80839IL001","7083617077","ILN001","ILS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010001-00","Illinois DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIL.dentalcareplus.com","https://hixindsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","31-1185262","80839IL0020003","DentaSpan Family High Option","80839IL002","7083617077","ILN001","ILS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIL.dentalcareplus.com","https://hixsgsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","31-1185262","80839IL0020003","DentaSpan Family High Option","80839IL002","7083617077","ILN001","ILS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIL.dentalcareplus.com","https://hixsgsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","Individual","Yes","31-1185262","80839IL0010001","Illinois DentaTrust - PPO Pediatric High Option","80839IL001","7083617077","ILN001","ILS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010001-01","Illinois DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIL.dentalcareplus.com","https://hixindsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","Individual","Yes","31-1185262","80839IL0010002","Illinois DentaTrust - PPO Pediatric Low Option","80839IL001","7083617077","ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","80839IL0010002-00","Illinois DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIL.dentalcareplus.com","https://hixindsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","31-1185262","80839IL0020004","DentaSpan Family Low Option","80839IL002","7083617077","ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIL.dentalcareplus.com","https://hixsgsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","SHOP (Small Group)","Yes","31-1185262","80839IL0020004","DentaSpan Family Low Option","80839IL002","7083617077","ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbIL.dentalcareplus.com","https://hixsgsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","Individual","Yes","31-1185262","80839IL0010002","Illinois DentaTrust - PPO Pediatric Low Option","80839IL001","7083617077","ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","80839IL0010002-01","Illinois DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIL.dentalcareplus.com","https://hixindsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","Individual","Yes","31-1185262","80839IL0010003","Illinois DentaTrust - PPO Family High Option","80839IL001","7083617077","ILN001","ILS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010003-00","Illinois DentaTrust - PPO Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIL.dentalcareplus.com","https://hixindsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","Individual","Yes","31-1185262","80839IL0010003","Illinois DentaTrust - PPO Family High Option","80839IL001","7083617077","ILN001","ILS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010003-01","Illinois DentaTrust - PPO Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIL.dentalcareplus.com","https://hixindsbIL.dentalcareplus.com"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5123390","85099IL0200004","Guardian Pediatric Essentials","85099IL020",,"ILN001","ILS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is  provided outside of the Service Area.","Yes",,"","85099IL0200004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","Individual","Yes","13-5123390","85099IL0220001","Guardian Select for Families and Individuals","85099IL022",,"ILN002","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","85099IL0220001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","Individual","Yes","13-5123390","85099IL0220001","Guardian Select for Families and Individuals","85099IL022",,"ILN002","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","85099IL0220001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5123390","85099IL0160004","Guardian Family Advantage","85099IL016",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","85099IL0160004-01","Guardian Family Advantage","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5123390","85099IL0160005","Guardian Family Advantage","85099IL016",,"ILN001","ILS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","85099IL0160005-00","Guardian Family Advantage","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5123390","85099IL0180004","Guardian Family Essentials","85099IL018",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","85099IL0180004-01","Guardian Family Essentials","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5123390","85099IL0180005","Guardian Family Essentials","85099IL018",,"ILN001","ILS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","85099IL0180005-00","Guardian Family Essentials","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","Individual","Yes","31-1185262","80839IL0010004","Illinois DentaTrust - PPO Family Low Option","80839IL001","7083617077","ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010004-00","Illinois DentaTrust - PPO Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIL.dentalcareplus.com","https://hixindsbIL.dentalcareplus.com"
"2017","IL","80839","SERFF","2016-11-16 22:15:47","Individual","Yes","31-1185262","80839IL0010004","Illinois DentaTrust - PPO Family Low Option","80839IL001","7083617077","ILN001","ILS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010004-01","Illinois DentaTrust - PPO Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbIL.dentalcareplus.com","https://hixindsbIL.dentalcareplus.com"
"2017","IL","83350","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5581829","83350IL0170002","EHB Basic Dental Plan (Low)","83350IL017",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0170002-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$200","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","IL","83350","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5581829","83350IL0190001","Family Basic Dental Plan (Low)","83350IL019",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0190001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49083"
"2017","IL","83350","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5581829","83350IL0190001","Family Basic Dental Plan (Low)","83350IL019",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0190001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49083"
"2017","IL","83350","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5581829","83350IL0200001","Family Enhanced Dental Plan (High)","83350IL020",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0200001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49085"
"2017","IL","83350","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5581829","83350IL0200001","Family Enhanced Dental Plan (High)","83350IL020",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.87","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0200001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49085"
"2017","IL","84033","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","84033IL0020001","BESTOne Dental Plus-Silver","84033IL002",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","FULL","Yes","http://www.bestlife.com/exchange/payment_option.html","","84033IL0020001-00","BESTOne Dental Plus-Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IL/2017/IL_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","IL","84033","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","84033IL0020001","BESTOne Dental Plus-Silver","84033IL002",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","FULL","Yes","http://www.bestlife.com/exchange/payment_option.html","","84033IL0020001-01","BESTOne Dental Plus-Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IL/2017/IL_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","Individual","Yes","13-5123390","85099IL0210001","Guardian Essentials for Families and Individuals","85099IL021",,"ILN002","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","85099IL0210001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5123390","85099IL0190004","Guardian Pediatric Advantage","85099IL019",,"ILN001","ILS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is  provided outside of the Service Area.","Yes",,"","85099IL0190004-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","85099","SERFF","2016-08-24 05:44:16","Individual","Yes","13-5123390","85099IL0210001","Guardian Essentials for Families and Individuals","85099IL021",,"ILN002","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","85099IL0210001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IL","87304","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-4189451","87304IL0030003","Managed DentalGuard IL10 Family Plan","87304IL003",,"ILN001","ILS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.966","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","87304IL0030003-00","Managed DentalGuard IL10 Family Plan","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","87304","SERFF","2016-08-24 05:44:16","Individual","Yes","36-4189451","87304IL0060004","Managed DentalGuard IL Essentials 1","87304IL006",,"ILN002","ILS002",,"New","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.97","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/payments","","87304IL0060004-01","Managed DentalGuard IL Essentials 1","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IL","87304","SERFF","2016-08-24 05:44:16","Individual","Yes","36-4189451","87304IL0060005","Managed DentalGuard IL Essentials 1","87304IL006",,"ILN002","ILS001",,"New","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.97","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/payments","","87304IL0060005-00","Managed DentalGuard IL Essentials 1","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","IL","87304","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-4189451","87304IL0030003","Managed DentalGuard IL10 Family Plan","87304IL003",,"ILN001","ILS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.966","Guaranteed Rate","2017-01-01",,"No",,"No",,"No",,"","87304IL0030003-01","Managed DentalGuard IL10 Family Plan","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","87304","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-4189451","87304IL0040003","Managed DentalGuard IL20 Family Plan","87304IL004",,"ILN001","ILS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.968","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","87304IL0040003-00","Managed DentalGuard IL20 Family Plan","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","IL","87304","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-4189451","87304IL0050003","Managed DentalGuard IL30 Family Plan","87304IL005",,"ILN001","ILS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.972","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","87304IL0050003-00","Managed DentalGuard IL30 Family Plan","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010011","BlueCare Solutions Simple Silver","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010011-03","BlueCare Solutions Simple Silver","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010011-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010011-03"
"2017","KS","11339","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","11339KS0010009","Dentegra Dental PPO Pediatric Basic Plan","11339KS001",,"KSN001","KSS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010009-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010009-17"
"2017","KS","11339","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","11339KS0020009","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","11339KS002",,"KSN001","KSS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0020009-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0020009-17"
"2017","KS","11339","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","11339KS0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","11339KS002",,"KSN001","KSS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0020008-17"
"2017","KS","11339","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","11339KS0010008","Dentegra Dental PPO Family Preferred Plan","11339KS001",,"KSN001","KSS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010008-17"
"2017","KS","11339","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","11339KS0010007","Dentegra Dental PPO Family Basic Plan","11339KS001",,"KSN001","KSS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010007-17"
"2017","KS","11339","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","11339KS0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","11339KS002",,"KSN001","KSS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0020007-17"
"2017","KS","25268","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","25268KS0010001","TruAssure Basic Adult or Child Dental Plan","25268KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS"
"2017","KS","25268","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-3757528","25268KS0030001","TruAssure Dental Small Group Basic Plan","25268KS003",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","25268KS0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","25268","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-3757528","25268KS0040001","TruAssure Dental Small Group Preferred Plan","25268KS004",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","25268KS0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","25268","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","25268KS0010001","TruAssure Basic Adult or Child Dental Plan","25268KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS"
"2017","KS","25268","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","25268KS0020001","TruAssure Preferred Adult or Child Dental Plan","25268KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS"
"2017","KS","25268","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","25268KS0020001","TruAssure Preferred Adult or Child Dental Plan","25268KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","80-0968685","27811KS0020001","BlueCare Solutions GoldSHOP","27811KS002",,"KSN001","KSS001","KSF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.991435037029664",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0020001-00","BlueCare Solutions GoldSHOP","Standard Gold Off Exchange Plan","78.69%","0.78690367937088","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$200","$500","$1,300","$0","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0020001-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0020001-00"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","80-0968685","27811KS0020013","BlueCare Solutions Simple SilverSHOP","27811KS002",,"KSN001","KSS001","KSF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.991435037029664",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0020013-00","BlueCare Solutions Simple SilverSHOP","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0020013-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0020013-00"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","80-0968685","27811KS0020013","BlueCare Solutions Simple SilverSHOP","27811KS002",,"KSN001","KSS001","KSF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.991435037029664",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0020013-01","BlueCare Solutions Simple SilverSHOP","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0020013-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0020013-01"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010009","BlueCare Solutions Gold","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010009-02","BlueCare Solutions Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010009-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010009-02"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010009","BlueCare Solutions Gold","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010009-03","BlueCare Solutions Gold","Limited Cost Sharing Plan Variation","79.72%","0.797174870967865","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$200","$500","$1,500","$0","$40","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010009-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010009-03"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010010","BlueCare Solutions Silver","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010010-00","BlueCare Solutions Silver","Standard Silver Off Exchange Plan","70.36%","0.703558385372162","Yes","Yes","No","100%",,"$3,000","$20","$800","$200","$400","$1,700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010010-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010010-00"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010010","BlueCare Solutions Silver","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010010-01","BlueCare Solutions Silver","Standard Silver On Exchange Plan","70.36%","0.703558385372162","Yes","Yes","No","100%",,"$3,000","$20","$800","$200","$400","$1,700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010010-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010010-01"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010010","BlueCare Solutions Silver","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010010-02","BlueCare Solutions Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010010-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010010-02"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010010","BlueCare Solutions Silver","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010010-03","BlueCare Solutions Silver","Limited Cost Sharing Plan Variation","70.36%","0.703558385372162","Yes","Yes","No","100%",,"$3,000","$20","$800","$200","$400","$1,700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010010-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010010-03"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010010","BlueCare Solutions Silver","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010010-04","BlueCare Solutions Silver","73% AV Level Silver Plan","72.69%","0.726908981800079","Yes","Yes","No","100%",,"$2,800","$20","$900","$200","$400","$1,500","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010010-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010010-04"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010010","BlueCare Solutions Silver","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010010-05","BlueCare Solutions Silver","87% AV Level Silver Plan","87.94%","0.879388391971588","Yes","Yes","No","100%",,"$800","$0","$800","$200","$400","$1,100","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010010-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010010-05"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010010","BlueCare Solutions Silver","27811KS001",,"KSN001","KSS001","KSF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010010-06","BlueCare Solutions Silver","94% AV Level Silver Plan","94.32%","0.943247735500336","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$200","$10","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010010-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010010-06"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010011","BlueCare Solutions Simple Silver","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010011-00","BlueCare Solutions Simple Silver","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010011-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010011-00"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010011","BlueCare Solutions Simple Silver","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010011-01","BlueCare Solutions Simple Silver","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010011-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010011-01"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010011","BlueCare Solutions Simple Silver","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010011-02","BlueCare Solutions Simple Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010011-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010011-02"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010011","BlueCare Solutions Simple Silver","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010011-04","BlueCare Solutions Simple Silver","73% AV Level Silver Plan",,"0.735971808433533","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010011-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010011-04"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010011","BlueCare Solutions Simple Silver","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010011-05","BlueCare Solutions Simple Silver","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010011-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010011-05"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010011","BlueCare Solutions Simple Silver","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010011-06","BlueCare Solutions Simple Silver","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010011-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010011-06"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010012","BlueCare Solutions Bronze","27811KS001",,"KSN001","KSS001","KSF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010012-00","BlueCare Solutions Bronze","Standard Bronze Off Exchange Plan",,"0.618160963058472","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,200","$1,000","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010012-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010012-00"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010012","BlueCare Solutions Bronze","27811KS001",,"KSN001","KSS001","KSF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010012-01","BlueCare Solutions Bronze","Standard Bronze On Exchange Plan",,"0.618160963058472","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,200","$1,000","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010012-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010012-01"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010012","BlueCare Solutions Bronze","27811KS001",,"KSN001","KSS001","KSF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010012-02","BlueCare Solutions Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010012-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010012-02"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010012","BlueCare Solutions Bronze","27811KS001",,"KSN001","KSS001","KSF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010012-03","BlueCare Solutions Bronze","Limited Cost Sharing Plan Variation",,"0.618160963058472","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,200","$1,000","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010012-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010012-03"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010013","BlueCare Solutions Simple Bronze","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010013-00","BlueCare Solutions Simple Bronze","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010013-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010013-00"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010013","BlueCare Solutions Simple Bronze","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010013-01","BlueCare Solutions Simple Bronze","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010013-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010013-01"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010013","BlueCare Solutions Simple Bronze","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010013-02","BlueCare Solutions Simple Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010013-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010013-02"
"2017","KS","27811","SERFF","2017-04-21 20:15:32","Individual","No","80-0968685","27811KS0010013","BlueCare Solutions Simple Bronze","27811KS001",,"KSN001","KSS001","KSF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_KS_6T_HealthInsuranceMarketplace.pdf","27811KS0010013-03","BlueCare Solutions Simple Bronze","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=s&hi=27811KS0010013-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2017&sb=b&hi=27811KS0010013-03"
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010011","Medica Connect Bronze H S A","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010011-00","Medica Connect Bronze H S A","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBHKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010011","Medica Connect Bronze H S A","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010011-01","Medica Connect Bronze H S A","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBHKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010011","Medica Connect Bronze H S A","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010011-02","Medica Connect Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBHKSZ&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010011","Medica Connect Bronze H S A","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010011-03","Medica Connect Bronze H S A","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBHKSL&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010013","Medica Connect Catastrophic","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010013-00","Medica Connect Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CCKS&uid=FFM",
"2017","KS","31098","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","31098KS0040002","EHB High PPO","31098KS004",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31098KS0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","KS","31098","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","31098KS0040001","EHB Low PPO","31098KS004",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31098KS0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","KS","31098","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","31098KS0030002","EHB High Passive","31098KS003",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31098KS0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","KS","31098","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","31098KS0030001","EHB Low Passive","31098KS003",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31098KS0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","KY","11469","SERFF","2016-08-20 11:23:22","Individual","Yes","52-1157181","11469KY0010002","Humana Dental Smart Choice","11469KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9975","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","11469KY0010002-00","Humana Dental Smart Choice","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857036"
"2017","KY","11469","SERFF","2016-08-20 11:23:22","Individual","Yes","52-1157181","11469KY0010002","Humana Dental Smart Choice","11469KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9975","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","11469KY0010002-01","Humana Dental Smart Choice","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857036"
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010001","Medica Connect Gold Copay","39520KS001",,"KSN001","KSS001","KSF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010001-00","Medica Connect Gold Copay","Standard Gold Off Exchange Plan",,"0.796494245529175","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CGCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010001","Medica Connect Gold Copay","39520KS001",,"KSN001","KSS001","KSF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010001-01","Medica Connect Gold Copay","Standard Gold On Exchange Plan",,"0.796494245529175","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CGCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010001","Medica Connect Gold Copay","39520KS001",,"KSN001","KSS001","KSF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010001-02","Medica Connect Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CGCKSZ&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010001","Medica Connect Gold Copay","39520KS001",,"KSN001","KSS001","KSF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010001-03","Medica Connect Gold Copay","Limited Cost Sharing Plan Variation",,"0.796494245529175","Yes","Yes","No","100%",,"$300","$10","$1,500","$1,000","$300","$400","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CGCKSL&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010019","Medica Connect Gold Copay Plus","39520KS001",,"KSN001","KSS001","KSF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010019-00","Medica Connect Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.794800639152527","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CGPCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010019","Medica Connect Gold Copay Plus","39520KS001",,"KSN001","KSS001","KSF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010019-01","Medica Connect Gold Copay Plus","Standard Gold On Exchange Plan",,"0.794800639152527","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CGPCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010019","Medica Connect Gold Copay Plus","39520KS001",,"KSN001","KSS001","KSF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010019-02","Medica Connect Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CGPCKSZ&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010019","Medica Connect Gold Copay Plus","39520KS001",,"KSN001","KSS001","KSF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010019-03","Medica Connect Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.794800639152527","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CGPCKSL&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010005","Medica Connect Bronze Copay","39520KS001",,"KSN001","KSS001","KSF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010005-00","Medica Connect Bronze Copay","Standard Bronze Off Exchange Plan",,"0.618277251720428","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010005","Medica Connect Bronze Copay","39520KS001",,"KSN001","KSS001","KSF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010005-01","Medica Connect Bronze Copay","Standard Bronze On Exchange Plan",,"0.618277251720428","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010005","Medica Connect Bronze Copay","39520KS001",,"KSN001","KSS001","KSF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010005-02","Medica Connect Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBCKSZ&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010005","Medica Connect Bronze Copay","39520KS001",,"KSN001","KSS001","KSF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010005-03","Medica Connect Bronze Copay","Limited Cost Sharing Plan Variation",,"0.618277251720428","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBCKSL&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010013","Medica Connect Catastrophic","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010013-01","Medica Connect Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010003-00","Medica Connect Silver Copay","Standard Silver Off Exchange Plan",,"0.707191944122314","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010003-01","Medica Connect Silver Copay","Standard Silver On Exchange Plan",,"0.707191944122314","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSCKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010003-02","Medica Connect Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSCKSZ&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010003-03","Medica Connect Silver Copay","Limited Cost Sharing Plan Variation",,"0.707191944122314","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSCKSL&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010003-04","Medica Connect Silver Copay","73% AV Level Silver Plan",,"0.739694714546204","Yes","Yes","No","100%",,"$2,400","$10","$900","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSCKS73&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010003-05","Medica Connect Silver Copay","87% AV Level Silver Plan",,"0.875705480575562","Yes","Yes","No","100%",,"$400","$10","$1,000","$1,000","$400","$400","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSCKS87&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010003-06","Medica Connect Silver Copay","94% AV Level Silver Plan",,"0.934722244739532","Yes","Yes","No","100%",,"$100","$10","$300","$1,000","$100","$400","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSCKS94&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010009","Medica Connect Silver H S A","39520KS001",,"KSN001","KSS001","KSF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010009-00","Medica Connect Silver H S A","Standard Silver Off Exchange Plan",,"0.706670701503754","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSHKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010009","Medica Connect Silver H S A","39520KS001",,"KSN001","KSS001","KSF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010009-01","Medica Connect Silver H S A","Standard Silver On Exchange Plan",,"0.706670701503754","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSHKS&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010009","Medica Connect Silver H S A","39520KS001",,"KSN001","KSS001","KSF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010009-02","Medica Connect Silver H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSHKSZ&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010009","Medica Connect Silver H S A","39520KS001",,"KSN001","KSS001","KSF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010009-03","Medica Connect Silver H S A","Limited Cost Sharing Plan Variation",,"0.706670701503754","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSHKSL&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010009","Medica Connect Silver H S A","39520KS001",,"KSN001","KSS001","KSF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010009-04","Medica Connect Silver H S A","73% AV Level Silver Plan",,"0.738716244697571","Yes","Yes","No","100%",,"$1,100","$0","$1,300","$1,000","$1,100","$0","$1,300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$3300 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSHKS73&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010009","Medica Connect Silver H S A","39520KS001",,"KSN001","KSS001","KSF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010009-05","Medica Connect Silver H S A","87% AV Level Silver Plan",,"0.874496221542358","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSHKS87&uid=FFM",
"2017","KS","39520","SERFF","2016-11-16 22:15:47","Individual","No","41-1490988","39520KS0010009","Medica Connect Silver H S A","39520KS001",,"KSN001","KSS001","KSF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","39520KS0010009-06","Medica Connect Silver H S A","94% AV Level Silver Plan",,"0.941815733909607","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CSHKS94&uid=FFM",
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010009","BESTDental Standard - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Standard-L_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","63790KS0020005","BESTOne Plus Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2017/KS_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","63790KS0020006","BESTOne Basic Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2017/KS_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010011","BESTDental Choice - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Choice-L_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010011","BESTDental Choice - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Choice-L_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","63790KS0020006","BESTOne Basic Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2017/KS_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010012","BESTDental Value","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Value_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010012","BESTDental Value","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Value_Plan.pdf"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150004-01","First Select Silver","Standard Silver On Exchange Plan",,"0.700782597064972","Yes","Yes","Yes","45%","55%","$5,000","$10","$0","$150","$5,000","$20","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%","$5,000","$5000 per person","$10000 per group","0.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectsilver.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140024","Standard PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF010","New","PPO","Bronze","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140024-01","Standard PCB Bronze","Standard Bronze On Exchange Plan",,"0.618824541568756","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/standardpcbbronze.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","63790KS0020003","BESTOne Advantage Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2017/KS_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010007","BESTDental Premium","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Premium_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010007","BESTDental Premium","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Premium_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","63790KS0020003","BESTOne Advantage Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2017/KS_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010008","BESTDental Standard - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Standard-H_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","63790KS0020004","BESTOne Plus Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2017/KS_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","63790KS0020004","BESTOne Plus Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2017/KS_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010008","BESTDental Standard - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Standard-H_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010010","BESTDental Choice - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Choice-H_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010010","BESTDental Choice - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Choice-H_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","63790KS0020005","BESTOne Plus Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2017/KS_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","KS","63790","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","63790KS0010009","BESTDental Standard - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/2017/KS_BESTDental_Standard-L_Plan.pdf"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140014-06","Saver PCB Silver","94% AV Level Silver Plan",,"0.931500434875488","Yes","Yes","No","100%",,"$350","$0","$370","$150","$350","$170","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbsilver7.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","Individual","Yes","31-1185262","18726KY0040002","DentaTrust - PPO Pediatric Low Option","18726KY004","7083617077","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040002-00","DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbKY.dentalcareplus.com","http://hixindsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","31-1185262","18726KY0050004","DentaSpan Family Low Option","18726KY005","7083617077","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0050004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbKY.dentalcareplus.com","http://hixsgsbKY.dentalcareplus.com"
"2017","KS","79684","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","79684KS0040002","EHB High PPO","79684KS004",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","79684KS0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","KS","79684","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","79684KS0040001","EHB Low PPO","79684KS004",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","79684KS0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","KS","79684","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","79684KS0030002","EHB High Passive","79684KS003",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","79684KS0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","KS","79684","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","79684KS0030001","EHB Low Passive","79684KS003",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","79684KS0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","KS","81711","SERFF","2016-08-20 11:23:22","Individual","Yes","48-0793267","81711KS0010003","Delta Dental Individual & Family - Basic+POEHB","81711KS001","7427051660","KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0010003-01","Delta Dental Individual & Family - Basic+POEHB","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$70","$70 per person","$210 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/plan-options/KS-plans","https://www.deltadentalcoversme.com/plan-options/KS-plans"
"2017","KS","81711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","48-0793267","81711KS0020009","Delta Dental PPO - Basic Family+POEHB","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is nationwide PPO network presence.","Yes",,"","81711KS0020009-00","Delta Dental PPO - Basic Family+POEHB","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$70","$70 per person","$210 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalks.com/Employers/SHOP2017/","http://www.deltadentalks.com/IndividualOptions/shop/"
"2017","KS","81711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","48-0793267","81711KS0020009","Delta Dental PPO - Basic Family+POEHB","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is nationwide PPO network presence.","Yes",,"","81711KS0020009-01","Delta Dental PPO - Basic Family+POEHB","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$70","$70 per person","$210 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalks.com/Employers/SHOP2017/","http://www.deltadentalks.com/IndividualOptions/shop/"
"2017","KS","81711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","48-0793267","81711KS0020010","Delta Dental PPO - Preferred Family+POEHB","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020010-00","Delta Dental PPO - Preferred Family+POEHB","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","$120 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalks.com/Employers/SHOP2017/","http://www.deltadentalks.com/IndividualOptions/shop/"
"2017","KS","81711","SERFF","2016-08-20 11:23:22","Individual","Yes","48-0793267","81711KS0010004","Delta Dental Individual & Family - Preferred+POEHB","81711KS001","7427051660","KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0010004-01","Delta Dental Individual & Family - Preferred+POEHB","Standard High On Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","$120 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/plan-options/KS-plans","https://www.deltadentalcoversme.com/plan-options/KS-plans"
"2017","KS","81711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","48-0793267","81711KS0020010","Delta Dental PPO - Preferred Family+POEHB","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020010-01","Delta Dental PPO - Preferred Family+POEHB","Standard High On Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","$120 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalks.com/Employers/SHOP2017/","http://www.deltadentalks.com/IndividualOptions/shop/"
"2017","KS","81711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","48-0793267","81711KS0020011","Delta Dental PPO - Basic POEHB Addendum","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Provides Coverage in United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020011-00","Delta Dental PPO - Basic POEHB Addendum","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$70","$70 per person","$210 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","81711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","48-0793267","81711KS0020013","Delta Dental Premier - Basic POEHB Addendum","81711KS002","7427051660","KSN003","KSS001",,"Existing","POS","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Provides Coverage in United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes",,"","81711KS0020013-00","Delta Dental Premier - Basic POEHB Addendum","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","81711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","48-0793267","81711KS0020012","Delta Dental PPO - Preferred POEHB Addendum","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Provides Coverage in United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020012-00","Delta Dental PPO - Preferred POEHB Addendum","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","$120 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","81711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","48-0793267","81711KS0020014","Delta Dental Premier - Preferred POEHB Addendum","81711KS002","7427051660","KSN003","KSS001",,"Existing","POS","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Provides Coverage in United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes",,"","81711KS0020014-00","Delta Dental Premier - Preferred POEHB Addendum","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","86067","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","57-0523959","86067KS0020001","Group Dental Policy","86067KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","86067KS0020001-00","Group Dental Policy","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","86246","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","86246KS0040002","EHB High PPO","86246KS004",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86246KS0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","KS","86246","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","86246KS0040001","EHB Low PPO","86246KS004",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86246KS0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","KS","86246","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","86246KS0030002","EHB High Passive","86246KS003",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86246KS0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","KS","86246","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","86246KS0030001","EHB Low Passive","86246KS003",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86246KS0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","KS","93384","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","93384KS0090001","EHB Basic Dental Plan (Low)","93384KS009",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","93384KS0090001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140006","First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140006-01","First PCB Bronze","Standard Bronze On Exchange Plan",,"0.618651986122131","Yes","Yes","No","100%",,"$6,800","$20","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","0.00%",,,,,"$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstpcbbronze.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","No","43-1257251","94248KS0220001","First 1000 PCB Gold","94248KS022","7023011258","KSN001","KSS001","KSF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0220001-00","First 1000 PCB Gold","Standard Gold Off Exchange Plan",,"0.818041026592255","Yes","Yes","No","100%",,"$1,000","$20","$940","$150","$1,000","$400","$160","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2017/sg/ks/firstpcbgold1000.html","http://www.bluekc.com/qhp/2017/sgbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","No","43-1257251","94248KS0220001","First 1000 PCB Gold","94248KS022","7023011258","KSN001","KSS001","KSF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0220001-01","First 1000 PCB Gold","Standard Gold On Exchange Plan",,"0.818041026592255","Yes","Yes","No","100%",,"$1,000","$20","$940","$150","$1,000","$400","$160","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2017/sg/ks/firstpcbgold21000.html","http://www.bluekc.com/qhp/2017/sgbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140006","First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140006-02","First PCB Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstpcbbronze3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140006","First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140006-03","First PCB Bronze","Limited Cost Sharing Plan Variation",,"0.618651986122131","Yes","Yes","No","100%",,"$6,800","$20","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","0.00%",,,,,"$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstpcbbronze4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","No","43-1257251","94248KS0220002","First 2500 PCB Silver","94248KS022","7023011258","KSN001","KSS001","KSF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0220002-00","First 2500 PCB Silver","Standard Silver Off Exchange Plan",,"0.716590523719788","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$280","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2017/sg/ks/firstpcbsilver2500.html","http://www.bluekc.com/qhp/2017/sgbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","No","43-1257251","94248KS0220002","First 2500 PCB Silver","94248KS022","7023011258","KSN001","KSS001","KSF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0220002-01","First 2500 PCB Silver","Standard Silver On Exchange Plan",,"0.716590523719788","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$280","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2017/sg/ks/firstpcbsilver22500.html","http://www.bluekc.com/qhp/2017/sgbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150004-02","First Select Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","45%","55%","$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectsilver3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150004-03","First Select Silver","Limited Cost Sharing Plan Variation",,"0.700782597064972","Yes","Yes","Yes","45%","55%","$5,000","$10","$0","$150","$5,000","$20","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%","$5,000","$5000 per person","$10000 per group","0.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectsilver4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150004-04","First Select Silver","73% AV Level Silver Plan",,"0.736137866973877","Yes","Yes","Yes","45%","55%","$4,600","$10","$0","$150","$4,600","$40","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","0.00%","$4,600","$4600 per person","$9200 per group","0.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectsilver5.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150004-05","First Select Silver","87% AV Level Silver Plan",,"0.860273599624634","Yes","Yes","Yes","45%","55%","$1,500","$10","$0","$150","$1,500","$190","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","$2,100","$2100 per person","$4200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0.00%","$1,500","$1500 per person","$3000 per group","0.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectsilver6.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150004-06","First Select Silver","94% AV Level Silver Plan",,"0.930369973182678","Yes","Yes","Yes","45%","55%","$500","$10","$0","$150","$500","$240","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectsilver7.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150006","First Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150006-01","First Select Bronze","Standard Bronze On Exchange Plan",,"0.61641389131546","Yes","Yes","Yes","45%","55%","$6,800","$10","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","0.00%","$6,900","$6900 per person","$13800 per group","0.00%","$8,300","$8300 per person","$16600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectbronze.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150006","First Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150006-02","First Select Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","45%","55%","$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectbronze3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150006","First Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150006-03","First Select Bronze","Limited Cost Sharing Plan Variation",,"0.61641389131546","Yes","Yes","Yes","45%","55%","$6,800","$10","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","0.00%","$6,900","$6900 per person","$13800 per group","0.00%","$8,300","$8300 per person","$16600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/firstselectbronze4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140012","Saver PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140012-01","Saver PCB Gold","Standard Gold On Exchange Plan",,"0.794401049613953","Yes","Yes","No","100%",,"$1,500","$20","$580","$150","$1,500","$330","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"$6,000","$12000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbgold2.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140012","Saver PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140012-02","Saver PCB Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbgold3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140012","Saver PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140012-03","Saver PCB Gold","Limited Cost Sharing Plan Variation",,"0.794401049613953","Yes","Yes","No","100%",,"$1,500","$20","$580","$150","$1,500","$330","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"$6,000","$12000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbgold4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140014-01","Saver PCB Silver","Standard Silver On Exchange Plan",,"0.696421265602112","Yes","Yes","No","100%",,"$3,000","$20","$430","$150","$3,000","$200","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbsilver2.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140014-02","Saver PCB Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbsilver3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140014-03","Saver PCB Silver","Limited Cost Sharing Plan Variation",,"0.696421265602112","Yes","Yes","No","100%",,"$3,000","$20","$430","$150","$3,000","$200","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbsilver4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140014-04","Saver PCB Silver","73% AV Level Silver Plan",,"0.734800219535828","Yes","Yes","No","100%",,"$2,500","$10","$480","$150","$2,500","$120","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbsilver5.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Silver","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140014-05","Saver PCB Silver","87% AV Level Silver Plan",,"0.870028734207153","Yes","Yes","No","100%",,"$950","$0","$500","$150","$950","$180","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbsilver6.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140016","Saver PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140016-01","Saver PCB Bronze","Standard Bronze On Exchange Plan",,"0.61985170841217","Yes","Yes","No","100%",,"$5,500","$0","$250","$150","$5,130","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbbronze2.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140016","Saver PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140016-02","Saver PCB Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbbronze3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140016","Saver PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF002","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140016-03","Saver PCB Bronze","Limited Cost Sharing Plan Variation",,"0.61985170841217","Yes","Yes","No","100%",,"$5,500","$0","$250","$150","$5,130","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverpcbbronze4.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150012","Saver Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150012-01","Saver Select Gold","Standard Gold On Exchange Plan",,"0.788734793663025","Yes","Yes","Yes","45%","55%","$1,500","$10","$580","$150","$1,500","$260","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","$3,000","$6000 per person","$6000 per group","$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%","$1,500","$3000 per person","$3000 per group","10.00%","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverselectgold2.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150012","Saver Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150012-02","Saver Select Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","45%","55%","$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverselectgold3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0150012","Saver Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Gold","Not Applicable","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0150012-03","Saver Select Gold","Limited Cost Sharing Plan Variation",,"0.788734793663025","Yes","Yes","Yes","45%","55%","$1,500","$10","$580","$150","$1,500","$260","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","$3,000","$6000 per person","$6000 per group","$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%","$1,500","$3000 per person","$3000 per group","10.00%","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2017/dp/ks/saverselectgold4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140022","Standard PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF009","New","PPO","Silver","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140022-01","Standard PCB Silver","Standard Silver On Exchange Plan",,"0.706410109996796","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/standardpcbsilver.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140022","Standard PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF009","New","PPO","Silver","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140022-02","Standard PCB Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/standardpcbsilver2.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140022","Standard PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF009","New","PPO","Silver","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140022-03","Standard PCB Silver","Limited Cost Sharing Plan Variation",,"0.706410109996796","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/standardpcbsilver3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140022","Standard PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF009","New","PPO","Silver","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140022-04","Standard PCB Silver","73% AV Level Silver Plan",,"0.735600113868713","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$420","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/standardpcbsilver4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140022","Standard PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF009","New","PPO","Silver","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140022-05","Standard PCB Silver","87% AV Level Silver Plan",,"0.874833643436432","Yes","Yes","No","100%",,"$700","$0","$1,300","$150","$700","$280","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/standardpcbsilver5.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140022","Standard PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF009","New","PPO","Silver","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140022-06","Standard PCB Silver","94% AV Level Silver Plan",,"0.943240940570831","Yes","Yes","No","100%",,"$250","$0","$1,000","$150","$250","$170","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/mo/standardpcbsilver6.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140024","Standard PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF010","New","PPO","Bronze","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140024-02","Standard PCB Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/standardpcbbronze2.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0140024","Standard PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF010","New","PPO","Bronze","Design 1","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For genetic testing except as provided. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0140024-03","Standard PCB Bronze","Limited Cost Sharing Plan Variation",,"0.618824541568756","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2017/dp/ks/standardpcbbronze3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500001","Basic Select Silver","94248KS050","7023011258","KSN004","KSS001","KSF005","New","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500001-01","Basic Select Silver","Standard Silver On Exchange Plan",,"0.692024827003479","No","Yes","No","100%",,"$3,500","$0","$1,500","$150","$3,420","$270","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectsilver.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500001","Basic Select Silver","94248KS050","7023011258","KSN004","KSS001","KSF005","New","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500001-02","Basic Select Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectsilver3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500001","Basic Select Silver","94248KS050","7023011258","KSN004","KSS001","KSF005","New","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500001-03","Basic Select Silver","Limited Cost Sharing Plan Variation",,"0.692024827003479","No","Yes","No","100%",,"$3,500","$0","$1,500","$150","$3,420","$270","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectsilver4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500001","Basic Select Silver","94248KS050","7023011258","KSN004","KSS001","KSF005","New","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500001-04","Basic Select Silver","73% AV Level Silver Plan",,"0.72823840379715","No","Yes","No","100%",,"$2,750","$0","$0","$150","$2,560","$190","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectsilver5.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500001","Basic Select Silver","94248KS050","7023011258","KSN004","KSS001","KSF005","New","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500001-05","Basic Select Silver","87% AV Level Silver Plan",,"0.874348819255829","No","Yes","No","100%",,"$600","$0","$850","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectsilver6.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500001","Basic Select Silver","94248KS050","7023011258","KSN004","KSS001","KSF005","New","EPO","Silver","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500001-06","Basic Select Silver","94% AV Level Silver Plan",,"0.933957695960999","No","Yes","No","100%",,"$300","$0","$250","$150","$400","$90","$60","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectsilver7.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500002","Basic Select Bronze","94248KS050","7023011258","KSN004","KSS001","KSF006","New","EPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500002-01","Basic Select Bronze","Standard Bronze On Exchange Plan",,"0.615511953830719","No","Yes","No","100%",,"$6,350","$0","$0","$150","$3,220","$600","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectbronze.html","http://www.bluekc.com/qhp/2017/dpbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500002","Basic Select Bronze","94248KS050","7023011258","KSN004","KSS001","KSF006","New","EPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500002-02","Basic Select Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectbronze3.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","94248","SERFF","2016-08-20 11:23:22","Individual","No","43-1257251","94248KS0500002","Basic Select Bronze","94248KS050","7023011258","KSN004","KSS001","KSF006","New","EPO","Bronze","Not Applicable","No","On the Exchange","No","No",,"Services received from Non-Preferred Providers except as specified. Services received if there is no obligation for payment or payment has been fully/partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Genetic testing except as provided. Court ordered services, including but not limited to examinations, treatment and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of sexual dysfunction, including drugs and prosthesis. Growth hormone therapy and testing for growth hormone deficiencies in Covered Persons 19 or older. Services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/2017/ksdruglist.html","94248KS0500002-03","Basic Select Bronze","Limited Cost Sharing Plan Variation",,"0.615511953830719","No","Yes","No","100%",,"$6,350","$0","$0","$150","$3,220","$600","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2017/dp/ks/basicselectbronze4.html","http://www.bluekc.com/qhp/2017/dpvarbrochure.html"
"2017","KS","95038","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","95038KS0020003","Renaissance Individual Dental PPO, EHB Certified","95038KS002",,"KSN001","KSS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","95038KS0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","95038","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","95038KS0020004","Renaissance Individual Dental PPO, EHB Certified","95038KS002",,"KSN001","KSS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","95038KS0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","95038","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","95038KS0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","95038KS004",,"KSN001","KSS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/95038","","95038KS0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/KS_EHB_High_2017","http://www.renaissancedental.com/KS_EHB_High_2017"
"2017","KS","95038","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","95038KS0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","95038KS004",,"KSN001","KSS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/95038","","95038KS0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/KS_EHB_Low_2017","http://www.renaissancedental.com/KS_EHB_Low_2017"
"2017","KS","95038","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","95038KS0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","95038KS005",,"KSN001","KSS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/95038","","95038KS0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/KS_Ped_High_2017","http://www.renaissancedental.com/KS_Ped_High_2017"
"2017","KS","95038","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","95038KS0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","95038KS005",,"KSN001","KSS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/95038","","95038KS0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/KS_Ped_Low_2017","http://www.renaissancedental.com/KS_Ped_Low_2017"
"2017","KS","95038","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","95038KS0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","95038KS006",,"KSN001","KSS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","95038KS0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KS","95038","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","95038KS0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","95038KS006",,"KSN001","KSS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","95038KS0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KY","11469","SERFF","2016-08-20 11:23:22","Individual","Yes","52-1157181","11469KY0010001","Humana Dental Smart Choice","11469KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.997","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","11469KY0010001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857049"
"2017","KY","11469","SERFF","2016-08-20 11:23:22","Individual","Yes","52-1157181","11469KY0010001","Humana Dental Smart Choice","11469KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.997","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","11469KY0010001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857049"
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450001","Humana Basic 7150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450001-00","Humana Basic 7150/Lexington UK HealthCare HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845427",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450001","Humana Basic 7150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450001-01","Humana Basic 7150/Lexington UK HealthCare HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845427",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450031","Humana Basic 7150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450031-00","Humana Basic 7150/Norton + Just For Kids HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845466",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450033","Humana Silver 4150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450033-01","Humana Silver 4150/Norton + Just For Kids HMOx","Standard Silver On Exchange Plan",,"0.687128245830536","No","Yes","No","100%",,"$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846038",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450033","Humana Silver 4150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450033-02","Humana Silver 4150/Norton + Just For Kids HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846051",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450033","Humana Silver 4150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450033-03","Humana Silver 4150/Norton + Just For Kids HMOx","Limited Cost Sharing Plan Variation",,"0.687128245830536","No","Yes","No","100%",,"$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846064",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450031","Humana Basic 7150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450031-01","Humana Basic 7150/Norton + Just For Kids HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845466",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450002","Humana Bronze 6550/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450002-00","Humana Bronze 6550/Lexington UK HealthCare HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2845596",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450002","Humana Bronze 6550/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450002-01","Humana Bronze 6550/Lexington UK HealthCare HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2845596",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450002","Humana Bronze 6550/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450002-02","Humana Bronze 6550/Lexington UK HealthCare HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845609",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450002","Humana Bronze 6550/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450002-03","Humana Bronze 6550/Lexington UK HealthCare HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845622",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450032","Humana Bronze 6550/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450032-00","Humana Bronze 6550/Norton + Just For Kids HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2845687",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450032","Humana Bronze 6550/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450032-01","Humana Bronze 6550/Norton + Just For Kids HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2845687",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450032","Humana Bronze 6550/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450032-02","Humana Bronze 6550/Norton + Just For Kids HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845700",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450032","Humana Bronze 6550/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus","15411KY1450032-03","Humana Bronze 6550/Norton + Just For Kids HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2845713",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450003","Humana Silver 4150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450003-00","Humana Silver 4150/Lexington UK HealthCare HMOx","Standard Silver Off Exchange Plan",,"0.687128245830536","No","Yes","No","100%",,"$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845947",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450003","Humana Silver 4150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450003-01","Humana Silver 4150/Lexington UK HealthCare HMOx","Standard Silver On Exchange Plan",,"0.687128245830536","No","Yes","No","100%",,"$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845947",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450003","Humana Silver 4150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450003-02","Humana Silver 4150/Lexington UK HealthCare HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845960",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450003","Humana Silver 4150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450003-03","Humana Silver 4150/Lexington UK HealthCare HMOx","Limited Cost Sharing Plan Variation",,"0.687128245830536","No","Yes","No","100%",,"$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845973",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450003","Humana Silver 4150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450003-04","Humana Silver 3500/Lexington UK HealthCare HMOx","73% AV Level Silver Plan",,"0.730920314788818","No","Yes","No","100%",,"$3,500","$10","$800","$30","$3,200","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845843",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450003","Humana Silver 4150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450003-05","Humana Silver 900/Lexington UK HealthCare HMOx","87% AV Level Silver Plan",,"0.868357598781586","No","Yes","No","100%",,"$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846103",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450003","Humana Silver 4150/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450003-06","Humana Silver 250/Lexington UK HealthCare HMOx","94% AV Level Silver Plan",,"0.933077454566956","No","Yes","No","100%",,"$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845791",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450033","Humana Silver 4150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450033-00","Humana Silver 4150/Norton + Just For Kids HMOx","Standard Silver Off Exchange Plan",,"0.687128245830536","No","Yes","No","100%",,"$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846038",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450033","Humana Silver 4150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450033-04","Humana Silver 3500/Norton + Just For Kids HMOx","73% AV Level Silver Plan",,"0.730920314788818","No","Yes","No","100%",,"$3,500","$10","$800","$30","$3,200","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845869",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450033","Humana Silver 4150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450033-05","Humana Silver 900/Norton + Just For Kids HMOx","87% AV Level Silver Plan",,"0.868357598781586","No","Yes","No","100%",,"$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846129",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450033","Humana Silver 4150/Norton + Just For Kids HMOx","15411KY145",,"KYN005","KYS005","KYF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450033-06","Humana Silver 250/Norton + Just For Kids HMOx","94% AV Level Silver Plan",,"0.933077454566956","No","Yes","No","100%",,"$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845817",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450048","Humana Gold 1400/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS006","KYF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450048-00","Humana Gold 1400/Lexington UK HealthCare HMOx","Standard Gold Off Exchange Plan",,"0.783262848854065","No","Yes","No","100%",,"$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845739",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450048","Humana Gold 1400/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS006","KYF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450048-01","Humana Gold 1400/Lexington UK HealthCare HMOx","Standard Gold On Exchange Plan",,"0.783262848854065","No","Yes","No","100%",,"$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845739",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450048","Humana Gold 1400/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS006","KYF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450048-02","Humana Gold 1400/Lexington UK HealthCare HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845752",
"2017","KY","15411","SERFF","2016-08-21 07:17:17","Individual","No","61-1013183","15411KY1450048","Humana Gold 1400/Lexington UK HealthCare HMOx","15411KY145",,"KYN001","KYS006","KYF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors and OB/GYN.","0","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9996",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","15411KY1450048-03","Humana Gold 1400/Lexington UK HealthCare HMOx","Limited Cost Sharing Plan Variation",,"0.783262848854065","No","Yes","No","100%",,"$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2845765",
"2017","KY","18726","SERFF","2016-07-01 17:23:52","Individual","Yes","31-1185262","18726KY0040001","DentaTrust - PPO Pediatric High Option","18726KY004","7083617077","KYN001","KYS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040001-00","DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbKY.dentalcareplus.com","http://hixindsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","31-1185262","18726KY0050003","DentaSpan Family High Option","18726KY005","7083617077","KYN001","KYS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0050003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbKY.dentalcareplus.com","http://hixsgsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","31-1185262","18726KY0050003","DentaSpan Family High Option","18726KY005","7083617077","KYN001","KYS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0050003-01","DentaSpan Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbKY.dentalcareplus.com","http://hixsgsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","Individual","Yes","31-1185262","18726KY0040001","DentaTrust - PPO Pediatric High Option","18726KY004","7083617077","KYN001","KYS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040001-01","DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbKY.dentalcareplus.com","http://hixindsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","31-1185262","18726KY0050004","DentaSpan Family Low Option","18726KY005","7083617077","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0050004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbKY.dentalcareplus.com","http://hixsgsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","Individual","Yes","31-1185262","18726KY0040002","DentaTrust - PPO Pediatric Low Option","18726KY004","7083617077","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040002-01","DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbKY.dentalcareplus.com","http://hixindsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","Individual","Yes","31-1185262","18726KY0040003","DentaTrust - PPO Family High Option","18726KY004","7083617077","KYN001","KYS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040003-00","DentaTrust - PPO Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbKY.dentalcareplus.com","http://hixindsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","Individual","Yes","31-1185262","18726KY0040003","DentaTrust - PPO Family High Option","18726KY004","7083617077","KYN001","KYS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040003-01","DentaTrust - PPO Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbKY.dentalcareplus.com","http://hixindsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","Individual","Yes","31-1185262","18726KY0040004","DentaTrust - PPO Family Low Option","18726KY004","7083617077","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","18726KY0040004-00","DentaTrust - PPO Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbKY.dentalcareplus.com","http://hixindsbKY.dentalcareplus.com"
"2017","KY","18726","SERFF","2016-07-01 17:23:52","Individual","Yes","31-1185262","18726KY0040004","DentaTrust - PPO Family Low Option","18726KY004","7083617077","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","18726KY0040004-01","DentaTrust - PPO Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbKY.dentalcareplus.com","http://hixindsbKY.dentalcareplus.com"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970015","Anthem Bronze Pathway X PPO 6100","36239KY097",,"KYN002","KYS002","KYF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970015-00","Anthem Bronze Pathway PPO 6100","Standard Bronze Off Exchange Plan","61.91%","0.633161664009094","Yes","Yes","Yes","43%","57%","$6,100","$80","$300","$0","$500","$2,500","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","25.00%","$6,100","$6100 per person","$12200 per group","25.00%","$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X16","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","Yes","61-1237516","36239KY1060005","Anthem Dental Family Value","36239KY106",,"KYN004","KYS009",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","36239KY1060005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/ky/f0/s0/t0/pw_e215609.pdf",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","Yes","61-1237516","36239KY1030003","Anthem Dental Family","36239KY103",,"KYN004","KYS009",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","36239KY1030003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/ky/f0/s0/t0/pw_e215607.pdf",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980040","Anthem Bronze Pathway X PPO 5000 30 6850 Plus","36239KY098",,"KYN002","KYS001","KYF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980040-00","Anthem Bronze Pathway X PPO 5000 30 6850 Plus","Standard Bronze Off Exchange Plan","61.15%","0.649928212165833","No","Yes","No","100%",,"$5,000","$100","$600","$0","$900","$1,500","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FWS",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980040","Anthem Bronze Pathway X PPO 5000 30 6850 Plus","36239KY098",,"KYN002","KYS001","KYF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980040-01","Anthem Bronze Pathway X PPO 5000 30 6850 Plus","Standard Bronze On Exchange Plan","61.15%","0.649928212165833","No","Yes","No","100%",,"$5,000","$100","$600","$0","$900","$1,500","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FWS",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970015","Anthem Bronze Pathway X PPO 6100","36239KY097",,"KYN002","KYS002","KYF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970015-01","Anthem Bronze Pathway X PPO 6100","Standard Bronze On Exchange Plan","61.91%","0.633161664009094","Yes","Yes","Yes","43%","57%","$6,100","$80","$300","$0","$500","$2,500","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","25.00%","$6,100","$6100 per person","$12200 per group","25.00%","$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X15","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970015","Anthem Bronze Pathway X PPO 6100","36239KY097",,"KYN002","KYS002","KYF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970015-02","Anthem Bronze Pathway X PPO 6100 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X20","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970015","Anthem Bronze Pathway X PPO 6100","36239KY097",,"KYN002","KYS002","KYF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970015-03","Anthem Bronze Pathway X PPO 6100","Limited Cost Sharing Plan Variation","61.91%","0.633161664009094","Yes","Yes","Yes","43%","57%","$6,100","$80","$300","$0","$500","$2,500","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","25.00%","$6,100","$6100 per person","$12200 per group","25.00%","$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X15","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970016","Anthem Bronze Pathway X PPO 4900","36239KY097",,"KYN002","KYS002","KYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970016-00","Anthem Bronze Pathway PPO 4900","Standard Bronze Off Exchange Plan","61.78%","0.635894894599915","Yes","Yes","Yes","43%","57%","$4,900","$300","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","20.00%","$4,900","$4900 per person","$9800 per group","20.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1A","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970016","Anthem Bronze Pathway X PPO 4900","36239KY097",,"KYN002","KYS002","KYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970016-01","Anthem Bronze Pathway X PPO 4900","Standard Bronze On Exchange Plan","61.78%","0.635894894599915","Yes","Yes","Yes","43%","57%","$4,900","$300","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","20.00%","$4,900","$4900 per person","$9800 per group","20.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X19","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970016","Anthem Bronze Pathway X PPO 4900","36239KY097",,"KYN002","KYS002","KYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970016-02","Anthem Bronze Pathway X PPO 4900 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X22","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970016","Anthem Bronze Pathway X PPO 4900","36239KY097",,"KYN002","KYS002","KYF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970016-03","Anthem Bronze Pathway X PPO 4900","Limited Cost Sharing Plan Variation","61.78%","0.635894894599915","Yes","Yes","Yes","43%","57%","$4,900","$300","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","20.00%","$4,900","$4900 per person","$9800 per group","20.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X19","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970018","Anthem Bronze Pathway X PPO 6000","36239KY097",,"KYN002","KYS002","KYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970018-00","Anthem Bronze Pathway PPO 6000","Standard Bronze Off Exchange Plan","59.34%","0.615350604057312","Yes","Yes","Yes","43%","57%","$6,000","$0","$400","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X18","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970018","Anthem Bronze Pathway X PPO 6000","36239KY097",,"KYN002","KYS002","KYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970018-01","Anthem Bronze Pathway X PPO 6000","Standard Bronze On Exchange Plan","59.34%","0.615350604057312","Yes","Yes","Yes","43%","57%","$6,000","$0","$400","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X17","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970018","Anthem Bronze Pathway X PPO 6000","36239KY097",,"KYN002","KYS002","KYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970018-02","Anthem Bronze Pathway X PPO 6000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X21","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970018","Anthem Bronze Pathway X PPO 6000","36239KY097",,"KYN002","KYS002","KYF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970018-03","Anthem Bronze Pathway X PPO 6000","Limited Cost Sharing Plan Variation","59.34%","0.615350604057312","Yes","Yes","Yes","43%","57%","$6,000","$0","$400","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X17","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970019","Anthem Bronze Pathway X PPO 0 for HSA","36239KY097",,"KYN002","KYS002","KYF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970019-00","Anthem Bronze Pathway PPO 0 for HSA","Standard Bronze Off Exchange Plan","60.74%","0.616997122764587","Yes","Yes","Yes","43%","57%","$6,400","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","$25,600","$25600 per person","$51200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%","$6,400","$6400 per person","$12800 per group","0.00%","$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X12","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980041","Anthem Silver Pathway X PPO 5000 0 5500 Plus","36239KY098",,"KYN002","KYS001","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980041-00","Anthem Silver Pathway X PPO 5000 0 5500 Plus","Standard Silver Off Exchange Plan","69.50%","0.698533177375793","No","Yes","No","100%",,"$5,000","$80","$0","$0","$900","$1,500","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FWY",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","Yes","61-1237516","36239KY1030004","Anthem Dental Family Enhanced","36239KY103",,"KYN004","KYS009",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.837","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","36239KY1030004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/ky/f0/s0/t0/pw_e215608.pdf",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","Yes","61-1237516","36239KY1060003","Anthem Dental Family","36239KY106",,"KYN004","KYS009",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","36239KY1060003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/ky/f0/s0/t0/pw_e215607.pdf",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980041","Anthem Silver Pathway X PPO 5000 0 5500 Plus","36239KY098",,"KYN002","KYS001","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980041-01","Anthem Silver Pathway X PPO 5000 0 5500 Plus","Standard Silver On Exchange Plan","69.50%","0.698533177375793","No","Yes","No","100%",,"$5,000","$80","$0","$0","$900","$1,500","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FWY",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970019","Anthem Bronze Pathway X PPO 0 for HSA","36239KY097",,"KYN002","KYS002","KYF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970019-01","Anthem Bronze Pathway X PPO 0 for HSA","Standard Bronze On Exchange Plan","60.74%","0.616997122764587","Yes","Yes","Yes","43%","57%","$6,400","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","$25,600","$25600 per person","$51200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%","$6,400","$6400 per person","$12800 per group","0.00%","$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X11","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970019","Anthem Bronze Pathway X PPO 0 for HSA","36239KY097",,"KYN002","KYS002","KYF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970019-02","Anthem Bronze Pathway X PPO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X1Y","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970019","Anthem Bronze Pathway X PPO 0 for HSA","36239KY097",,"KYN002","KYS002","KYF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970019-03","Anthem Bronze Pathway X PPO 0 for HSA","Limited Cost Sharing Plan Variation","60.74%","0.616997122764587","Yes","Yes","Yes","43%","57%","$6,400","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","$25,600","$25600 per person","$51200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%","$6,400","$6400 per person","$12800 per group","0.00%","$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X11","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970020","Anthem Silver Pathway X PPO for HSA","36239KY097",,"KYN002","KYS002","KYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970020-00","Anthem Silver Pathway PPO for HSA","Standard Silver Off Exchange Plan","70.83%","0.704213440418243","Yes","Yes","Yes","43%","57%","$3,200","$500","$400","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","$4,300","$4300 per person","$8600 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X1F","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970020","Anthem Silver Pathway X PPO for HSA","36239KY097",,"KYN002","KYS002","KYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970020-01","Anthem Silver Pathway X PPO for HSA","Standard Silver On Exchange Plan","70.83%","0.704213440418243","Yes","Yes","Yes","43%","57%","$3,200","$500","$400","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","$4,300","$4300 per person","$8600 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X1B","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970020","Anthem Silver Pathway X PPO for HSA","36239KY097",,"KYN002","KYS002","KYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970020-02","Anthem Silver Pathway X PPO AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X23","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970020","Anthem Silver Pathway X PPO for HSA","36239KY097",,"KYN002","KYS002","KYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970020-03","Anthem Silver Pathway X PPO for HSA","Limited Cost Sharing Plan Variation","70.83%","0.704213440418243","Yes","Yes","Yes","43%","57%","$3,200","$500","$400","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","$4,300","$4300 per person","$8600 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X1B","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970020","Anthem Silver Pathway X PPO for HSA","36239KY097",,"KYN002","KYS002","KYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970020-04","Anthem Silver Pathway X PPO for HSA S04","73% AV Level Silver Plan","72.98%","0.731782674789429","Yes","Yes","Yes","43%","57%","$2,700","$500","$400","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","$3,700","$3700 per person","$7400 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X1C","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970020","Anthem Silver Pathway X PPO for HSA","36239KY097",,"KYN002","KYS002","KYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970020-05","Anthem Silver Pathway X PPO S05","87% AV Level Silver Plan","87.46%","0.863974511623383","Yes","Yes","Yes","43%","57%","$1,350","$0","$0","$0","$1,350","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%","$1,350","$1350 per person","$2700 per group","0.00%","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1D","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970020","Anthem Silver Pathway X PPO for HSA","36239KY097",,"KYN002","KYS002","KYF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970020-06","Anthem Silver Pathway X PPO S06","94% AV Level Silver Plan","93.96%","0.932620525360107","Yes","Yes","Yes","43%","57%","$600","$0","$0","$0","$600","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%","$600","$600 per person","$1200 per group","0.00%","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1E","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980039","Anthem Gold Pathway X PPO 1000 20 5000 Plus","36239KY098",,"KYN002","KYS001","KYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980039-00","Anthem Gold Pathway X PPO 1000 20 5000 Plus","Standard Gold Off Exchange Plan","79.73%","0.803383588790894","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FWL",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970022","Anthem Silver Pathway X PPO 2000","36239KY097",,"KYN002","KYS002","KYF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970022-00","Anthem Silver Pathway PPO 2000","Standard Silver Off Exchange Plan","70.77%","0.721600592136383","Yes","Yes","Yes","43%","57%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1U","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","Yes","61-1237516","36239KY1060004","Anthem Dental Family Enhanced","36239KY106",,"KYN004","KYS009",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.837","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","36239KY1060004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/ky/f0/s0/t0/pw_e215608.pdf",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970022","Anthem Silver Pathway X PPO 2000","36239KY097",,"KYN002","KYS002","KYF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970022-01","Anthem Silver Pathway X PPO 2000","Standard Silver On Exchange Plan","70.77%","0.721600592136383","Yes","Yes","Yes","43%","57%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1Q","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980039","Anthem Gold Pathway X PPO 1000 20 5000 Plus","36239KY098",,"KYN002","KYS001","KYF007","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980039-01","Anthem Gold Pathway X PPO 1000 20 5000 Plus","Standard Gold On Exchange Plan","79.73%","0.803383588790894","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2FWL",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970022","Anthem Silver Pathway X PPO 2000","36239KY097",,"KYN002","KYS002","KYF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970022-02","Anthem Silver Pathway X PPO 2000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X25","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970022","Anthem Silver Pathway X PPO 2000","36239KY097",,"KYN002","KYS002","KYF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970022-03","Anthem Silver Pathway X PPO 2000","Limited Cost Sharing Plan Variation","70.77%","0.721600592136383","Yes","Yes","Yes","43%","57%","$2,000","$900","$1,500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1Q","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970022","Anthem Silver Pathway X PPO 2000","36239KY097",,"KYN002","KYS002","KYF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970022-04","Anthem Silver Pathway X PPO 2000 S04","73% AV Level Silver Plan","73.94%","0.750137031078339","Yes","Yes","Yes","43%","57%","$1,700","$1,100","$1,600","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%","$1,700","$1700 per person","$3400 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1R","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970022","Anthem Silver Pathway X PPO 2000","36239KY097",,"KYN002","KYS002","KYF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970022-05","Anthem Silver Pathway X PPO 2000 S05","87% AV Level Silver Plan","86.80%","0.868748962879181","Yes","Yes","Yes","43%","57%","$750","$500","$700","$0","$175","$700","$70","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1S","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970022","Anthem Silver Pathway X PPO 2000","36239KY097",,"KYN002","KYS002","KYF014","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970022-06","Anthem Silver Pathway X PPO 2000 S06","94% AV Level Silver Plan","93.64%","0.934615135192871","Yes","Yes","Yes","43%","57%","$175","$200","$500","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","$900","$900 per person","$1800 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20.00%","$175","$175 per person","$350 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1T","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970023","Anthem Catastrophic Pathway X PPO 7150","36239KY097",,"KYN002","KYS002","KYF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970023-00","Anthem Catastrophic Pathway PPO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","43%","57%","$7,150","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1X","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970023","Anthem Catastrophic Pathway X PPO 7150","36239KY097",,"KYN002","KYS002","KYF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970023-01","Anthem Catastrophic Pathway X PPO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","43%","57%","$7,150","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X1W","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY1180027","Anthem Silver Pathway X HMO 2000 50 6350 Plus","36239KY118",,"KYN003","KYS015","KYF003","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/KYSelectdrugtier4","36239KY1180027-00","Anthem Silver Pathway X HMO 2000 50 6350 Plus","Standard Silver Off Exchange Plan","71.82%","0.73935866355896","No","Yes","No","100%",,"$2,000","$100","$2,600","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2G9P",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970025","Anthem Silver Pathway X PPO 4000","36239KY097",,"KYN002","KYS002","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970025-00","Anthem Silver Pathway PPO 4000","Standard Silver Off Exchange Plan","68.09%","0.696519672870636","No","Yes","Yes","43%","57%","$4,000","$60","$700","$0","$1,400","$1,200","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%","$4,000","$4000 per person","$8000 per group","10.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X1H","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970025","Anthem Silver Pathway X PPO 4000","36239KY097",,"KYN002","KYS002","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970025-01","Anthem Silver Pathway X PPO 4000","Standard Silver On Exchange Plan","68.09%","0.696519672870636","No","Yes","Yes","43%","57%","$4,000","$60","$700","$0","$1,400","$1,200","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%","$4,000","$4000 per person","$8000 per group","10.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X1G","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY1180027","Anthem Silver Pathway X HMO 2000 50 6350 Plus","36239KY118",,"KYN003","KYS015","KYF003","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/KYSelectdrugtier4","36239KY1180027-01","Anthem Silver Pathway X HMO 2000 50 6350 Plus","Standard Silver On Exchange Plan","71.82%","0.73935866355896","No","Yes","No","100%",,"$2,000","$100","$2,600","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2G9P",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970025","Anthem Silver Pathway X PPO 4000","36239KY097",,"KYN002","KYS002","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970025-02","Anthem Silver Pathway X PPO 4000 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2B","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970025","Anthem Silver Pathway X PPO 4000","36239KY097",,"KYN002","KYS002","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970025-03","Anthem Silver Pathway X PPO 4000","Limited Cost Sharing Plan Variation","68.09%","0.696519672870636","No","Yes","Yes","43%","57%","$4,000","$60","$700","$0","$1,400","$1,200","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%","$4,000","$4000 per person","$8000 per group","10.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X1G","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970025","Anthem Silver Pathway X PPO 4000","36239KY097",,"KYN002","KYS002","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970025-04","Anthem Silver Pathway X PPO 4000 S04","73% AV Level Silver Plan","72.78%","0.713399171829224","No","Yes","Yes","43%","57%","$2,450","$60","$1,500","$0","$1,300","$1,200","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","10.00%","$2,450","$2450 per person","$4900 per group","10.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","40.00%","$900","$900 per person","$1800 per group","40.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X26","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970025","Anthem Silver Pathway X PPO 4000","36239KY097",,"KYN002","KYS002","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970025-05","Anthem Silver Pathway X PPO 4000 S05","87% AV Level Silver Plan","87.07%","0.820961177349091","No","Yes","Yes","43%","57%","$750","$40","$1,200","$0","$700","$1,300","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%","$750","$750 per person","$1500 per group","10.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X27","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY0970025","Anthem Silver Pathway X PPO 4000","36239KY097",,"KYN002","KYS002","KYF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY0970025-06","Anthem Silver Pathway X PPO 4000 S06","94% AV Level Silver Plan","93.80%","0.897937595844269","No","Yes","Yes","43%","57%","$250","$40","$700","$0","$250","$1,200","$50","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X28","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY1180025","Anthem Gold Pathway X HMO 4000 0 4000 Plus","36239KY118",,"KYN003","KYS015","KYF002","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/KYSelectdrugtier4","36239KY1180025-00","Anthem Gold Pathway X HMO 4000 0 4000 Plus","Standard Gold Off Exchange Plan","79.12%","0.77304881811142","No","Yes","No","100%",,"$4,000","$40","$0","$0","$400","$1,500","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2G9R",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140001","Anthem Bronze Pathway X HMO 5000","36239KY114",,"KYN003","KYS015","KYF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140001-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","59.87%","0.617973685264587","Yes","Yes","Yes","43%","57%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GG7","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140001","Anthem Bronze Pathway X HMO 5000","36239KY114",,"KYN003","KYS015","KYF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140001-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","59.87%","0.617973685264587","Yes","Yes","Yes","43%","57%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GG6","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY1180025","Anthem Gold Pathway X HMO 4000 0 4000 Plus","36239KY118",,"KYN003","KYS015","KYF002","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/KYSelectdrugtier4","36239KY1180025-01","Anthem Gold Pathway X HMO 4000 0 4000 Plus","Standard Gold On Exchange Plan","79.12%","0.77304881811142","No","Yes","No","100%",,"$4,000","$40","$0","$0","$400","$1,500","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2G9R",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140001","Anthem Bronze Pathway X HMO 5000","36239KY114",,"KYN003","KYS015","KYF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140001-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J5T","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140001","Anthem Bronze Pathway X HMO 5000","36239KY114",,"KYN003","KYS015","KYF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140001-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","59.87%","0.617973685264587","Yes","Yes","Yes","43%","57%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GG6","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980042","Anthem Bronze Pathway X PPO 5500E 20 6550 Plus w HSA","36239KY098",,"KYN002","KYS001","KYF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980042-00","Anthem Bronze Pathway X PPO 5500E 20 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2FX4",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN003","KYS015","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.55%","0.697231471538544","No","Yes","Yes","43%","57%","$3,500","$500","$1,000","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GHT","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN003","KYS015","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.55%","0.697231471538544","No","Yes","Yes","43%","57%","$3,500","$500","$1,000","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GHS","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980042","Anthem Bronze Pathway X PPO 5500E 20 6550 Plus w HSA","36239KY098",,"KYN002","KYS001","KYF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980042-01","Anthem Bronze Pathway X PPO 5500E 20 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2FX4",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN003","KYS015","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1J60","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN003","KYS015","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.55%","0.697231471538544","No","Yes","Yes","43%","57%","$3,500","$500","$1,000","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GHS","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN003","KYS015","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","73.87%","0.734921991825104","No","Yes","Yes","43%","57%","$2,250","$600","$1,600","$0","$1,400","$1,000","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1H88","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN003","KYS015","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.34%","0.835980772972107","No","Yes","Yes","43%","57%","$750","$500","$700","$0","$700","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1H89","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN003","KYS015","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","93.51%","0.915205538272858","No","Yes","Yes","43%","57%","$250","$200","$400","$0","$250","$1,300","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1H8A","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140009","Anthem Gold Pathway X HMO 1450","36239KY114",,"KYN003","KYS015","KYF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140009-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","79.33%","0.766172170639038","No","Yes","Yes","43%","57%","$1,450","$1,000","$1,600","$0","$1,000","$1,100","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","$4,100","$4100 per person","$8200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GH9","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140009","Anthem Gold Pathway X HMO 1450","36239KY114",,"KYN003","KYS015","KYF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140009-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","79.33%","0.766172170639038","No","Yes","Yes","43%","57%","$1,450","$1,000","$1,600","$0","$1,000","$1,100","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","$4,100","$4100 per person","$8200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GH8","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140009","Anthem Gold Pathway X HMO 1450","36239KY114",,"KYN003","KYS015","KYF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140009-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1J5Z","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140009","Anthem Gold Pathway X HMO 1450","36239KY114",,"KYN003","KYS015","KYF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140009-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","79.33%","0.766172170639038","No","Yes","Yes","43%","57%","$1,450","$1,000","$1,600","$0","$1,000","$1,100","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","$4,100","$4100 per person","$8200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GH8","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN003","KYS015","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-00","Anthem Silver Pathway HMO 5300","Standard Silver Off Exchange Plan","68.29%","0.682487607002258","Yes","Yes","Yes","43%","57%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDC","http://editiondigital.net/view/IU65/2017/OFF_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN003","KYS015","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-01","Anthem Silver Pathway X HMO 5300","Standard Silver On Exchange Plan","68.29%","0.682487607002258","Yes","Yes","Yes","43%","57%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDB","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN003","KYS015","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-02","Anthem Silver Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDG","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN003","KYS015","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-03","Anthem Silver Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.29%","0.682487607002258","Yes","Yes","Yes","43%","57%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDB","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN003","KYS015","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-04","Anthem Silver Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.14%","0.720676839351654","Yes","Yes","Yes","43%","57%","$4,000","$500","$800","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","25.00%","$4,000","$4000 per person","$8000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDD","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN003","KYS015","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-05","Anthem Silver Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.04%","0.859281599521637","Yes","Yes","Yes","43%","57%","$1,000","$400","$500","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDE","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN003","KYS015","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-06","Anthem Silver Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.01%","0.928769111633301","Yes","Yes","Yes","43%","57%","$200","$100","$500","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDF","http://editiondigital.net/view/IU65/2017/ON_HIX_KY_KIT_2017"
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY1180026","Anthem Bronze Pathway X HMO 4500E 50 6550 Plus w HSA","36239KY118",,"KYN003","KYS015","KYF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9944",,,"2017-01-01","2017-12-31","Yes","Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/KYSelectdrugtier4","36239KY1180026-00","Anthem Bronze Pathway X HMO 4500E 50 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,400","$0","$4,500","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2G9M",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY1180026","Anthem Bronze Pathway X HMO 4500E 50 6550 Plus w HSA","36239KY118",,"KYN003","KYS015","KYF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9944",,,"2017-01-01","2017-12-31","Yes","Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/KYSelectdrugtier4","36239KY1180026-01","Anthem Bronze Pathway X HMO 4500E 50 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,400","$0","$4,500","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2G9M",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980043","Anthem Gold Pathway X PPO 1250 10 6000 Plus","36239KY098",,"KYN002","KYS001","KYF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980043-00","Anthem Gold Pathway X PPO 1250 10 6000 Plus","Standard Gold Off Exchange Plan",,"0.804433047771454","Yes","Yes","No","100%",,"$1,250","$0","$600","$0","$1,250","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10.00%",,,,,"$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.sbc.anthem.com/dps/ccd2FX6",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980043","Anthem Gold Pathway X PPO 1250 10 6000 Plus","36239KY098",,"KYN002","KYS001","KYF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980043-01","Anthem Gold Pathway X PPO 1250 10 6000 Plus","Standard Gold On Exchange Plan",,"0.804433047771454","Yes","Yes","No","100%",,"$1,250","$0","$600","$0","$1,250","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10.00%",,,,,"$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.sbc.anthem.com/dps/ccd2FX6",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980044","Anthem Silver Pathway X PPO 2000 30 4750 Plus","36239KY098",,"KYN002","KYS001","KYF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980044-00","Anthem Silver Pathway X PPO 2000 30 4750 Plus","Standard Silver Off Exchange Plan",,"0.713008463382721","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,000","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.sbc.anthem.com/dps/ccd2FX8",
"2017","KY","36239","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","61-1237516","36239KY0980044","Anthem Silver Pathway X PPO 2000 30 4750 Plus","36239KY098",,"KYN002","KYS001","KYF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9955",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/KYSelectdrugtier4","36239KY0980044-01","Anthem Silver Pathway X PPO 2000 30 4750 Plus","Standard Silver On Exchange Plan",,"0.713008463382721","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,000","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.sbc.anthem.com/dps/ccd2FX8",
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010001","CareSource Gold","45636KY001",,"KYN001","KYS001","KYF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010001-02","CareSource Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-goldzero-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010001","CareSource Gold","45636KY001",,"KYN001","KYS001","KYF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010001-03","CareSource Gold Limited","Limited Cost Sharing Plan Variation",,"0.819806694984436","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-goldltd-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010004","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010004-00","CareSource Silver","Standard Silver Off Exchange Plan","71.48%","0.720397293567657","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010004","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010004-01","CareSource Silver","Standard Silver On Exchange Plan","71.48%","0.720397293567657","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010004","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010004-02","CareSource Silver Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silverzero-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010004","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010004-03","CareSource Silver Limited","Limited Cost Sharing Plan Variation","71.48%","0.720397293567657","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silverltd-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","43492","SERFF","2016-05-11 11:53:06","SHOP (Small Group)","Yes","75-1233841","43492KY0020009","Dentegra Dental PPO for Small Businesses Family Preferred Plan","43492KY002",,"KYN001","KYS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","43492KY0020009-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ky/43492ky0020009-17"
"2017","KY","43492","SERFF","2016-05-11 11:53:06","Individual","Yes","75-1233841","43492KY0010009","Dentegra Dental PPO Family Preferred Plan","43492KY001",,"KYN001","KYS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","43492KY0010009-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ky/43492ky0010009-17"
"2017","KY","43492","SERFF","2016-05-11 11:53:06","Individual","Yes","75-1233841","43492KY0010008","Dentegra Dental PPO Family Basic Plan","43492KY001",,"KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","43492KY0010008-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ky/43492ky0010008-17"
"2017","KY","43492","SERFF","2016-05-11 11:53:06","SHOP (Small Group)","Yes","75-1233841","43492KY0020008","Dentegra Dental PPO for Small Businesses Family Basic Plan","43492KY002",,"KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","43492KY0020008-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ky/43492ky0020008-17"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010001","CareSource Gold","45636KY001",,"KYN001","KYS001","KYF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010001-00","CareSource Gold","Standard Gold Off Exchange Plan",,"0.819806694984436","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010001","CareSource Gold","45636KY001",,"KYN001","KYS001","KYF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010001-01","CareSource Gold","Standard Gold On Exchange Plan",,"0.819806694984436","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010004","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010004-04","CareSource Silver 1","73% AV Level Silver Plan","73.77%","0.742822170257568","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver1-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010004","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010004-05","CareSource  Silver 2","87% AV Level Silver Plan","86.91%","0.875994265079498","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver2-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010004","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010004-06","CareSource Silver 3","94% AV Level Silver Plan","94.69%","0.944468021392822","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver3-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010007","CareSource Bronze","45636KY001",,"KYN001","KYS001","KYF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010007-00","CareSource Bronze","Standard Bronze Off Exchange Plan","60.27%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-bronze-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010007","CareSource Bronze","45636KY001",,"KYN001","KYS001","KYF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010007-01","CareSource Bronze","Standard Bronze On Exchange Plan","60.27%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-bronze-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010007","CareSource Bronze","45636KY001",,"KYN001","KYS001","KYF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010007-02","CareSource Bronze Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-bronzezero-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010007","CareSource Bronze","45636KY001",,"KYN001","KYS001","KYF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.99",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010007-03","CareSource Bronze Limited","Limited Cost Sharing Plan Variation","60.27%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-bronzeltd-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020001","CareSource Gold Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.91",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020001-00","CareSource Gold Limited Dental and Vision","Standard Gold Off Exchange Plan",,"0.819806694984436","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-gold-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020001","CareSource Gold Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.91",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020001-01","CareSource Gold Limited Dental and Vision","Standard Gold On Exchange Plan",,"0.819806694984436","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-gold-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020001","CareSource Gold Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.91",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020001-02","CareSource Gold Limited Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-goldzero-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020001","CareSource Gold Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.91",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020001-03","CareSource Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.819806694984436","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-goldltd-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020004","CareSource Silver Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020004-00","CareSource Silver Limited Dental and Vision","Standard Silver Off Exchange Plan","70.67%","0.720397293567657","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020004","CareSource Silver Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020004-01","CareSource Silver Limited Dental and Vision","Standard Silver On Exchange Plan","70.67%","0.720397293567657","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020004","CareSource Silver Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020004-02","CareSource Silver Limited Dental and Vision","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silverzero-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020004","CareSource Silver Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020004-03","CareSource Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation","70.67%","0.720397293567657","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silverltd-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020004","CareSource Silver Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020004-04","CareSource Silver Limited Dental and Vision","73% AV Level Silver Plan","73.67%","0.742822170257568","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver1-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020004","CareSource Silver Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020004-05","CareSource Silver Limited Dental and Vision","87% AV Level Silver Plan","86.47%","0.875994265079498","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver2-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020004","CareSource Silver Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020004-06","CareSource Silver Limited Dental and Vision","94% AV Level Silver Plan","93.26%","0.944468021392822","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-ky-silver3-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020007","CareSource Bronze Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.89",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020007-00","CareSource Bronze Limited Dental and Vision","Standard Bronze Off Exchange Plan","61.63%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-bronze-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020007","CareSource Bronze Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.89",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020007-01","CareSource Bronze Limited Dental and Vision","Standard Bronze On Exchange Plan","61.63%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-bronze-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020007","CareSource Bronze Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.89",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020007-02","CareSource Bronze Limited Dental and Vision","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-bronzezero-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0020007","CareSource Bronze Limited Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.89",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0020007-03","CareSource Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation","61.63%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-bronzeltd-dv-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030001","CareSource Federal Simple Choice Gold","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030001-00","CareSource Federal Simple Choice Gold","Standard Gold Off Exchange Plan",,"0.798423528671265","Yes","Yes","No","100%",,"$1,250","$420","$2,001","$60","$1,250","$900","$372","$55","$1,250","$60","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030001","CareSource Federal Simple Choice Gold","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030001-01","CareSource Federal Simple Choice Gold","Standard Gold On Exchange Plan",,"0.798423528671265","Yes","Yes","No","100%",,"$1,250","$420","$2,001","$60","$1,250","$900","$372","$55","$1,250","$60","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030001","CareSource Federal Simple Choice Gold","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030001-02","CareSource Federal Simple Choice Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030001","CareSource Federal Simple Choice Gold","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030001-03","CareSource Federal Simple Choice Gold","Limited Cost Sharing Plan Variation",,"0.798423528671265","Yes","Yes","No","100%",,"$1,250","$420","$2,001","$60","$1,250","$900","$372","$55","$1,250","$60","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030002","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030002-00","CareSource Federal Simple Choice Silver","Standard Silver Off Exchange Plan",,"0.705686151981354","Yes","Yes","No","100%",,"$3,500","$1,225","$2,001","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030002","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030002-01","CareSource Federal Simple Choice Silver","Standard Silver On Exchange Plan",,"0.705686151981354","Yes","Yes","No","100%",,"$3,500","$1,225","$2,001","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030002","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030002-02","CareSource Federal Simple Choice Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030002","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030002-03","CareSource Federal Simple Choice Silver","Limited Cost Sharing Plan Variation",,"0.705686151981354","Yes","Yes","No","100%",,"$3,500","$1,225","$2,001","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030002","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030002-04","CareSource Federal Simple Choice Silver","73% AV Level Silver Plan",,"0.73501318693161","Yes","Yes","No","100%",,"$2,789","$910","$2,001","$60","$1,489","$1,330","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$5700 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030002","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030002-05","CareSource Federal Simple Choice Silver","87% AV Level Silver Plan",,"0.874874353408813","Yes","Yes","No","100%",,"$700","$350","$950","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$2000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030002","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF001","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030002-06","CareSource Federal Simple Choice Silver","94% AV Level Silver Plan",,"0.94230991601944","Yes","Yes","No","100%",,"$250","$277","$500","$60","$250","$228","$93","$55","$250","$45","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$1250 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-gold-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030003","CareSource Federal Simple Choice Bronze","45636KY003",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030003-00","CareSource Federal Simple Choice Bronze","Standard Bronze Off Exchange Plan",,"0.615750074386597","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-bronze-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030003","CareSource Federal Simple Choice Bronze","45636KY003",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030003-01","CareSource Federal Simple Choice Bronze","Standard Bronze On Exchange Plan",,"0.615750074386597","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-bronze-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030003","CareSource Federal Simple Choice Bronze","45636KY003",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030003-02","CareSource Federal Simple Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-bronzezero-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0030003","CareSource Federal Simple Choice Bronze","45636KY003",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0030003-03","CareSource Federal Simple Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.615750074386597","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-ky-bronzeltd-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0040001","CareSource Low Premium Silver","45636KY004",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0040001-00","CareSource Low Premium Silver","Standard Silver Off Exchange Plan",,"0.689052760601044","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-ky-silver-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0040001","CareSource Low Premium Silver","45636KY004",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0040001-01","CareSource Low Premium Silver","Standard Silver On Exchange Plan",,"0.689052760601044","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-ky-silver-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0040001","CareSource Low Premium Silver","45636KY004",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0040001-02","CareSource Low Premium Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-lp-ky-silverzero-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0040001","CareSource Low Premium Silver","45636KY004",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0040001-03","CareSource Low Premium Silver Limited","Limited Cost Sharing Plan Variation",,"0.689052760601044","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-ky-silverltd-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0040001","CareSource Low Premium Silver","45636KY004",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0040001-04","CareSource Low Premium Silver 1","73% AV Level Silver Plan",,"0.723194479942322","Yes","Yes","No","100%",,"$5,000","$0","$340","$150","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"https://caresource.com/documents/mp2017-lp-ky-silver1-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0040001","CareSource Low Premium Silver","45636KY004",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0040001-05","CareSource Low Premium Silver 2","87% AV Level Silver Plan",,"0.867690443992615","Yes","Yes","No","100%",,"$1,100","$30","$510","$150","$1,100","$90","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"https://caresource.com/documents/mp2017-lp-ky-silver2-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0040001","CareSource Low Premium Silver","45636KY004",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0040001-06","CareSource Low Premium Silver 3","94% AV Level Silver Plan",,"0.932569026947021","Yes","Yes","No","100%",,"$500","$10","$250","$150","$500","$50","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"https://caresource.com/documents/mp2017-lp-ky-silver3-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010010","CareSource Catastrophic","45636KY001",,"KYN001","KYS001","KYF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.98",,,"2017-01-01","2017-12-31","No","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010010-00","CareSource Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-catastrophic-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","45636","SERFF","2016-09-29 04:19:41","Individual","No","46-4991603","45636KY0010010","CareSource Catastrophic","45636KY001",,"KYN001","KYS001","KYF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.98",,,"2017-01-01","2017-12-31","No","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","45636KY0010010-01","CareSource Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.caresource.com/documents/mp2017-ky-catastrophic-sum","https://www.caresource.com/documents/mp2017-ky-broch"
"2017","KY","62201","SERFF","2016-08-19 03:49:17","Individual","Yes","61-0659432","62201KY0290001","Delta Dental PPO Gold","62201KY029","7568465752","KYN001","KYS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level.","Yes","If a member does not use a network dentist services will be reimbursed at the out of network level.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/62201","","62201KY0290001-01","Delta Dental PPO Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$25","$25 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KY","62201","SERFF","2016-08-19 03:49:17","Individual","Yes","61-0659432","62201KY0300001","Delta Dental PPO Silver","62201KY030","7568465752","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/62201","","62201KY0300001-01","Delta Dental PPO Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010005","Community Value","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010005-05","Community Value - 87% CSR","87% AV Level Silver Plan","86.26%","0.860923528671265","Yes","Yes","No","100%",,"$800","$50","$1,150","$0","$0","$0","$210","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Value_33653ME0010005-05","https://www.healthoptions.org/Documents/2017/SOB_for_Value_33653ME0010005-05"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010005","Community Value","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010005-06","Community Value - 94% CSR","94% AV Level Silver Plan","93.25%","0.932508170604706","Yes","Yes","No","100%",,"$500","$50","$200","$0","$0","$0","$105","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Value_33653ME0010005-06","https://www.healthoptions.org/Documents/2017/SOB_for_Value_33653ME0010005-06"
"2017","KY","62201","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","61-0659432","62201KY0250001","Delta Dental PPO Gold Family with Cosmetic Orthodontics","62201KY025","7568465752","KYN001","KYS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level.","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level.","Yes",,"","62201KY0250001-01","Delta Dental PPO Gold Family with Cosmetic Orthodontics","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$25","$25 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KY","62201","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","61-0659432","62201KY0260001","Delta Dental PPO Silver Family","62201KY026","7568465752","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level.","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level.","Yes",,"","62201KY0260001-01","Delta Dental PPO Silver Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010007","BESTDental Premium","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Premium_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","Individual","Yes","95-6042390","86825KY0020003","BESTOne Advantage Gold","86825KY002",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","Individual","Yes","95-6042390","86825KY0020003","BESTOne Advantage Gold","86825KY002",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010007","BESTDental Premium","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Premium_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","Individual","Yes","95-6042390","86825KY0020004","BESTOne Plus Gold","86825KY002",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010008","BESTDental Standard - H","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Standard-H_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010008","BESTDental Standard - H","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Standard-H_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","Individual","Yes","95-6042390","86825KY0020004","BESTOne Plus Gold","86825KY002",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010010","BESTDental Choice - H","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Choice-H_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010010","BESTDental Choice - H","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Choice-H_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010009","BESTDental Standard - L","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Standard-L_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","Individual","Yes","95-6042390","86825KY0020005","BESTOne Plus Silver","86825KY002",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","Individual","Yes","95-6042390","86825KY0020005","BESTOne Plus Silver","86825KY002",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010009","BESTDental Standard - L","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Standard-L_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010011","BESTDental Choice - L","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Choice-L_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","Individual","Yes","95-6042390","86825KY0020006","BESTOne Basic Silver","86825KY002",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","Individual","Yes","95-6042390","86825KY0020006","BESTOne Basic Silver","86825KY002",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010011","BESTDental Choice - L","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Choice-L_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010012","BESTDental Value","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Value_Plan.pdf"
"2017","KY","86825","SERFF","2016-07-01 17:23:52","SHOP (Small Group)","Yes","95-6042390","86825KY0010012","BESTDental Value","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/2017/KY_BESTDental_Value_Plan.pdf"
"2017","ME","28804","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5581829","28804ME0100001","EHB Basic Dental Plan (Low)","28804ME010",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","28804ME0100001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010001","Community Safe Harbor","33653ME001",,"MEN001","MES001","MEF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010001-00","Community Safe Harbor","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Safe_Harbor_33653ME0010001-01","https://www.healthoptions.org/Documents/2017/SOB_for_Safe_Harbor_33653ME0010001-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010001","Community Safe Harbor","33653ME001",,"MEN001","MES001","MEF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010001-01","Community Safe Harbor","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Safe_Harbor_33653ME0010001-01","https://www.healthoptions.org/Documents/2017/SOB_for_Safe_Harbor_33653ME0010001-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","45-3416923","33653ME0101707","Community Preferred","33653ME010",,"MEN001","MES001","MEF007","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","0.988",,,"2017-01-01",,"Yes","Emergency services only.","Yes","Small Group plans include a leased national network for In-Network coverage.  Services obtained from Providers not in our direct network or in the national network will be Out-of-Network.","Yes",,"https://www.healthoptions.org/Documents/2017_Group_Formulary","33653ME0101707-00","Community Preferred","Standard Silver Off Exchange Plan","71.20%","0.704186618328094","Yes","Yes","No","100%",,"$2,500","$50","$960","$0","$0","$350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/2017/SBC_for_Preferred_33653ME0101707-01","https://www.healthoptions.org/Documents/2017/SOB_for_Preferred_33653ME0101707-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","45-3416923","33653ME0101707","Community Preferred","33653ME010",,"MEN001","MES001","MEF007","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","0.988",,,"2017-01-01",,"Yes","Emergency services only.","Yes","Small Group plans include a leased national network for In-Network coverage.  Services obtained from Providers not in our direct network or in the national network will be Out-of-Network.","Yes",,"https://www.healthoptions.org/Documents/2017_Group_Formulary","33653ME0101707-01","Community Preferred","Standard Silver On Exchange Plan","71.20%","0.704186618328094","Yes","Yes","No","100%",,"$2,500","$50","$960","$0","$0","$350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/2017/SBC_for_Preferred_33653ME0101707-01","https://www.healthoptions.org/Documents/2017/SOB_for_Preferred_33653ME0101707-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010002","Communty Focus","33653ME001",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010002-00","Community Focus","Standard Bronze Off Exchange Plan","59.94%","0.599399983882904","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Focus_33653ME0010002-01","https://www.healthoptions.org/Documents/2017/SOB_for_Focus_33653ME0010002-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010002","Communty Focus","33653ME001",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010002-01","Community Focus","Standard Bronze On Exchange Plan","59.94%","0.599399983882904","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Focus_33653ME0010002-01","https://www.healthoptions.org/Documents/2017/SOB_for_Focus_33653ME0010002-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010002","Communty Focus","33653ME001",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010002-02","Community Focus - ZCS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Focus_33653ME0010002-02","https://www.healthoptions.org/Documents/2017/SOB_for_Focus_33653ME0010002-02"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","45-3416923","33653ME0101709","Community Prime","33653ME010",,"MEN001","MES001","MEF008","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","0.988",,,"2017-01-01",,"Yes","Emergency services only.","Yes","Small Group plans include a leased national network for In-Network coverage.  Services obtained from Providers not in our direct network or in the national network will be Out-of-Network.","Yes",,"https://www.healthoptions.org/Documents/2017_Group_Formulary","33653ME0101709-00","Community Prime","Standard Gold Off Exchange Plan","78.12%","0.774812161922455","Yes","Yes","No","100%",,"$1,500","$50","$1,740","$0","$0","$350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/2017/SBC_for_Prime_33653ME0101709-01","https://www.healthoptions.org/Documents/2017/SOB_for_Prime_33653ME0101709-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","45-3416923","33653ME0101709","Community Prime","33653ME010",,"MEN001","MES001","MEF008","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","0.988",,,"2017-01-01",,"Yes","Emergency services only.","Yes","Small Group plans include a leased national network for In-Network coverage.  Services obtained from Providers not in our direct network or in the national network will be Out-of-Network.","Yes",,"https://www.healthoptions.org/Documents/2017_Group_Formulary","33653ME0101709-01","Community Prime","Standard Gold On Exchange Plan","78.12%","0.774812161922455","Yes","Yes","No","100%",,"$1,500","$50","$1,740","$0","$0","$350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/2017/SBC_for_Prime_33653ME0101709-01","https://www.healthoptions.org/Documents/2017/SOB_for_Prime_33653ME0101709-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010002","Communty Focus","33653ME001",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010002-03","Community Focus - LCS","Limited Cost Sharing Plan Variation","59.94%","0.599399983882904","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Focus_33653ME0010002-03","https://www.healthoptions.org/Documents/2017/SOB_for_Focus_33653ME0010002-03"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0020001","Community Reliant HSA","33653ME002",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0020001-00","Community Reliant HSA","Standard Bronze Off Exchange Plan",,"0.6136434674263","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Reliant_HSA_33653ME0020001-01","https://www.healthoptions.org/Documents/2017/SOB_for_Reliant_HSA_33653ME0020001-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0020001","Community Reliant HSA","33653ME002",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0020001-01","Community Reliant HSA","Standard Bronze On Exchange Plan",,"0.6136434674263","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Reliant_HSA_33653ME0020001-01","https://www.healthoptions.org/Documents/2017/SOB_for_Reliant_HSA_33653ME0020001-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","45-3416923","33653ME0101702","Community Access HSA","33653ME010",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","0.988",,,"2017-01-01",,"Yes","Emergency services only.","Yes","Small Group plans include a leased national network for In-Network coverage.  Services obtained from Providers not in our direct network or in the national network will be Out-of-Network.","Yes",,"https://www.healthoptions.org/Documents/2017_Group_Formulary","33653ME0101702-00","Community Access HSA","Standard Bronze Off Exchange Plan","61.25%","0.61248242855072","Yes","Yes","No","100%",,"$6,300","$0","$240","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","20.00%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/2017/SBC_for_AccessHSA_33653ME0101702-01","https://www.healthoptions.org/Documents/2017/SOB_for_AccessHSA_33653ME0101702-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","45-3416923","33653ME0101702","Community Access HSA","33653ME010",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","0.988",,,"2017-01-01",,"Yes","Emergency services only.","Yes","Small Group plans include a leased national network for In-Network coverage.  Services obtained from Providers not in our direct network or in the national network will be Out-of-Network.","Yes",,"https://www.healthoptions.org/Documents/2017_Group_Formulary","33653ME0101702-01","Community Access HSA","Standard Bronze On Exchange Plan","61.25%","0.61248242855072","Yes","Yes","No","100%",,"$6,300","$0","$240","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","20.00%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/2017/SBC_for_AccessHSA_33653ME0101702-01","https://www.healthoptions.org/Documents/2017/SOB_for_AccessHSA_33653ME0101702-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0020001","Community Reliant HSA","33653ME002",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0020001-02","Community Reliant HSA - ZCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Reliant_HSA_33653ME0020001-02","https://www.healthoptions.org/Documents/2017/SOB_for_Reliant_HSA_33653ME0020001-02"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0020001","Community Reliant HSA","33653ME002",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0020001-03","Community Reliant HSA - LCS","Limited Cost Sharing Plan Variation",,"0.6136434674263","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Reliant_HSA_33653ME0020001-03","https://www.healthoptions.org/Documents/2017/SOB_for_Reliant_HSA_33653ME0020001-03"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","45-3416923","33653ME0101704","Community Core HSA","33653ME010",,"MEN001","MES001","MEF005","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","0.988",,,"2017-01-01",,"Yes","Emergency services only.","Yes","Small Group plans include a leased national network for In-Network coverage.  Services obtained from Providers not in our direct network or in the national network will be Out-of-Network.","Yes",,"https://www.healthoptions.org/Documents/2017_Group_Formulary","33653ME0101704-00","Community Core HSA","Standard Silver Off Exchange Plan","69.95%","0.699514746665955","Yes","Yes","No","100%",,"$3,000","$0","$450","$0","$3,000","$0","$230","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/2017/SBC_for_CoreHSA_33653ME0101704-01","https://www.healthoptions.org/Documents/2017/SOB_for_CoreHSA_33653ME0101704-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","45-3416923","33653ME0101704","Community Core HSA","33653ME010",,"MEN001","MES001","MEF005","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","0.988",,,"2017-01-01",,"Yes","Emergency services only.","Yes","Small Group plans include a leased national network for In-Network coverage.  Services obtained from Providers not in our direct network or in the national network will be Out-of-Network.","Yes",,"https://www.healthoptions.org/Documents/2017_Group_Formulary","33653ME0101704-01","Community Core HSA","Standard Silver On Exchange Plan","69.95%","0.699514746665955","Yes","Yes","No","100%",,"$3,000","$0","$450","$0","$3,000","$0","$230","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/2017/SBC_for_CoreHSA_33653ME0101704-01","https://www.healthoptions.org/Documents/2017/SOB_for_CoreHSA_33653ME0101704-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050001","Community Align","33653ME005",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050001-00","Community Align","Standard Bronze Off Exchange Plan","59.94%","0.599399983882904","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Align_33653ME0050001-01","https://www.healthoptions.org/Documents/2017/SOB_for_Align_33653ME0050001-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050001","Community Align","33653ME005",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050001-01","Community Align","Standard Bronze On Exchange Plan","59.94%","0.599399983882904","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Align_33653ME0050001-01","https://www.healthoptions.org/Documents/2017/SOB_for_Align_33653ME0050001-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050001","Community Align","33653ME005",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050001-02","Community Align - ZCS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Align_33653ME0050001-02","https://www.healthoptions.org/Documents/2017/SOB_for_Align_33653ME0050001-02"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050003","Community Complete","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050003-06","Community Complete - 94% CSR","94% AV Level Silver Plan","93.25%","0.932508170604706","Yes","Yes","No","100%",,"$500","$50","$200","$0","$0","$0","$105","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Complete_33653ME0050003-06","https://www.healthoptions.org/Documents/2017/SOB_for_Complete_33653ME0050003-06"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010003","Community Choice","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010003-00","Community Choice","Standard Silver Off Exchange Plan","70.39%","0.697943449020386","Yes","Yes","No","100%",,"$2,000","$50","$1,590","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Choice_33653ME0010003-01","https://www.healthoptions.org/Documents/2017/SOB_for_Choice_33653ME0010003-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010003","Community Choice","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010003-01","Community Choice","Standard Silver On Exchange Plan","70.39%","0.697943449020386","Yes","Yes","No","100%",,"$2,000","$50","$1,590","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Choice_33653ME0010003-01","https://www.healthoptions.org/Documents/2017/SOB_for_Choice_33653ME0010003-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010003","Community Choice","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010003-02","Community Choice - ZCS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Choice_33653ME0010003-02","https://www.healthoptions.org/Documents/2017/SOB_for_Choice_33653ME0010003-02"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010003","Community Choice","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010003-03","Community Choice - LCS","Limited Cost Sharing Plan Variation","70.39%","0.697943449020386","Yes","Yes","No","100%",,"$2,000","$50","$1,590","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Choice_33653ME0010003-03","https://www.healthoptions.org/Documents/2017/SOB_for_Choice_33653ME0010003-03"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010003","Community Choice","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010003-04","Community Choice - 73% CSR","73% AV Level Silver Plan","72.57%","0.721670806407928","Yes","Yes","No","100%",,"$2,000","$50","$1,590","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Choice_33653ME0010003-04","https://www.healthoptions.org/Documents/2017/SOB_for_Choice_33653ME0010003-04"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010003","Community Choice","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010003-05","Community Choice - 87% CSR","87% AV Level Silver Plan","86.12%","0.859827220439911","Yes","Yes","No","100%",,"$800","$50","$1,150","$0","$0","$0","$158","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Choice_33653ME0010003-05","https://www.healthoptions.org/Documents/2017/SOB_for_Choice_33653ME0010003-05"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050001","Community Align","33653ME005",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050001-03","Community Align - LCS","Limited Cost Sharing Plan Variation","59.94%","0.599399983882904","Yes","Yes","No","100%",,"$5,500","$0","$960","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Align_33653ME0050001-03","https://www.healthoptions.org/Documents/2017/SOB_for_Align_33653ME0050001-03"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050002","Community Advance","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050002-00","Community Advance","Standard Silver Off Exchange Plan","70.39%","0.697943449020386","Yes","Yes","No","100%",,"$2,000","$50","$1,590","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Advance_33653ME0050002-01","https://www.healthoptions.org/Documents/2017/SOB_for_Advance_33653ME0050002-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050002","Community Advance","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050002-01","Community Advance","Standard Silver On Exchange Plan","70.39%","0.697943449020386","Yes","Yes","No","100%",,"$2,000","$50","$1,590","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Advance_33653ME0050002-01","https://www.healthoptions.org/Documents/2017/SOB_for_Advance_33653ME0050002-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050002","Community Advance","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050002-02","Community Advance - ZCS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Advance_33653ME0050002-02","https://www.healthoptions.org/Documents/2017/SOB_for_Advance_33653ME0050002-02"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050002","Community Advance","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050002-03","Community Advance - LCS","Limited Cost Sharing Plan Variation","70.39%","0.697943449020386","Yes","Yes","No","100%",,"$2,000","$50","$1,590","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Advance_33653ME0050002-03","https://www.healthoptions.org/Documents/2017/SOB_for_Advance_33653ME0050002-03"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050002","Community Advance","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050002-04","Community Advance - 73% CSR","73% AV Level Silver Plan","72.57%","0.721670806407928","Yes","Yes","No","100%",,"$2,000","$50","$1,590","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Advance_33653ME0050002-04","https://www.healthoptions.org/Documents/2017/SOB_for_Advance_33653ME0050002-04"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050002","Community Advance","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050002-05","Community Advance - 87% CSR","87% AV Level Silver Plan","86.12%","0.859827220439911","Yes","Yes","No","100%",,"$800","$50","$1,150","$0","$0","$0","$158","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Advance_33653ME0050002-05","https://www.healthoptions.org/Documents/2017/SOB_for_Advance_33653ME0050002-05"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050002","Community Advance","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050002-06","Community Advance - 94% CSR","94% AV Level Silver Plan","93.17%","0.931295454502106","Yes","Yes","No","100%",,"$500","$50","$200","$0","$0","$0","$105","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Advance_33653ME0050002-06","https://www.healthoptions.org/Documents/2017/SOB_for_Advance_33653ME0050002-06"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050003","Community Complete","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050003-00","Community Complete","Standard Silver Off Exchange Plan","68.20%","0.676921546459198","Yes","Yes","No","100%",,"$2,500","$50","$1,920","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Complete_33653ME0050003-01","https://www.healthoptions.org/Documents/2017/SOB_for_Complete_33653ME0050003-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050003","Community Complete","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050003-01","Community Complete","Standard Silver On Exchange Plan","68.20%","0.676921546459198","Yes","Yes","No","100%",,"$2,500","$50","$1,920","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Complete_33653ME0050003-01","https://www.healthoptions.org/Documents/2017/SOB_for_Complete_33653ME0050003-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050003","Community Complete","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050003-02","Community Complete - ZCS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Complete_33653ME0050003-02","https://www.healthoptions.org/Documents/2017/SOB_for_Complete_33653ME0050003-02"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050003","Community Complete","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050003-03","Community Complete - LCS","Limited Cost Sharing Plan Variation","68.20%","0.676921546459198","Yes","Yes","No","100%",,"$2,500","$50","$1,920","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Complete_33653ME0050003-03","https://www.healthoptions.org/Documents/2017/SOB_for_Complete_33653ME0050003-03"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050003","Community Complete","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050003-04","Community Complete - 73% CSR","73% AV Level Silver Plan","72.24%","0.717101395130157","Yes","Yes","No","100%",,"$2,200","$50","$1,530","$0","$0","$0","$263","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Complete_33653ME0050003-04","https://www.healthoptions.org/Documents/2017/SOB_for_Complete_33653ME0050003-04"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0050003","Community Complete","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0050003-05","Community Complete - 87% CSR","87% AV Level Silver Plan","86.26%","0.860923528671265","Yes","Yes","No","100%",,"$800","$50","$1,150","$0","$0","$0","$210","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Complete_33653ME0050003-05","https://www.healthoptions.org/Documents/2017/SOB_for_Complete_33653ME0050003-05"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010003","Community Choice","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010003-06","Community Choice - 94% CSR","94% AV Level Silver Plan","93.17%","0.931295454502106","Yes","Yes","No","100%",,"$500","$50","$200","$0","$0","$0","$105","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Choice_33653ME0010003-06","https://www.healthoptions.org/Documents/2017/SOB_for_Choice_33653ME0010003-06"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010005","Community Value","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010005-00","Community Value","Standard Silver Off Exchange Plan","68.20%","0.676921546459198","Yes","Yes","No","100%",,"$2,500","$50","$1,920","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Value_33653ME0010005-01","https://www.healthoptions.org/Documents/2017/SOB_for_Value_33653ME0010005-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010005","Community Value","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010005-01","Community Value","Standard Silver On Exchange Plan","68.20%","0.676921546459198","Yes","Yes","No","100%",,"$2,500","$50","$1,920","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Value_33653ME0010005-01","https://www.healthoptions.org/Documents/2017/SOB_for_Value_33653ME0010005-01"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710020","Anthem Bronze X HMO 5000 for HSA","48396ME071",,"MEN001","MES003","MEF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710020-01","Anthem Bronze X HMO 5000 for HSA","Standard Bronze On Exchange Plan","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4C","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710020","Anthem Bronze X HMO 5000 for HSA","48396ME071",,"MEN001","MES003","MEF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710020-02","Anthem Bronze X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4D","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710020","Anthem Bronze X HMO 5000 for HSA","48396ME071",,"MEN001","MES003","MEF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710020-03","Anthem Bronze X HMO 5000 for HSA","Limited Cost Sharing Plan Variation","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4C","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 2900 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-00","Anthem Silver X HMO 2900 for HSA","Standard Silver Off Exchange Plan","68.10%","0.683758556842804","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRV","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 2900 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-01","Anthem Silver X HMO 2900 for HSA","Standard Silver On Exchange Plan","68.10%","0.683758556842804","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010005","Community Value","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010005-02","Community Value - ZCS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Value_33653ME0010005-02","https://www.healthoptions.org/Documents/2017/SOB_for_Value_33653ME0010005-02"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010005","Community Value","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010005-03","Community Value - LCS","Limited Cost Sharing Plan Variation","68.20%","0.676921546459198","Yes","Yes","No","100%",,"$2,500","$50","$1,920","$0","$0","$0","$315","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Value_33653ME0010005-03","https://www.healthoptions.org/Documents/2017/SOB_for_Value_33653ME0010005-03"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010005","Community Value","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010005-04","Community Value - 73% CSR","73% AV Level Silver Plan","72.24%","0.717101395130157","Yes","Yes","No","100%",,"$2,200","$50","$1,530","$0","$0","$0","$263","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Value_33653ME0010005-04","https://www.healthoptions.org/Documents/2017/SOB_for_Value_33653ME0010005-04"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010007","Community Edge","33653ME001",,"MEN001","MES001","MEF005","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010007-00","Community Edge","Standard Gold Off Exchange Plan","78.23%","0.776404917240143","Yes","Yes","No","100%",,"$1,200","$50","$1,220","$0","$0","$0","$210","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Edge_33653ME0010007-01","https://www.healthoptions.org/Documents/2017/SOB_for_Edge_33653ME0010007-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010007","Community Edge","33653ME001",,"MEN001","MES001","MEF005","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010007-01","Community Edge","Standard Gold On Exchange Plan","78.23%","0.776404917240143","Yes","Yes","No","100%",,"$1,200","$50","$1,220","$0","$0","$0","$210","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Edge_33653ME0010007-01","https://www.healthoptions.org/Documents/2017/SOB_for_Edge_33653ME0010007-01"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010007","Community Edge","33653ME001",,"MEN001","MES001","MEF005","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010007-02","Community Edge - ZCS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Edge_33653ME0010007-02","https://www.healthoptions.org/Documents/2017/SOB_for_Edge_33653ME0010007-02"
"2017","ME","33653","SERFF","2017-01-25 20:15:24","Individual","No","45-3416923","33653ME0010007","Community Edge","33653ME001",,"MEN001","MES001","MEF005","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency services coverage available within the United States.  Non-emergency service coverage is available outside the Service Area on and Out-of-Network basis.","No","https://enroll.healthoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/2017_Individual_Formulary","33653ME0010007-03","Community Edge - LCS","Limited Cost Sharing Plan Variation","78.23%","0.776404917240143","Yes","Yes","No","100%",,"$1,200","$50","$1,220","$0","$0","$0","$210","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/Documents/2017/SBC_for_Edge_33653ME0010007-03","https://www.healthoptions.org/Documents/2017/SOB_for_Edge_33653ME0010007-03"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2250","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-02","Anthem Silver X HMO 2250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2250","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-03","Anthem Silver X HMO 2250","Limited Cost Sharing Plan Variation","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2250","$2250 per person","$4500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4P","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2250","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-04","Anthem Silver X HMO 2250 S04","73% AV Level Silver Plan","72.81%","0.728607475757599","Yes","Yes","No","100%",,"$2,100","$40","$2,500","$0","$2,100","$400","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2100","$2100 per person","$4200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4S","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2250","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-05","Anthem Silver X HMO 2250 S05","87% AV Level Silver Plan","87.55%","0.875367522239685","Yes","Yes","No","100%",,"$750","$40","$700","$0","$750","$200","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4T","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2250","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-06","Anthem Silver X HMO 2250 S06","94% AV Level Silver Plan","94.02%","0.939842581748962","Yes","Yes","No","100%",,"$150","$40","$400","$0","$150","$90","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4U","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","47540","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","93-0242990","47540ME0040002","EHB High PPO","47540ME004",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","47540ME0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","ME","47540","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","93-0242990","47540ME0040001","EHB Low PPO","47540ME004",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","47540ME0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","ME","47540","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","93-0242990","47540ME0030002","EHB High Passive","47540ME003",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","47540ME0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","ME","47540","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","93-0242990","47540ME0030001","EHB Low Passive","47540ME003",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","47540ME0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","Yes","31-1705652","48396ME0830003","Anthem Dental Family","48396ME083",,"MEN005","MES008",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0830003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215726.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","Yes","31-1705652","48396ME0860005","Anthem Dental Family Value","48396ME086",,"MEN005","MES008",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0860005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215728.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0770003","Anthem Silver X Blue Choice PPO 3500 0 6550 Plus w HSA","48396ME077",,"MEN004","MES001","MEF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/MESelectdrugtier4","48396ME0770003-00","Anthem Silver X Blue Choice PPO 3500 0 6550 Plus w HSA","Standard Silver Off Exchange Plan","70.74%","0.695163488388062","Yes","Yes","No","100%",,"$3,500","$0","$10","$0","$3,500","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2HU5",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3850","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-00","Anthem Silver X HMO 3850","Standard Silver Off Exchange Plan","68.03%","0.681426405906677","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRU","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3850","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-01","Anthem Silver X HMO 3850","Standard Silver On Exchange Plan","68.03%","0.681426405906677","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4E","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0770003","Anthem Silver X Blue Choice PPO 3500 0 6550 Plus w HSA","48396ME077",,"MEN004","MES001","MEF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/MESelectdrugtier4","48396ME0770003-01","Anthem Silver X Blue Choice PPO 3500 0 6550 Plus w HSA","Standard Silver On Exchange Plan","70.74%","0.695163488388062","Yes","Yes","No","100%",,"$3,500","$0","$10","$0","$3,500","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2HU2",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","Yes","31-1705652","48396ME0920005","Anthem Dental Family Value","48396ME092",,"MEN005","MES008",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0920005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215728.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","Yes","31-1705652","48396ME0890003","Anthem Dental Family","48396ME089",,"MEN005","MES008",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0890003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215726.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3850","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-02","Anthem Silver X HMO 3850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4F","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2018"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3850","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-03","Anthem Silver X HMO 3850","Limited Cost Sharing Plan Variation","68.03%","0.681426405906677","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4E","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2019"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3850","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-04","Anthem Silver X HMO 3850 S04","73% AV Level Silver Plan","73.38%","0.734883189201355","Yes","Yes","No","100%",,"$2,500","$60","$1,400","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4G","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2020"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3850","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-05","Anthem Silver X HMO 3850 S05","87% AV Level Silver Plan","87.21%","0.872288882732391","Yes","Yes","No","100%",,"$750","$40","$800","$0","$500","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4H","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2021"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3850","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-06","Anthem Silver X HMO 3850 S06","94% AV Level Silver Plan","94.10%","0.940732538700104","Yes","Yes","No","100%",,"$200","$20","$400","$0","$200","$400","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4J","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2022"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710020","Anthem Bronze X HMO 5000 for HSA","48396ME071",,"MEN001","MES003","MEF019","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710020-00","Anthem Bronze X HMO 5000 for HSA","Standard Bronze Off Exchange Plan","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRT","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 2900 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-02","Anthem Silver X HMO 2900 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4R","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 2900 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-03","Anthem Silver X HMO 2900 for HSA","Limited Cost Sharing Plan Variation","68.10%","0.683758556842804","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4Q","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 2900 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-04","Anthem Silver X HMO 2900 for HSA S04","73% AV Level Silver Plan","72.10%","0.719497621059418","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4S","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 2900 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-05","Anthem Silver X HMO 2900 S05","87% AV Level Silver Plan","87.64%","0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$0","$1,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1200","$1200 per person","$2400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4T","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710016","Anthem Catastrophic X HMO 7150","48396ME071",,"MEN001","MES003","MEF017","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710016-00","Anthem Catastrophic X HMO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRN","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","Yes","31-1705652","48396ME0860003","Anthem Dental Family","48396ME086",,"MEN005","MES008",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0860003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215726.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","Yes","31-1705652","48396ME0830004","Anthem Dental Family Enhanced","48396ME083",,"MEN005","MES008",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0830004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215727.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0770004","Anthem Bronze X Blue Choice PPO 6000 0 7150","48396ME077",,"MEN004","MES001","MEF002","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9967",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/MESelectdrugtier5","48396ME0770004-00","Anthem Bronze X Blue Choice PPO 6000 0 7150","Standard Bronze Off Exchange Plan","60.61%","0.628450870513916","No","Yes","No","100%",,"$6,000","$100","$0","$0","$900","$2,000","$0","$200","$0","$0","$0","$0","$300","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HU4",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0770004","Anthem Bronze X Blue Choice PPO 6000 0 7150","48396ME077",,"MEN004","MES001","MEF002","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9967",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/MESelectdrugtier5","48396ME0770004-01","Anthem Bronze X Blue Choice PPO 6000 0 7150","Standard Bronze On Exchange Plan","60.61%","0.628450870513916","No","Yes","No","100%",,"$6,000","$100","$0","$0","$900","$2,000","$0","$200","$0","$0","$0","$0","$300","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HU3",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 2900 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-06","Anthem Silver X HMO 2900 S06","94% AV Level Silver Plan","94.28%","0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4U","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710031","Anthem Bronze X HMO 6250 for HSA","48396ME071",,"MEN001","MES003","MEF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710031-00","Anthem Bronze X HMO 6250 for HSA","Standard Bronze Off Exchange Plan","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4N","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710031","Anthem Bronze X HMO 6250 for HSA","48396ME071",,"MEN001","MES003","MEF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710031-01","Anthem Bronze X HMO 6250 for HSA","Standard Bronze On Exchange Plan","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4L","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710031","Anthem Bronze X HMO 6250 for HSA","48396ME071",,"MEN001","MES003","MEF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710031-02","Anthem Bronze X HMO 6250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4M","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710031","Anthem Bronze X HMO 6250 for HSA","48396ME071",,"MEN001","MES003","MEF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710031-03","Anthem Bronze X HMO 6250 for HSA","Limited Cost Sharing Plan Variation","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4L","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2250","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-00","Anthem Silver X HMO 2250","Standard Silver Off Exchange Plan","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2250","$2250 per person","$4500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4R","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2250","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-01","Anthem Silver X HMO 2250","Standard Silver On Exchange Plan","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2250","$2250 per person","$4500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4P","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710034","Anthem Bronze X HMO 6250","48396ME071",,"MEN001","MES003","MEF020","New","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710034-00","Anthem Bronze X HMO 6250","Standard Bronze Off Exchange Plan","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECE","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710034","Anthem Bronze X HMO 6250","48396ME071",,"MEN001","MES003","MEF020","New","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710034-01","Anthem Bronze X HMO 6250","Standard Bronze On Exchange Plan","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECC","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710034","Anthem Bronze X HMO 6250","48396ME071",,"MEN001","MES003","MEF020","New","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710034-02","Anthem Bronze X HMO 6250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECD","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710034","Anthem Bronze X HMO 6250","48396ME071",,"MEN001","MES003","MEF020","New","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710034-03","Anthem Bronze X HMO 6250","Limited Cost Sharing Plan Variation","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECC","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710035","Anthem Silver Core X HMO 4650","48396ME071",,"MEN001","MES003","MEF014","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710035-00","Anthem Silver Core X HMO 4650","Standard Silver Off Exchange Plan","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECH","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710035","Anthem Silver Core X HMO 4650","48396ME071",,"MEN001","MES003","MEF014","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710035-01","Anthem Silver Core X HMO 4650","Standard Silver On Exchange Plan","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECH","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710035","Anthem Silver Core X HMO 4650","48396ME071",,"MEN001","MES003","MEF014","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710035-02","Anthem Silver Core X HMO 4650 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECF","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710035","Anthem Silver Core X HMO 4650","48396ME071",,"MEN001","MES003","MEF014","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710035-03","Anthem Silver Core X HMO 4650","Limited Cost Sharing Plan Variation","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECF","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710035","Anthem Silver Core X HMO 4650","48396ME071",,"MEN001","MES003","MEF014","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710035-04","Anthem Silver Core X HMO 4650 S04","73% AV Level Silver Plan","72.02%","0.720879375934601","Yes","Yes","No","100%",,"$3,800","$60","$800","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3800","$3800 per person","$7600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECJ","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710035","Anthem Silver Core X HMO 4650","48396ME071",,"MEN001","MES003","MEF014","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710035-05","Anthem Silver Core X HMO 4650 S05","87% AV Level Silver Plan","86.10%","0.861255943775177","Yes","Yes","No","100%",,"$950","$40","$800","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECK","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710035","Anthem Silver Core X HMO 4650","48396ME071",,"MEN001","MES003","MEF014","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710035-06","Anthem Silver Core X HMO 4650 S06","94% AV Level Silver Plan","93.16%","0.931454837322235","Yes","Yes","No","100%",,"$200","$20","$500","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2JTS","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","Yes","31-1705652","48396ME0890004","Anthem Dental Family Enhanced","48396ME089",,"MEN005","MES008",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0890004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215727.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","Yes","31-1705652","48396ME0920003","Anthem Dental Family","48396ME092",,"MEN005","MES008",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0920003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215726.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720032","Anthem Bronze X POS 5000 for HSA","48396ME072",,"MEN002","MES006","MEF003","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720032-02","Anthem Bronze X POS 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3C","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720032","Anthem Bronze X POS 5000 for HSA","48396ME072",,"MEN002","MES006","MEF003","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720032-03","Anthem Bronze X POS 5000 for HSA","Limited Cost Sharing Plan Variation","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3B","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-00","Anthem Silver X POS 2900 for HSA","Standard Silver Off Exchange Plan","68.10%","0.690566599369049","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRJ","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-01","Anthem Silver X POS 2900 for HSA","Standard Silver On Exchange Plan","68.10%","0.690566599369049","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3D","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710016","Anthem Catastrophic X HMO 7150","48396ME071",,"MEN001","MES003","MEF017","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710016-01","Anthem Catastrophic X HMO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J43","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-00","Anthem Silver X POS 3850","Standard Silver Off Exchange Plan","68.03%","0.695851266384125","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRK","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","Yes","31-1705652","48396ME0860004","Anthem Dental Family Enhanced","48396ME086",,"MEN005","MES008",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0860004-01","Anthem Dental Family Value","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215727.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0770002","Anthem Silver X Blue Choice PPO 2500 50 7150","48396ME077",,"MEN004","MES001","MEF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/MESelectdrugtier5","48396ME0770002-00","Anthem Silver X Blue Choice PPO 2500 50 7150","Standard Silver Off Exchange Plan","68.23%","0.695296466350555","No","Yes","No","100%",,"$2,500","$200","$2,300","$0","$400","$2,300","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HT8",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0770002","Anthem Silver X Blue Choice PPO 2500 50 7150","48396ME077",,"MEN004","MES001","MEF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/MESelectdrugtier5","48396ME0770002-01","Anthem Silver X Blue Choice PPO 2500 50 7150","Standard Silver On Exchange Plan","68.23%","0.695296466350555","No","Yes","No","100%",,"$2,500","$200","$2,300","$0","$400","$2,300","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HU0",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","Yes","31-1705652","48396ME0920004","Anthem Dental Family Enhanced","48396ME092",,"MEN005","MES008",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0920004-00","Anthem Dental Family Value","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215727.pdf",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-01","Anthem Silver X POS 3850","Standard Silver On Exchange Plan","68.03%","0.695851266384125","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-02","Anthem Silver X POS 3850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3K","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-03","Anthem Silver X POS 3850","Limited Cost Sharing Plan Variation","68.03%","0.695851266384125","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-04","Anthem Silver X POS 3850 S04","73% AV Level Silver Plan","73.38%","0.734883189201355","Yes","Yes","No","100%",,"$2,500","$60","$1,400","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5250","$5250 per person","$10500 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2500","$2500 per person","$5000 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3L","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-05","Anthem Silver X POS 3850 S05","87% AV Level Silver Plan","87.21%","0.872288882732391","Yes","Yes","No","100%",,"$750","$40","$800","$0","$500","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1600","$1600 per person","$3200 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3M","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-06","Anthem Silver X POS 3850 S06","94% AV Level Silver Plan","94.10%","0.939845502376556","Yes","Yes","No","100%",,"$200","$20","$400","$0","$200","$400","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3N","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720018","Anthem Bronze X POS 5000 for HSA","48396ME072",,"MEN002","MES005","MEF003","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720018-00","Anthem Bronze X POS 5000 for HSA","Standard Bronze Off Exchange Plan","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRH","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720018","Anthem Bronze X POS 5000 for HSA","48396ME072",,"MEN002","MES005","MEF003","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720018-01","Anthem Bronze X POS 5000 for HSA","Standard Bronze On Exchange Plan","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3B","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720018","Anthem Bronze X POS 5000 for HSA","48396ME072",,"MEN002","MES005","MEF003","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720018-02","Anthem Bronze X POS 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3C","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720018","Anthem Bronze X POS 5000 for HSA","48396ME072",,"MEN002","MES005","MEF003","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720018-03","Anthem Bronze X POS 5000 for HSA","Limited Cost Sharing Plan Variation","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3B","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-00","Anthem Silver X POS 2900 for HSA","Standard Silver Off Exchange Plan","68.10%","0.690566599369049","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRJ","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-01","Anthem Silver X POS 2900 for HSA","Standard Silver On Exchange Plan","68.10%","0.690566599369049","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3D","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-02","Anthem Silver X POS 2900 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3E","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-03","Anthem Silver X POS 2900 for HSA","Limited Cost Sharing Plan Variation","68.10%","0.690566599369049","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3D","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-04","Anthem Silver X POS 2900 for HSA S04","73% AV Level Silver Plan","72.33%","0.724064648151398","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3700","$3700 per person","$7400 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3F","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-05","Anthem Silver X POS 2900 S05","87% AV Level Silver Plan","87.64%","0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$0","$1,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1200","$1200 per person","$2400 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1200","$1200 per person","$2400 per group","0%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-06","Anthem Silver X POS 2900 S06","94% AV Level Silver Plan","94.28%","0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3H","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-00","Anthem Silver X POS 3850","Standard Silver Off Exchange Plan","68.03%","0.695851266384125","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRK","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-01","Anthem Silver X POS 3850","Standard Silver On Exchange Plan","68.03%","0.695851266384125","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-02","Anthem Silver X POS 3850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3K","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-03","Anthem Silver X POS 3850","Limited Cost Sharing Plan Variation","68.03%","0.695851266384125","Yes","Yes","No","100%",,"$3,850","$60","$1,000","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7000","$7000 per person","$14000 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3850","$3850 per person","$7700 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3J","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-04","Anthem Silver X POS 3850 S04","73% AV Level Silver Plan","73.38%","0.734883189201355","Yes","Yes","No","100%",,"$2,500","$60","$1,400","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5250","$5250 per person","$10500 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2500","$2500 per person","$5000 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3L","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-05","Anthem Silver X POS 3850 S05","87% AV Level Silver Plan","87.21%","0.872288882732391","Yes","Yes","No","100%",,"$750","$40","$800","$0","$500","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1600","$1600 per person","$3200 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3M","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 3850","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-06","Anthem Silver X POS 3850 S06","94% AV Level Silver Plan","94.10%","0.939845502376556","Yes","Yes","No","100%",,"$200","$20","$400","$0","$200","$400","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$21000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30%",,,,,"$11550","$11550 per person","$23100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3N","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720032","Anthem Bronze X POS 5000 for HSA","48396ME072",,"MEN002","MES006","MEF003","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720032-00","Anthem Bronze X POS 5000 for HSA","Standard Bronze Off Exchange Plan","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRH","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720032","Anthem Bronze X POS 5000 for HSA","48396ME072",,"MEN002","MES006","MEF003","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720032-01","Anthem Bronze X POS 5000 for HSA","Standard Bronze On Exchange Plan","61.87%","0.619062662124634","Yes","Yes","No","100%",,"$5,000","$0","$800","$0","$5,000","$0","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3B","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-02","Anthem Silver X POS 2900 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3E","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-03","Anthem Silver X POS 2900 for HSA","Limited Cost Sharing Plan Variation","68.10%","0.690566599369049","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3D","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-04","Anthem Silver X POS 2900 for HSA S04","73% AV Level Silver Plan","72.33%","0.724064648151398","Yes","Yes","No","100%",,"$2,900","$0","$700","$0","$2,900","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3700","$3700 per person","$7400 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2900","$2900 per person","$5800 per group","15%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3F","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-05","Anthem Silver X POS 2900 S05","87% AV Level Silver Plan","87.64%","0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$0","$1,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1200","$1200 per person","$2400 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1200","$1200 per person","$2400 per group","0%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3G","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 2900 for HSA","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-06","Anthem Silver X POS 2900 S06","94% AV Level Silver Plan","94.28%","0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$8700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3H","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720035","Anthem Bronze X POS 6250 for HSA","48396ME072",,"MEN002","MES005","MEF004","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720035-00","Anthem Bronze X POS 6250 for HSA","Standard Bronze Off Exchange Plan","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X44","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720035","Anthem Bronze X POS 6250 for HSA","48396ME072",,"MEN002","MES005","MEF004","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720035-01","Anthem Bronze X POS 6250 for HSA","Standard Bronze On Exchange Plan","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X42","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720035","Anthem Bronze X POS 6250 for HSA","48396ME072",,"MEN002","MES005","MEF004","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720035-02","Anthem Bronze X POS 6250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X46","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720035","Anthem Bronze X POS 6250 for HSA","48396ME072",,"MEN002","MES005","MEF004","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720035-03","Anthem Bronze X POS 6250 for HSA","Limited Cost Sharing Plan Variation","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X42","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720036","Anthem Bronze X POS 6250 for HSA","48396ME072",,"MEN002","MES006","MEF004","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720036-00","Anthem Bronze X POS 6250 for HSA","Standard Bronze Off Exchange Plan","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X44","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720036","Anthem Bronze X POS 6250 for HSA","48396ME072",,"MEN002","MES006","MEF004","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720036-01","Anthem Bronze X POS 6250 for HSA","Standard Bronze On Exchange Plan","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X42","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720036","Anthem Bronze X POS 6250 for HSA","48396ME072",,"MEN002","MES006","MEF004","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720036-02","Anthem Bronze X POS 6250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X46","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720036","Anthem Bronze X POS 6250 for HSA","48396ME072",,"MEN002","MES006","MEF004","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720036-03","Anthem Bronze X POS 6250 for HSA","Limited Cost Sharing Plan Variation","61.14%","0.61224502325058","Yes","Yes","No","100%",,"$6,250","$0","$300","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group",,,,"$19650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X42","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES005","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-00","Anthem Silver X POS 2250","Standard Silver Off Exchange Plan","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4G","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES005","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-01","Anthem Silver X POS 2250","Standard Silver On Exchange Plan","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X48","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES005","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-02","Anthem Silver X POS 2250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X4J","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES005","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-03","Anthem Silver X POS 2250","Limited Cost Sharing Plan Variation","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X48","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES005","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-04","Anthem Silver X POS 2250 S04","73% AV Level Silver Plan","72.81%","0.728607475757599","Yes","Yes","No","100%",,"$2,100","$40","$2,500","$0","$2,100","$400","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4600","$4600 per person","$9200 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2100","$2100 per person","$4200 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4A","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES005","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-05","Anthem Silver X POS 2250 S05","87% AV Level Silver Plan","87.55%","0.875367522239685","Yes","Yes","No","100%",,"$750","$40","$700","$0","$750","$200","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1450","$1450 per person","$2900 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4C","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES005","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-06","Anthem Silver X POS 2250 S06","94% AV Level Silver Plan","94.02%","0.939842581748962","Yes","Yes","No","100%",,"$150","$40","$400","$0","$150","$90","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4E","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES006","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-00","Anthem Silver X POS 2250","Standard Silver Off Exchange Plan","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4G","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES006","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-01","Anthem Silver X POS 2250","Standard Silver On Exchange Plan","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X48","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES006","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-02","Anthem Silver X POS 2250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X4J","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES006","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-03","Anthem Silver X POS 2250","Limited Cost Sharing Plan Variation","68.04%","0.681423604488373","Yes","Yes","No","100%",,"$2,250","$60","$2,500","$0","$2,250","$400","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6500","$6500 per person","$13000 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X48","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES006","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-04","Anthem Silver X POS 2250 S04","73% AV Level Silver Plan","72.81%","0.728607475757599","Yes","Yes","No","100%",,"$2,100","$40","$2,500","$0","$2,100","$400","$600","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4600","$4600 per person","$9200 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2100","$2100 per person","$4200 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4A","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES006","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-05","Anthem Silver X POS 2250 S05","87% AV Level Silver Plan","87.55%","0.875367522239685","Yes","Yes","No","100%",,"$750","$40","$700","$0","$750","$200","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1450","$1450 per person","$2900 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4C","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250","48396ME072",,"MEN002","MES006","MEF005","Existing","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-06","Anthem Silver X POS 2250 S06","94% AV Level Silver Plan","94.02%","0.939842581748962","Yes","Yes","No","100%",,"$150","$40","$400","$0","$150","$90","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$19500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4E","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720040","Anthem Bronze X POS 6250","48396ME072",,"MEN002","MES005","MEF004","New","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720040-00","Anthem Bronze X POS 6250","Standard Bronze Off Exchange Plan","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC2","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720040","Anthem Bronze X POS 6250","48396ME072",,"MEN002","MES005","MEF004","New","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720040-01","Anthem Bronze X POS 6250","Standard Bronze On Exchange Plan","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC0","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720040","Anthem Bronze X POS 6250","48396ME072",,"MEN002","MES005","MEF004","New","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720040-02","Anthem Bronze X POS 6250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EC1","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720040","Anthem Bronze X POS 6250","48396ME072",,"MEN002","MES005","MEF004","New","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720040-03","Anthem Bronze X POS 6250","Limited Cost Sharing Plan Variation","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC0","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720041","Anthem Bronze X POS 6250","48396ME072",,"MEN002","MES006","MEF004","New","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720041-00","Anthem Bronze X POS 6250","Standard Bronze Off Exchange Plan","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC2","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720041","Anthem Bronze X POS 6250","48396ME072",,"MEN002","MES006","MEF004","New","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720041-01","Anthem Bronze X POS 6250","Standard Bronze On Exchange Plan","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC0","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720041","Anthem Bronze X POS 6250","48396ME072",,"MEN002","MES006","MEF004","New","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720041-02","Anthem Bronze X POS 6250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EC1","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720041","Anthem Bronze X POS 6250","48396ME072",,"MEN002","MES006","MEF004","New","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720041-03","Anthem Bronze X POS 6250","Limited Cost Sharing Plan Variation","59.49%","0.595058500766754","Yes","Yes","No","100%",,"$6,250","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6250","$6250 per person","$12500 per group","50%",,,,,"$18750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC0","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720044","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES005","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720044-00","Anthem Silver Core X POS 4650","Standard Silver Off Exchange Plan","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC8","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720044","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES005","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720044-01","Anthem Silver Core X POS 4650","Standard Silver On Exchange Plan","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC6","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720044","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES005","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720044-02","Anthem Silver Core X POS 4650 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EC7","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720044","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES005","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720044-03","Anthem Silver Core X POS 4650","Limited Cost Sharing Plan Variation","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC6","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720044","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES005","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720044-04","Anthem Silver Core X POS 4650 S04","73% AV Level Silver Plan","72.02%","0.720879375934601","Yes","Yes","No","100%",,"$3,800","$60","$800","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5150","$5150 per person","$10300 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3800","$3800 per person","$7600 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC9","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720044","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES005","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720044-05","Anthem Silver Core X POS 4650 S05","87% AV Level Silver Plan","86.10%","0.861255943775177","Yes","Yes","No","100%",,"$950","$40","$800","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1750","$1750 per person","$3500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC9","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720044","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES005","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720044-06","Anthem Silver Core X POS 4650 S06","94% AV Level Silver Plan","93.16%","0.931454837322235","Yes","Yes","No","100%",,"$200","$20","$500","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECA","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720045","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES006","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720045-00","Anthem Silver Core X POS 4650","Standard Silver Off Exchange Plan","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECB","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720045","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES006","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720045-01","Anthem Silver Core X POS 4650","Standard Silver On Exchange Plan","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC8","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720045","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES006","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720045-02","Anthem Silver Core X POS 4650 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EC6","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720045","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES006","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720045-03","Anthem Silver Core X POS 4650","Limited Cost Sharing Plan Variation","68.02%","0.68115621805191","Yes","Yes","No","100%",,"$4,650","$60","$600","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6750","$6750 per person","$13500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4650","$4650 per person","$9300 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC7","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720045","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES006","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720045-04","Anthem Silver Core X POS 4650 S04","73% AV Level Silver Plan","72.02%","0.720879375934601","Yes","Yes","No","100%",,"$3,800","$60","$800","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5150","$5150 per person","$10300 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3800","$3800 per person","$7600 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EC6","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720045","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES006","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720045-05","Anthem Silver Core X POS 4650 S05","87% AV Level Silver Plan","86.10%","0.861255943775177","Yes","Yes","No","100%",,"$950","$40","$800","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1750","$1750 per person","$3500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECA","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720045","Anthem Silver Core X POS 4650","48396ME072",,"MEN002","MES006","MEF009","New","POS","Silver","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720045-06","Anthem Silver Core X POS 4650 S06","94% AV Level Silver Plan","93.16%","0.931454837322235","Yes","Yes","No","100%",,"$200","$20","$500","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$20250","$20250 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25%",,,,,"$13950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECB","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720022","Anthem Catastrophic X POS 7150","48396ME072",,"MEN002","MES005","MEF001","Existing","POS","Catastrophic","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720022-00","Anthem Catastrophic X POS 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$28600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0%",,,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRB","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730016","Anthem Silver X Pathway HMO 3000 30 6650","48396ME073",,"MEN003","MES002","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730016-00","Anthem Silver X Pathway HMO 3000 30 6650","Standard Silver Off Exchange Plan","70.36%","0.702243030071259","No","Yes","No","100%",,"$3,000","$200","$1,200","$0","$400","$2,200","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTG",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730016","Anthem Silver X Pathway HMO 3000 30 6650","48396ME073",,"MEN003","MES002","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730016-01","Anthem Silver X Pathway HMO 3000 30 6650","Standard Silver On Exchange Plan","70.36%","0.702243030071259","No","Yes","No","100%",,"$3,000","$200","$1,200","$0","$400","$2,200","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HU1",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720022","Anthem Catastrophic X POS 7150","48396ME072",,"MEN002","MES005","MEF001","Existing","POS","Catastrophic","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720022-01","Anthem Catastrophic X POS 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$28600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0%",,,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J30","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720034","Anthem Catastrophic X POS 7150","48396ME072",,"MEN002","MES006","MEF001","Existing","POS","Catastrophic","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720034-00","Anthem Catastrophic X POS 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$28600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0%",,,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRB","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","Individual","Yes","01-0286541","50165ME0170001","Delta Dental Family Low Plan","50165ME017","7447253908","MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9961","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0170001-00","Delta Dental Family Low Plan","Standard Low Off Exchange Plan","71.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocme2017b.pdf"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","01-0286541","50165ME0210001","Delta Dental PPO Family Low Plan","50165ME021","7447253908","MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9961","Guaranteed Rate","2017-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","50165ME0210001-01","Delta Dental PPO Family Low Plan","Standard Low On Exchange Plan","71.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20176.pdf"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240012","Bronze HMO 6000","96667ME024",,"MEN001","MES001","MEF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240012-01","Bronze HMO 6000","Standard Bronze On Exchange Plan",,"0.614998459815979","Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/2_sbc_PD0000005283_MD0000004294.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004294"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730017","Anthem Silver X Pathway HMO 3000 30 6650","48396ME073",,"MEN003","MES004","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730017-00","Anthem Silver X Pathway HMO 3000 30 6650","Standard Silver Off Exchange Plan","70.36%","0.702243030071259","No","Yes","No","100%",,"$3,000","$200","$1,200","$0","$400","$2,200","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTG",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730017","Anthem Silver X Pathway HMO 3000 30 6650","48396ME073",,"MEN003","MES004","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730017-01","Anthem Silver X Pathway HMO 3000 30 6650","Standard Silver On Exchange Plan","70.36%","0.702243030071259","No","Yes","No","100%",,"$3,000","$200","$1,200","$0","$400","$2,200","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HU1",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720034","Anthem Catastrophic X POS 7150","48396ME072",,"MEN002","MES006","MEF001","Existing","POS","Catastrophic","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720034-01","Anthem Catastrophic X POS 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$28600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0%",,,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J30",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730018","Anthem Silver X Pathway HMO 3000 30 6650","48396ME073",,"MEN003","MES007","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730018-00","Anthem Silver X Pathway HMO 3000 30 6650","Standard Silver Off Exchange Plan","70.36%","0.702243030071259","No","Yes","No","100%",,"$3,000","$200","$1,200","$0","$400","$2,200","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTG",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730018","Anthem Silver X Pathway HMO 3000 30 6650","48396ME073",,"MEN003","MES007","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","NO","YES","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730018-01","Anthem Silver X Pathway HMO 3000 30 6650","Standard Silver On Exchange Plan","70.36%","0.702243030071259","No","Yes","No","100%",,"$3,000","$200","$1,200","$0","$400","$2,200","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HU1",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710019","Anthem Bronze X HMO 5000","48396ME071",,"MEN001","MES003","MEF016","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710019-00","Anthem Bronze X HMO 5000","Standard Bronze Off Exchange Plan","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRS","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730019","Anthem Gold X Pathway HMO 2000 20 4000","48396ME073",,"MEN003","MES002","MEF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730019-00","Anthem Gold X Pathway HMO 2000 20 4000","Standard Gold Off Exchange Plan","78.06%","0.776805579662323","No","Yes","No","100%",,"$2,000","$100","$1,000","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTD",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730019","Anthem Gold X Pathway HMO 2000 20 4000","48396ME073",,"MEN003","MES002","MEF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730019-01","Anthem Gold X Pathway HMO 2000 20 4000","Standard Gold On Exchange Plan","78.06%","0.776805579662323","No","Yes","No","100%",,"$2,000","$100","$1,000","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTZ",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710019","Anthem Bronze X HMO 5000","48396ME071",,"MEN001","MES003","MEF016","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710019-01","Anthem Bronze X HMO 5000","Standard Bronze On Exchange Plan","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4A","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710019","Anthem Bronze X HMO 5000","48396ME071",,"MEN001","MES003","MEF016","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710019-02","Anthem Bronze X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J4B","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730020","Anthem Gold X Pathway HMO 2000 20 4000","48396ME073",,"MEN003","MES004","MEF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730020-00","Anthem Gold X Pathway HMO 2000 20 4000","Standard Gold Off Exchange Plan","78.06%","0.776805579662323","No","Yes","No","100%",,"$2,000","$100","$1,000","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTD",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730020","Anthem Gold X Pathway HMO 2000 20 4000","48396ME073",,"MEN003","MES004","MEF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9976",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730020-01","Anthem Gold X Pathway HMO 2000 20 4000","Standard Gold On Exchange Plan","78.06%","0.776805579662323","No","Yes","No","100%",,"$2,000","$100","$1,000","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTZ",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0710019","Anthem Bronze X HMO 5000","48396ME071",,"MEN001","MES003","MEF016","Existing","HMO","Bronze","Not Applicable","Yes","Both","NO","YES","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710019-03","Anthem Bronze X HMO 5000","Limited Cost Sharing Plan Variation","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4A","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_S_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730021","Anthem Gold X Pathway HMO 2000 20 4000","48396ME073",,"MEN003","MES007","MEF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730021-00","Anthem Gold X Pathway HMO 2000 20 4000","Standard Gold Off Exchange Plan","78.06%","0.776805579662323","No","Yes","No","100%",,"$2,000","$100","$1,000","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTD",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","31-1705652","48396ME0730021","Anthem Gold X Pathway HMO 2000 20 4000","48396ME073",,"MEN003","MES007","MEF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs, Emergency and must also include Chiropractors after the 36th visit of members self-referring.  For Chiropractic visits beyond 36, a referral is required.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/MESelectdrugtier5","48396ME0730021-01","Anthem Gold X Pathway HMO 2000 20 4000","Standard Gold On Exchange Plan","78.06%","0.776805579662323","No","Yes","No","100%",,"$2,000","$100","$1,000","$0","$400","$1,800","$0","$200","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HTZ",
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720017","Anthem Bronze X POS 5000","48396ME072",,"MEN002","MES005","MEF006","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720017-00","Anthem Bronze X POS 5000","Standard Bronze Off Exchange Plan","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRF","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720017","Anthem Bronze X POS 5000","48396ME072",,"MEN002","MES005","MEF006","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720017-01","Anthem Bronze X POS 5000","Standard Bronze On Exchange Plan","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J37","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720017","Anthem Bronze X POS 5000","48396ME072",,"MEN002","MES005","MEF006","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720017-02","Anthem Bronze X POS 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J38","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720017","Anthem Bronze X POS 5000","48396ME072",,"MEN002","MES005","MEF006","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720017-03","Anthem Bronze X POS 5000","Limited Cost Sharing Plan Variation","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J37","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720031","Anthem Bronze X POS 5000","48396ME072",,"MEN002","MES006","MEF006","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720031-00","Anthem Bronze X POS 5000","Standard Bronze Off Exchange Plan","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRF","http://editiondigital.net/view/IU65/2017/OFF_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720031","Anthem Bronze X POS 5000","48396ME072",,"MEN002","MES006","MEF006","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720031-01","Anthem Bronze X POS 5000","Standard Bronze On Exchange Plan","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J37","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720031","Anthem Bronze X POS 5000","48396ME072",,"MEN002","MES006","MEF006","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720031-02","Anthem Bronze X POS 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J38","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","48396","SERFF","2017-04-21 20:15:32","Individual","No","31-1705652","48396ME0720031","Anthem Bronze X POS 5000","48396ME072",,"MEN002","MES006","MEF006","Existing","POS","Bronze","Not Applicable","Yes","Both","NO","NO",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720031-03","Anthem Bronze X POS 5000","Limited Cost Sharing Plan Variation","61.00%","0.62825733423233","Yes","Yes","No","100%",,"$5,000","$100","$800","$0","$3,300","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group",,,,"$21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","35%",,,,,"$15000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J37","http://editiondigital.net/view/IU65/2017/ON_HIX_ME_KIT_N_2017"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","Individual","Yes","01-0286541","50165ME0160001","Delta Dental Family High Plan","50165ME016","7447253908","MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.8943","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0160001-00","Delta Dental Family High Plan","Standard High Off Exchange Plan","85.42%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocme2017a.pdf"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","01-0286541","50165ME0200001","Delta Dental PPO Family High Plan","50165ME020","7447253908","MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9961","Guaranteed Rate","2017-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","50165ME0200001-01","Delta Dental PPO Family High Plan","Standard High On Exchange Plan","85.42%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20175.pdf"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","01-0286541","50165ME0200002","Delta Dental PPO Family High  Plan","50165ME020","7447253908","MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.8943","Guaranteed Rate","2017-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","50165ME0200002-00","Delta Dental PPO Family High  Plan","Standard High Off Exchange Plan","85.42%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocme2017c.pdf"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","Individual","Yes","01-0286541","50165ME0160001","Delta Dental Family High Plan","50165ME016","7447253908","MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.8943","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0160001-01","Delta Dental Family High Plan","Standard High On Exchange Plan","85.42%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20171.pdf"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","01-0286541","50165ME0210002","Delta Dental PPO Family Low  Plan","50165ME021","7447253908","MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9961","Guaranteed Rate","2017-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","50165ME0210002-00","Delta Dental PPO Family Low  Plan","Standard Low Off Exchange Plan","71.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocme2017d.pdf"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","Individual","Yes","01-0286541","50165ME0170001","Delta Dental Family Low Plan","50165ME017","7447253908","MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9961","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0170001-01","Delta Dental Family Low Plan","Standard Low On Exchange Plan","71.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20172.pdf"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","Individual","Yes","01-0286541","50165ME0180001","Delta Dental Pediatric High Plan","50165ME018","7447253908","MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"0.9961","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0180001-01","Delta Dental Pediatric High Plan","Standard High On Exchange Plan","85.42%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20173.pdf"
"2017","ME","50165","SERFF","2016-08-19 03:49:17","Individual","Yes","01-0286541","50165ME0190001","Delta Dental Pediatric Low Plan","50165ME019","7447253908","MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"0.9961","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0190001-01","Delta Dental Pediatric Low Plan","Standard Low On Exchange Plan","71.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","per group not applicable",,,,,,"$150","per person not applicable","per group not applicable","$150","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20174.pdf"
"2017","ME","70024","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","36-0883760","70024ME0040002","EHB High PPO","70024ME004",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70024ME0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","ME","70024","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","36-0883760","70024ME0040001","EHB Low PPO","70024ME004",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70024ME0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","ME","70024","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","36-0883760","70024ME0030002","EHB High Passive","70024ME003",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70024ME0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","ME","70024","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","36-0883760","70024ME0030001","EHB Low Passive","70024ME003",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70024ME0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","ME","76302","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","76302ME0020003","Renaissance Individual Dental PPO, EHB Certified","76302ME002",,"MEN001","MES001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","76302ME0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","ME","76302","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","76302ME0020004","Renaissance Individual Dental PPO, EHB Certified","76302ME002",,"MEN001","MES001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","76302ME0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","ME","76302","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","76302ME0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","76302ME004",,"MEN001","MES001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/76302","","76302ME0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/ME_EHB_High_2017","http://www.renaissancedental.com/ME_EHB_High_2017"
"2017","ME","76302","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","76302ME0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","76302ME004",,"MEN001","MES001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/76302","","76302ME0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/ME_EHB_Low_2017","http://www.renaissancedental.com/ME_EHB_Low_2017"
"2017","ME","76302","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","76302ME0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","76302ME006",,"MEN001","MES001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","76302ME0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","ME","76302","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","76302ME0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","76302ME006",,"MEN001","MES001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","76302ME0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","ME","76302","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","76302ME0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","76302ME005",,"MEN001","MES001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/76302","","76302ME0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/ME_Ped_High_2017","http://www.renaissancedental.com/ME_Ped_High_2017"
"2017","ME","76302","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","76302ME0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","76302ME005",,"MEN001","MES001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/76302","","76302ME0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/ME_Ped_Low_2017","http://www.renaissancedental.com/ME_Ped_Low_2017"
"2017","ME","78496","SERFF","2016-08-18 04:06:30","SHOP (Small Group)","Yes","57-0523959","78496ME0020001","Group Dental Policy","78496ME002",,"MEN001","MES001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","78496ME0020001-00","Group Dental Policy","Standard High Off Exchange Plan","86.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","ME","86432","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","86432ME0040002","EHB High PPO","86432ME004",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","86432ME0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240014","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240014-02","Silver HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/22_sbc_PD0000005329_MD0000004316.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004316"
"2017","ME","86432","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","86432ME0040001","EHB Low PPO","86432ME004",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","86432ME0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","ME","86432","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","86432ME0030002","EHB High Passive","86432ME003",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","86432ME0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","ME","86432","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","86432ME0030001","EHB Low Passive","86432ME003",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","86432ME0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250042","Maine Difference HMO 1000","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250042-00","Maine Difference HMO 1000","Standard Gold Off Exchange Plan","80.48%","0.798839032649994","No","Yes","No","100%",,"$1,000","$10","$660","$150","$140","$1,450","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/1_sbc_PD0000005198_MD0000004232.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004232"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240010","Gold HMO 1000","96667ME024",,"MEN001","MES001","MEF002","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240010-00","Gold HMO 1000","Standard Gold Off Exchange Plan","78.92%","0.787669479846954","Yes","Yes","No","100%",,"$1,000","$20","$660","$150","$140","$2,760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/1_sbc_PD0000005279_MD0000004293.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004293"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240010","Gold HMO 1000","96667ME024",,"MEN001","MES001","MEF002","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240010-01","Gold HMO 1000","Standard Gold On Exchange Plan","78.92%","0.787669479846954","Yes","Yes","No","100%",,"$1,000","$20","$660","$150","$140","$2,760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/1_sbc_PD0000005279_MD0000004293.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004293"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250042","Maine Difference HMO 1000","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250042-01","Maine Difference HMO 1000","Standard Gold On Exchange Plan","80.48%","0.798839032649994","No","Yes","No","100%",,"$1,000","$10","$660","$150","$140","$1,450","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/1_sbc_PD0000005198_MD0000004232.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004232"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250044","Maine Difference HMO 1500","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250044-00","Maine Difference HMO 1500","Standard Gold Off Exchange Plan","78.68%","0.78160172700882","No","Yes","No","100%",,"$1,500","$10","$560","$150","$140","$1,450","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/2_sbc_PD0000005201_MD0000004233.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004233"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240010","Gold HMO 1000","96667ME024",,"MEN001","MES001","MEF002","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240010-02","Gold HMO 1000","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/22_sbc_PD0000005329_MD0000004316.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004316"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240010","Gold HMO 1000","96667ME024",,"MEN001","MES001","MEF002","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240010-03","Gold HMO 1000","Limited Cost Sharing Plan Variation","78.92%","0.787669479846954","Yes","Yes","No","100%",,"$1,000","$20","$660","$150","$140","$2,760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/1_sbc_PD0000005279_MD0000004293.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004293"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250044","Maine Difference HMO 1500","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250044-01","Maine Difference HMO 1500","Standard Gold On Exchange Plan","78.68%","0.78160172700882","No","Yes","No","100%",,"$1,500","$10","$560","$150","$140","$1,450","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/2_sbc_PD0000005201_MD0000004233.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004233"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250046","Maine Difference HMO 2600","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250046-00","Maine Difference HMO 2600","Standard Silver Off Exchange Plan","71.95%","0.714162647724152","No","Yes","No","100%",,"$2,600","$10","$520","$150","$140","$1,550","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/3_sbc_PD0000005204_MD0000004234.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004234"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250046","Maine Difference HMO 2600","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250046-01","Maine Difference HMO 2600","Standard Silver On Exchange Plan","71.95%","0.714162647724152","No","Yes","No","100%",,"$2,600","$10","$520","$150","$140","$1,550","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/3_sbc_PD0000005204_MD0000004234.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004234"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0270018","Maine's Choice Best Buy HSA HMO 2800","96667ME027",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0270018-00","Maine's Choice Best Buy HSA HMO 2800","Standard Silver Off Exchange Plan","69.02%","0.690320014953613","Yes","Yes","Yes","70%","30%","$2,800","$10","$450","$150","$2,800","$620","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","10.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/27_sbc_PD0000005256_MD0000004279.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004279"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240012","Bronze HMO 6000","96667ME024",,"MEN001","MES001","MEF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240012-00","Bronze HMO 6000","Standard Bronze Off Exchange Plan",,"0.614998459815979","Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/2_sbc_PD0000005283_MD0000004294.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004294"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0270018","Maine's Choice Best Buy HSA HMO 2800","96667ME027",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0270018-01","Maine's Choice Best Buy HSA HMO 2800","Standard Silver On Exchange Plan","69.02%","0.690320014953613","Yes","Yes","Yes","70%","30%","$2,800","$10","$450","$150","$2,800","$620","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","10.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/27_sbc_PD0000005256_MD0000004279.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004279"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240012","Bronze HMO 6000","96667ME024",,"MEN001","MES001","MEF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240012-02","Bronze HMO 6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/22_sbc_PD0000005329_MD0000004316.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004316"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240012","Bronze HMO 6000","96667ME024",,"MEN001","MES001","MEF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240012-03","Bronze HMO 6000","Limited Cost Sharing Plan Variation",,"0.614998459815979","Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/2_sbc_PD0000005283_MD0000004294.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004294"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240014","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240014-00","Silver HMO","Standard Silver Off Exchange Plan","70.70%","0","Yes","Yes","No","100%",,"$2,000","$20","$700","$150","$140","$2,810","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/3_sbc_PD0000005287_MD0000004295.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004295"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0270012","Maine's Choice HMO 1250","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0270012-00","Maine's Choice HMO 1250","Standard Gold Off Exchange Plan","79.35%","0.794811189174652","No","Yes","Yes","70%","30%","$1,250","$10","$610","$150","$140","$1,400","$0","$80","$0","$0","$0","$0","$500","0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/24-sbc_PD0000005247_MD0000004251.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004251"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0270012","Maine's Choice HMO 1250","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0270012-01","Maine's Choice HMO 1250","Standard Gold On Exchange Plan","79.35%","0.794811189174652","No","Yes","Yes","70%","30%","$1,250","$10","$610","$150","$140","$1,400","$0","$80","$0","$0","$0","$0","$500","0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/24-sbc_PD0000005247_MD0000004251.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004251"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240014","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240014-01","Silver HMO","Standard Silver On Exchange Plan","70.70%","0","Yes","Yes","No","100%",,"$2,000","$20","$700","$150","$140","$2,810","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/3_sbc_PD0000005287_MD0000004295.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004295"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0270014","Maine's Choice HMO 2000","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0270014-00","Maine's Choice HMO 2000","Standard Silver Off Exchange Plan","71.89%","0.718351423740387","No","Yes","Yes","70%","30%","$2,000","$10","$460","$150","$140","$1,550","$0","$80","$0","$0","$0","$0","$500","0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/24-sbc_PD0000005247_MD0000004251.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004251"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0270014","Maine's Choice HMO 2000","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0270014-01","Maine's Choice HMO 2000","Standard Silver On Exchange Plan","71.89%","0.718351423740387","No","Yes","Yes","70%","30%","$2,000","$10","$460","$150","$140","$1,550","$0","$80","$0","$0","$0","$0","$500","0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/24-sbc_PD0000005247_MD0000004251.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004251"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240014","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240014-03","Silver HMO","Limited Cost Sharing Plan Variation","70.70%","0","Yes","Yes","No","100%",,"$2,000","$20","$700","$150","$140","$2,810","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/3_sbc_PD0000005287_MD0000004295.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004295"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240014","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240014-04","Silver HMO","73% AV Level Silver Plan","72.91%","0","Yes","Yes","No","100%",,"$2,000","$20","$700","$150","$90","$2,640","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/12_sbc_PD0000005292_MD0000004298.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004298"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0270016","Maine's Choice HMO 3500","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0270016-00","Maine's Choice HMO 3500","Standard Silver Off Exchange Plan","69.98%","0.694300711154938","No","Yes","Yes","70%","30%","$3,500","$10","$160","$150","$140","$1,550","$0","$80","$0","$0","$0","$0","$500","0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/26_sbc_PD0000005253_MD0000004278.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004278"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0270016","Maine's Choice HMO 3500","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0270016-01","Maine's Choice HMO 3500","Standard Silver On Exchange Plan","69.98%","0.694300711154938","No","Yes","Yes","70%","30%","$3,500","$10","$160","$150","$140","$1,550","$0","$80","$0","$0","$0","$0","$500","0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/26_sbc_PD0000005253_MD0000004278.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004278"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240014","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240014-05","Silver HMO","87% AV Level Silver Plan","86.07%","0","Yes","Yes","No","100%",,"$600","$20","$740","$150","$140","$1,860","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/10_sbc_PD0000005290_MD0000004296.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004296"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240014","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240014-06","Silver HMO","94% AV Level Silver Plan","93.19%","0","Yes","Yes","No","100%",,"$300","$20","$400","$150","$90","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/11_sbc_PD0000005291_MD0000004297.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004297"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260010","Maine's Choice Gold HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260010-00","Maine's Choice Gold HMO","Standard Gold Off Exchange Plan",,"0.803594350814819","Yes","Yes","Yes","70%","30%","$750","$20","$360","$150","$140","$2,610","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%","$2,000","$2000 per person","$4000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/4_sbc_PD0000005294_MD0000004299.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004299"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260012","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260012-06","Maine's Choice Casco Silver HMO","94% AV Level Silver Plan",,"0.933376789093018","Yes","Yes","Yes","70%","30%","$200","$0","$300","$150","$90","$410","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15.00%","$500","$500 per person","$1000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/13_sbc_PD0000005301_MD0000004301.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004301"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350006-06","Blue Cross® Premier PPO Silver Saver","94% AV Level Silver Plan","93.55%","0.937799334526062","Yes","Yes","No","100%",,"$350","$50","$200","$150","$350","$180","$70","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%",,,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-saver.html?costshare=94"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier PPO Gold","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350004-00","Blue Cross® Premier PPO Gold","Standard Gold Off Exchange Plan","81.34%","0.821592390537262","Yes","Yes","No","100%",,"$250","$50","$1,100","$150","$250","$900","$800","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/premier-ppo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier PPO Gold","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350004-01","Blue Cross® Premier PPO Gold","Standard Gold On Exchange Plan","81.34%","0.821592390537262","Yes","Yes","No","100%",,"$250","$50","$1,100","$150","$250","$900","$800","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/premier-ppo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier PPO Gold","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350004-02","Blue Cross® Premier PPO Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-gold-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier PPO Gold","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350004-03","Blue Cross® Premier PPO Gold","Limited Cost Sharing Plan Variation","81.34%","0.821592390537262","Yes","Yes","No","100%",,"$250","$50","$1,100","$150","$250","$900","$800","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-gold-na-more-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1120001","Blue Cross® Premier PPO Bronze Extra","15560MI112","7538162760","MIN006","MIS001","MIF055","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1120001-00","Blue Cross® Premier PPO Bronze Extra","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,155","$65","$0","$150","$1,950","$1,530","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/premier-ppo-extra.html"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250056","Best Buy HSA HMO 3000","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250056-00","Best Buy HSA HMO 3000","Standard Silver Off Exchange Plan","69.04%","0.692021310329437","Yes","Yes","No","100%",,"$3,000","$10","$430","$150","$3,000","$580","$30","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/7_sbc_PD0000005213_MD0000004237.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004237"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250056","Best Buy HSA HMO 3000","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250056-01","Best Buy HSA HMO 3000","Standard Silver On Exchange Plan","69.04%","0.692021310329437","Yes","Yes","No","100%",,"$3,000","$10","$430","$150","$3,000","$580","$30","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/7_sbc_PD0000005213_MD0000004237.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004237"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260010","Maine's Choice Gold HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260010-01","Maine's Choice Gold HMO","Standard Gold On Exchange Plan",,"0.803594350814819","Yes","Yes","Yes","70%","30%","$750","$20","$360","$150","$140","$2,610","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%","$2,000","$2000 per person","$4000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/4_sbc_PD0000005294_MD0000004299.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004299"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260010","Maine's Choice Gold HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260010-02","Maine's Choice Gold HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/23_sbc_PD0000005333_MD0000004317.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004317"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250060","Best Buy HSA HMO 5300","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250060-00","Best Buy HSA HMO 5300","Standard Bronze Off Exchange Plan","61.96%","0.618216753005981","Yes","Yes","No","100%",,"$4,350","$0","$1,470","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/10_sbc_PD0000005219_MD0000004239.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004239"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250060","Best Buy HSA HMO 5300","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250060-01","Best Buy HSA HMO 5300","Standard Bronze On Exchange Plan","61.96%","0.618216753005981","Yes","Yes","No","100%",,"$4,350","$0","$1,470","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/10_sbc_PD0000005219_MD0000004239.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004239"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260010","Maine's Choice Gold HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260010-03","Maine's Choice Gold HMO","Limited Cost Sharing Plan Variation",,"0.803594350814819","Yes","Yes","Yes","70%","30%","$750","$20","$360","$150","$140","$2,610","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%","$2,000","$2000 per person","$4000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/4_sbc_PD0000005294_MD0000004299.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004299"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250062","Best Buy HSA HMO 6250","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250062-00","Best Buy HSA HMO 6250","Standard Bronze Off Exchange Plan","61.69%","0.614933371543884","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/11_sbc_PD0000005221_MD0000004240.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004240"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2452600","96667ME0250062","Best Buy HSA HMO 6250","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998098054032903",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","96667ME0250062-01","Best Buy HSA HMO 6250","Standard Bronze On Exchange Plan","61.69%","0.614933371543884","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20SMALL%20GROUP/ME%20SMALL%20GROUP/11_sbc_PD0000005221_MD0000004240.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004240"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260012","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260012-00","Maine's Choice Casco Silver HMO","Standard Silver Off Exchange Plan",,"0.719295501708984","Yes","Yes","Yes","70%","30%","$1,700","$20","$790","$150","$140","$2,710","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13200 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30.00%","$4,750","$4750 per person","$9500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/5_sbc_PD0000005298_MD0000004300.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004300"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260012","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260012-01","Maine's Choice Casco Silver HMO","Standard Silver On Exchange Plan",,"0.719295501708984","Yes","Yes","Yes","70%","30%","$1,700","$20","$790","$150","$140","$2,710","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13200 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30.00%","$4,750","$4750 per person","$9500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/5_sbc_PD0000005298_MD0000004300.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004300"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260012","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260012-02","Maine's Choice Casco Silver HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/23_sbc_PD0000005333_MD0000004317.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004317"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260012","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260012-03","Maine's Choice Casco Silver HMO","Limited Cost Sharing Plan Variation",,"0.719295501708984","Yes","Yes","Yes","70%","30%","$1,700","$20","$790","$150","$140","$2,710","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13200 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30.00%","$4,750","$4750 per person","$9500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/5_sbc_PD0000005298_MD0000004300.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004300"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260012","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260012-04","Maine's Choice Casco Silver HMO","73% AV Level Silver Plan",,"0.739708065986633","Yes","Yes","Yes","70%","30%","$1,700","$20","$90","$150","$90","$2,590","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30.00%","$4,750","$4750 per person","$9500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/15_sbc_PD0000005303_MD0000004303.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004303"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260012","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260012-05","Maine's Choice Casco Silver HMO","87% AV Level Silver Plan",,"0.873415410518646","Yes","Yes","Yes","70%","30%","$500","$20","$420","$150","$90","$1,110","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%","$1,200","$1200 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/14_sbc_PD0000005302_MD0000004302.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004302"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260014","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260014-00","Maine's Choice Sebago Silver HMO","Standard Silver Off Exchange Plan",,"0.711875677108765","Yes","Yes","Yes","70%","30%","$2,500","$20","$360","$150","$140","$2,710","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%","$5,400","$5400 per person","$10800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/6_sbc_PD0000005305_MD0000004304.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004304"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260014","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260014-01","Maine's Choice Sebago Silver HMO","Standard Silver On Exchange Plan",,"0.711875677108765","Yes","Yes","Yes","70%","30%","$2,500","$20","$360","$150","$140","$2,710","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%","$5,400","$5400 per person","$10800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/6_sbc_PD0000005305_MD0000004304.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004304"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260014","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260014-02","Maine's Choice Sebago Silver HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/23_sbc_PD0000005333_MD0000004317.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004317"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260014","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260014-03","Maine's Choice Sebago Silver HMO","Limited Cost Sharing Plan Variation",,"0.711875677108765","Yes","Yes","Yes","70%","30%","$2,500","$20","$360","$150","$140","$2,710","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%","$5,400","$5400 per person","$10800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/6_sbc_PD0000005305_MD0000004304.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004304"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260014","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260014-04","Maine's Choice Sebago Silver HMO","73% AV Level Silver Plan",,"0.733417510986328","Yes","Yes","Yes","70%","30%","$1,610","$20","$160","$150","$90","$2,560","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%","$5,400","$5400 per person","$10800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/18_sbc_PD0000005310_MD0000004307.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004307"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260014","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260014-05","Maine's Choice Sebago Silver HMO","87% AV Level Silver Plan",,"0.874875724315643","Yes","Yes","Yes","70%","30%","$600","$20","$180","$150","$90","$1,110","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%","$1,200","$1200 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/17_sbc_PD0000005309_MD0000004306.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004306"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260014","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260014-06","Maine's Choice Sebago Silver HMO","94% AV Level Silver Plan",,"0.930274307727814","Yes","Yes","Yes","70%","30%","$250","$0","$250","$150","$90","$410","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/16_sbc_PD0000005308_MD0000004305.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004305"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260016","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260016-00","Maine's Choice Pemaquid Silver HMO","Standard Silver Off Exchange Plan",,"0.688273370265961","Yes","Yes","Yes","70%","30%","$4,000","$20","$60","$150","$140","$2,760","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%","$6,250","$6250 per person","$12500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/7_sbc_PD0000005312_MD0000004308.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004308"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260016","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260016-01","Maine's Choice Pemaquid Silver HMO","Standard Silver On Exchange Plan",,"0.688273370265961","Yes","Yes","Yes","70%","30%","$4,000","$20","$60","$150","$140","$2,760","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%","$6,250","$6250 per person","$12500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/7_sbc_PD0000005312_MD0000004308.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004308"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260016","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260016-02","Maine's Choice Pemaquid Silver HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/23_sbc_PD0000005333_MD0000004317.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004317"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260016","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260016-03","Maine's Choice Pemaquid Silver HMO","Limited Cost Sharing Plan Variation",,"0.688273370265961","Yes","Yes","Yes","70%","30%","$4,000","$20","$60","$150","$140","$2,760","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%","$6,250","$6250 per person","$12500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/7_sbc_PD0000005312_MD0000004308.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004308"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260016","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260016-04","Maine's Choice Pemaquid Silver HMO","73% AV Level Silver Plan",,"0.725142002105713","Yes","Yes","Yes","70%","30%","$3,500","$20","$480","$150","$90","$2,640","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%","$5,000","$5000 per person","$10000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/21_sbc_PD0000005317_MD0000004311.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004311"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260016","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260016-05","Maine's Choice Pemaquid Silver HMO","87% AV Level Silver Plan",,"0.864481091499329","Yes","Yes","Yes","70%","30%","$750","$0","$650","$150","$90","$1,310","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/20_sbc_PD0000005316_MD0000004310.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004310"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0260016","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0260016-06","Maine's Choice Pemaquid Silver HMO","94% AV Level Silver Plan",,"0.930237829685211","Yes","Yes","Yes","70%","30%","$250","$0","$250","$150","$90","$410","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/19_sbc_PD0000005315_MD0000004309.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004309"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240016","Best Buy HSA HMO 5400","96667ME024",,"MEN001","MES001","MEF005","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240016-00","Best Buy HSA HMO 5400","Standard Bronze Off Exchange Plan",,"0.618122160434723","Yes","Yes","No","100%",,"$4,350","$0","$880","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/8_sbc_PD0000005319_MD0000004312.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004312"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240016","Best Buy HSA HMO 5400","96667ME024",,"MEN001","MES001","MEF005","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240016-01","Best Buy HSA HMO 5400","Standard Bronze On Exchange Plan",,"0.618122160434723","Yes","Yes","No","100%",,"$4,350","$0","$880","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/8_sbc_PD0000005319_MD0000004312.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004312"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240016","Best Buy HSA HMO 5400","96667ME024",,"MEN001","MES001","MEF005","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240016-02","Best Buy HSA HMO 5400","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/22_sbc_PD0000005329_MD0000004316.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004316"
"2017","ME","96667","SERFF","2017-04-20 20:15:32","Individual","No","04-2452600","96667ME0240016","Best Buy HSA HMO 5400","96667ME024",,"MEN001","MES001","MEF005","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998916015890984",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","96667ME0240016-03","Best Buy HSA HMO 5400","Limited Cost Sharing Plan Variation",,"0.618122160434723","Yes","Yes","No","100%",,"$4,350","$0","$880","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20ME%20INDIVIDUAL/ME%20INDIVIDUAL/8_sbc_PD0000005319_MD0000004312.pdf","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004312"
"2017","MI","11083","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5581829","11083MI0100001","EHB Basic Dental Plan (Low)","11083MI010",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0100001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$200","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","11083","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5581829","11083MI0120001","Family Basic Dental Plan (Low)","11083MI012",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.82","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0120001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49089"
"2017","MI","11083","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5581829","11083MI0120001","Family Basic Dental Plan (Low)","11083MI012",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.82","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0120001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49089"
"2017","MI","11083","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5581829","11083MI0130001","Family Enhanced Dental Plan (High)","11083MI013",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.81","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0130001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49091"
"2017","MI","11083","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5581829","11083MI0130001","Family Enhanced Dental Plan (High)","11083MI013",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.81","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0130001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49091"
"2017","MI","12858","SERFF","2016-08-19 03:49:17","Individual","Yes","36-3757528","12858MI0010001","TruAssure Basic Adult or Child Dental Plan","12858MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$110","$110 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI"
"2017","MI","12858","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","36-3757528","12858MI0030001","TruAssure Dental Small Group Basic Plan","12858MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12858MI0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","12858","SERFF","2016-08-19 03:49:17","Individual","Yes","36-3757528","12858MI0010001","TruAssure Basic Adult or Child Dental Plan","12858MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$110","$110 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI"
"2017","MI","12858","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","36-3757528","12858MI0040001","TruAssure Dental Small Group Preferred Plan","12858MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12858MI0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","12858","SERFF","2016-08-19 03:49:17","Individual","Yes","36-3757528","12858MI0020001","TruAssure Preferred Adult or Child Dental Plan","12858MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI"
"2017","MI","12858","SERFF","2016-08-19 03:49:17","Individual","Yes","36-3757528","12858MI0020001","TruAssure Preferred Adult or Child Dental Plan","12858MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0720001","Blue Dental PPO Standard","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0720001-00","Blue Dental PPO Standard","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/ppo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0430001","Blue Dental PPO Plus 100/80/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9573","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430001-00","Blue Dental PPO Plus 100/80/50/50 SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1500-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350001","Blue Cross® Premier PPO Value","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350001-00","Blue Cross® Premier PPO Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$30","$0","$150","$4,820","$90","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/catastrophic/premier-ppo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350001","Blue Cross® Premier PPO Value","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350001-01","Blue Cross® Premier PPO Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$30","$0","$150","$4,820","$90","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/catastrophic/premier-ppo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0430002","Blue Dental PPO Plus 100/80/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9681","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430002-00","Blue Dental PPO Plus 100/80/50/50 SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1000-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0720001","Blue Dental PPO Standard","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0720001-01","Blue Dental PPO Standard","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/ppo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0710001","Blue Dental PPO Plus Standard","15560MI071","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0710001-00","Blue Dental PPO Plus Standard","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/ppo-plus.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier PPO Bronze HSA","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350002-00","Blue Cross® Premier PPO Bronze HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/premier-ppo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0450001","Blue Dental PPO 100/80/50/50 (80/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9535","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450001-00","Blue Dental PPO 100/80/50/50 (80/50/50/50) SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-50-1250-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier PPO Bronze HSA","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350002-01","Blue Cross® Premier PPO Bronze HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/premier-ppo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Well-Being","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0900002-05","Blue Cross® Metro Detroit EPO Silver Well-Being","87% AV Level Silver Plan","87.24%","0.879567682743073","Yes","Yes","No","100%",,"$700","$30","$510","$150","$700","$640","$380","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-epo-well-being.html?costshare=87"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0690001","Blue Dental EPO 100/80/50/50 Voluntary SG","15560MI069","7538162760","MIN003","MIS003",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9765","Guaranteed Rate","2017-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0690001-00","Blue Dental EPO 100/80/50/50 Voluntary SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-epo-100-80-50-50-1250-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Well-Being","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0900002-06","Blue Cross® Metro Detroit EPO Silver Well-Being","94% AV Level Silver Plan","93.51%","0.938070833683014","Yes","Yes","No","100%",,"$300","$30","$370","$150","$300","$170","$230","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-epo-well-being.html?costshare=94"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0710001","Blue Dental PPO Plus Standard","15560MI071","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0710001-01","Blue Dental PPO Plus Standard","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/ppo-plus.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0450002","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9412","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450002-00","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-50-1500-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0450003","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.957","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450003-00","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-50-1000-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0730001","Blue Dental EPO Standard","15560MI073","7538162760","MIN003","MIS003",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","No",,"Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0730001-00","Blue Dental EPO Standard","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/epo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier PPO Bronze HSA","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350002-02","Blue Cross® Premier PPO Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier PPO Bronze HSA","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350002-03","Blue Cross® Premier PPO Bronze","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-na-more-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0730001","Blue Dental EPO Standard","15560MI073","7538162760","MIN003","MIS003",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","No",,"Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0730001-01","Blue Dental EPO Standard","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/epo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0450004","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9506","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450004-00","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-80-50-50-50-1000-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0450005","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$800 annual benefit maximum for members age 19 or older when coverage begins. $800 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9591","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450005-00","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-80-50-50-50-800-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier PPO Bronze Saver","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350005-00","Blue Cross® Premier PPO Bronze Saver","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/premier-ppo-saver.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0720002","Blue Dental PPO Extra","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $1,000 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0720002-00","Blue Dental PPO Extra","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/ppo-extra.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0720002","Blue Dental PPO Extra","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $1,000 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0720002-01","Blue Dental PPO Extra","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/ppo-extra.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier PPO Bronze Saver","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350005-01","Blue Cross® Premier PPO Bronze Saver","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/premier-ppo-saver.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0470001","Blue Dental EPO 100/80/50/50 SG","15560MI047","7538162760","MIN003","MIS003",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.956","Guaranteed Rate","2017-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0470001-00","Blue Dental EPO 100/80/50/50 SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-epo-100-80-50-50-1250-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0430005","Blue Dental  PPO Plus  80/50/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9587","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430005-00","Blue Dental  PPO Plus  80/50/50/50 SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-80-50-50-50-1000-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier PPO Bronze Saver","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350005-02","Blue Cross® Premier PPO Bronze Saver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-saver-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier PPO Bronze Saver","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350005-03","Blue Cross® Premier PPO Bronze Saver","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-saver-na-more-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350003-00","Blue Cross® Premier PPO Silver","Standard Silver Off Exchange Plan","70.25%","0.707568228244781","Yes","Yes","No","100%",,"$1,800","$50","$790","$150","$1,800","$610","$540","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo.html?costshare=70"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350003-01","Blue Cross® Premier PPO Silver","Standard Silver On Exchange Plan","70.25%","0.707568228244781","Yes","Yes","No","100%",,"$1,800","$50","$790","$150","$1,800","$610","$540","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo.html?costshare=70"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350003-02","Blue Cross® Premier PPO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350003-03","Blue Cross® Premier PPO Silver","Limited Cost Sharing Plan Variation","70.25%","0.707568228244781","Yes","Yes","No","100%",,"$1,800","$50","$790","$150","$1,800","$610","$540","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-na-more-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350003-04","Blue Cross® Premier PPO Silver","73% AV Level Silver Plan","72.95%","0.734884262084961","Yes","Yes","No","100%",,"$1,500","$50","$850","$150","$1,500","$650","$600","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo.html?costshare=73"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350003-05","Blue Cross® Premier PPO Silver","87% AV Level Silver Plan","87.13%","0.874952256679535","Yes","Yes","No","100%",,"$500","$50","$530","$150","$500","$870","$330","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo.html?costshare=87"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350003-06","Blue Cross® Premier PPO Silver","94% AV Level Silver Plan","94.84%","0.950826168060303","Yes","Yes","No","100%",,"$175","$30","$295","$150","$175","$280","$40","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10.00%",,,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo.html?costshare=94"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350006-00","Blue Cross® Premier PPO Silver Saver HSA","Standard Silver Off Exchange Plan","68.30%","0.682976841926575","Yes","Yes","No","100%",,"$4,000","$50","$350","$150","$4,000","$140","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-saver.html?costshare=70"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350006-01","Blue Cross® Premier PPO Silver Saver HSA","Standard Silver On Exchange Plan","68.30%","0.682976841926575","Yes","Yes","No","100%",,"$4,000","$50","$350","$150","$4,000","$140","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-saver.html?costshare=70"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350006-02","Blue Cross® Premier PPO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350006-03","Blue Cross® Premier PPO Silver Saver","Limited Cost Sharing Plan Variation","68.30%","0.682976841926575","Yes","Yes","No","100%",,"$4,000","$50","$350","$150","$4,000","$140","$200","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-na-more-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350006-04","Blue Cross® Premier PPO Silver Saver HSA","73% AV Level Silver Plan","73.17%","0.733644902706146","Yes","Yes","No","100%",,"$2,700","$50","$610","$150","$2,700","$60","$470","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-saver.html?costshare=73"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0350006-05","Blue Cross® Premier PPO Silver Saver","87% AV Level Silver Plan","86.90%","0.872010171413422","Yes","Yes","No","100%",,"$800","$50","$550","$150","$800","$150","$420","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-saver.html?costshare=87"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0740001","Blue Dental PPO Pediatric","15560MI074","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0740001-00","Blue Dental PPO Pediatric","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/ppo-pediatric.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0420001","Blue Dental PPO Plus 100/80/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420001-00","Blue Dental PPO Plus 100/80/50 SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-100-80-50-1500-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","38-2069753","15560MI0370015","Simply Blue PPO Gold $1500","15560MI037",,"MIN001","MIS001","MIF009","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management","1",,,"2017-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/druglists","15560MI0370015-01","Simply Blue PPO Gold $1500","Standard Gold On Exchange Plan","81.01%","0.765942573547363","No","Yes","No","100%",,"$1,500","$20","$730","$150","$1,500","$680","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/simply-blue-gold-370015.pdf","http://www.bcbsm.com/employers/products-services/health-insurance-plans.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0670003","Blue Dental PPO 80/50/50/50 (50/50/50/50)  Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9729","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670003-00","Blue Dental PPO 80/50/50/50 (50/50/50/50)  Voluntary SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-80-50-50-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Well-Being","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0900002-04","Blue Cross® Metro Detroit EPO Silver Well-Being","73% AV Level Silver Plan","73.69%","0.743615925312042","Yes","Yes","No","100%",,"$2,800","$40","$600","$150","$2,800","$410","$380","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-epo-well-being.html?costshare=73"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1130001-00","Blue Cross® Premier PPO Silver Extra","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$330","$150","$2,420","$600","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-extra.html?costshare=70"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","Yes","38-2069753","15560MI0740001","Blue Dental PPO Pediatric","15560MI074","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0740001-01","Blue Dental PPO Pediatric","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2017/ppo-pediatric.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0420002","Blue Dental PPO Plus 100/80/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420002-00","Blue Dental PPO Plus 100/80/50 SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-100-80-50-1000-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1120001","Blue Cross® Premier PPO Bronze Extra","15560MI112","7538162760","MIN006","MIS001","MIF055","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1120001-01","Blue Cross® Premier PPO Bronze Extra","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,155","$65","$0","$150","$1,950","$1,530","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/premier-ppo-extra.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1120001","Blue Cross® Premier PPO Bronze Extra","15560MI112","7538162760","MIN006","MIS001","MIF055","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1120001-02","Blue Cross® Premier PPO Bronze Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-extra-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1130001-06","Blue Cross® Premier PPO Silver Extra","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-extra.html?costshare=94"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","38-2069753","15560MI0390003","Simply Blue HSA PPO Silver $2700 ($0)","15560MI039",,"MIN001","MIS001","MIF021","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management","1",,,"2017-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/druglists","15560MI0390003-00","Simply Blue HSA PPO Silver $2700 ($0)","Standard Silver Off Exchange Plan","69.61%","0.694038987159729","Yes","Yes","No","100%",,"$2,700","$20","$490","$150","$2,700","$350","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/simply-blue-hsa-silver-390003.pdf","http://www.bcbsm.com/employers/products-services/health-insurance-plans.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","38-2069753","15560MI0390003","Simply Blue HSA PPO Silver $2700 ($0)","15560MI039",,"MIN001","MIS001","MIF021","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management","1",,,"2017-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/druglists","15560MI0390003-01","Simply Blue HSA PPO Silver $2700 ($0)","Standard Silver On Exchange Plan","69.61%","0.694038987159729","Yes","Yes","No","100%",,"$2,700","$20","$490","$150","$2,700","$350","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/simply-blue-hsa-silver-390003.pdf","http://www.bcbsm.com/employers/products-services/health-insurance-plans.html"
"2017","MI","26380","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","57-0523959","26380MI0020001","Group Dental Policy","26380MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","26380MI0020001-00","Group Dental Policy","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","27093","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","27093MI0010001","KCL EHB Low PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","69.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0420005","Blue Dental PPO Plus 80/50/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420005-00","Blue Dental PPO Plus 80/50/50 SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-80-50-50-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1120001","Blue Cross® Premier PPO Bronze Extra","15560MI112","7538162760","MIN006","MIS001","MIF055","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1120001-03","Blue Cross® Premier PPO Bronze Extra","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$5,155","$65","$0","$150","$1,950","$1,530","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-bronze-extra-na-more-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0440001","Blue Dental PPO 100/80/50 (80/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440001-00","Blue Dental PPO 100/80/50 (80/50/50) SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-1250-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0440002","Blue Dental PPO 100/80/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440002-00","Blue Dental PPO 100/80/50 (50/50/50) SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-1500-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0440003","Blue Dental PPO 100/80/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440003-00","Blue Dental PPO 100/80/50 (50/50/50) SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-1000-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0440004","Blue Dental PPO 80/50/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440004-00","Blue Dental PPO 80/50/50 (50/50/50) SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-80-50-50-1000-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0440005","Blue Dental PPO 80/50/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$800 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440005-00","Blue Dental PPO 80/50/50 (50/50/50) SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-80-50-50-800-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0460001","Blue Dental EPO 100/80/50 SG","15560MI046","7538162760","MIN003","MIS003",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0460001-00","Blue Dental EPO 100/80/50 SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-epo-100-80-50-1250-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0480002","Blue Dental PPO Plus 80/50/50 Pediatric SG","15560MI048","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0480002-00","Blue Dental PPO Plus 80/50/50 Pediatric SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-80-50-50-pediatric-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0890001","Blue Cross® Metro Detroit EPO Bronze HSA","15560MI089","7538162760","MIN002","MIS002","MIF051","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0890001-00","Blue Cross® Metro Detroit EPO Bronze HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/metro-detroit-epo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0890001","Blue Cross® Metro Detroit EPO Bronze HSA","15560MI089","7538162760","MIN002","MIS002","MIF051","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0890001-01","Blue Cross® Metro Detroit EPO Bronze HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/metro-detroit-epo.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0890001","Blue Cross® Metro Detroit EPO Bronze HSA","15560MI089","7538162760","MIN002","MIS002","MIF051","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0890001-02","Blue Cross® Metro Detroit EPO Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-bronze-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0890001","Blue Cross® Metro Detroit EPO Bronze HSA","15560MI089","7538162760","MIN002","MIS002","MIF051","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0890001-03","Blue Cross® Metro Detroit EPO Bronze","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,950","$0","$0","$150","$5,160","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-bronze-na-more-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0650001","Blue Dental PPO Plus 100/80/50/50 Voluntary SG","15560MI065","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9825","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0650001-00","Blue Dental PPO Plus 100/80/50/50 Voluntary SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Well-Being","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0900002-00","Blue Cross® Metro Detroit EPO Silver Well-Being","Standard Silver Off Exchange Plan","70.34%","0.708509087562561","Yes","Yes","No","100%",,"$3,500","$40","$450","$150","$3,500","$280","$270","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-epo-well-being.html?costshare=70"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Well-Being","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0900002-01","Blue Cross® Metro Detroit EPO Silver Well-Being","Standard Silver On Exchange Plan","70.34%","0.708509087562561","Yes","Yes","No","100%",,"$3,500","$40","$450","$150","$3,500","$280","$270","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-epo-well-being.html?costshare=70"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0650002","Blue Dental PPO Plus 80/50/50/50 Voluntary SG","15560MI065","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9776","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0650002-00","Blue Dental PPO Plus 80/50/50/50 Voluntary SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-80-50-50-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Well-Being","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0900002-02","Blue Cross® Metro Detroit EPO Silver Well-Being","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0670001","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9741","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670001-00","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-50-1250-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Well-Being","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,"EPO network only","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI0900002-03","Blue Cross® Metro Detroit EPO Silver Well-Being","Limited Cost Sharing Plan Variation","70.34%","0.708509087562561","Yes","Yes","No","100%",,"$3,500","$40","$450","$150","$3,500","$280","$270","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-na-more-than-300.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-epo-silver-well-being-na-more-than-300.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","38-2069753","15560MI0370015","Simply Blue PPO Gold $1500","15560MI037",,"MIN001","MIS001","MIF009","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management","1",,,"2017-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/druglists","15560MI0370015-00","Simply Blue PPO Gold $1500","Standard Gold Off Exchange Plan","81.01%","0.765942573547363","No","Yes","No","100%",,"$1,500","$20","$730","$150","$1,500","$680","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/simply-blue-gold-370015.pdf","http://www.bcbsm.com/employers/products-services/health-insurance-plans.html"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0670002","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.9791","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670002-00","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0490001","Blue Dental PPO Plus 100/80/50 Voluntary SG","15560MI049","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0490001-00","Blue Dental PPO Plus 100/80/50 Voluntary SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-100-80-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0490002","Blue Dental PPO Plus 80/50/50 Voluntary SG","15560MI049","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0490002-00","Blue Dental PPO Plus 80/50/50 Voluntary SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-80-50-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1130001-01","Blue Cross® Premier PPO Silver Extra","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$330","$150","$2,420","$600","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-extra.html?costshare=70"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1130001-02","Blue Cross® Premier PPO Silver Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-na-less-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0490002","Blue Dental PPO Plus 80/50/50 Voluntary SG","15560MI049","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0490002-01","Blue Dental PPO Plus 80/50/50 Voluntary SG","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-plus-80-50-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1130001-03","Blue Cross® Premier PPO Silver Extra","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$330","$150","$2,420","$600","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-na-more-than-300-sbc.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0660001","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660001-00","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-1250-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1130001-04","Blue Cross® Premier PPO Silver Extra","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$430","$150","$2,420","$400","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-extra.html?costshare=73"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0660002","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660002-00","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-100-80-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental injury and emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2017selectdruglistppo","15560MI1130001-05","Blue Cross® Premier PPO Silver Extra","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$890","$150","$700","$270","$170","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/premier-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/premier-ppo-extra.html?costshare=87"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0660003","Blue Dental PPO 80/50/50 (50/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660003-00","Blue Dental PPO 80/50/50 (50/50/50) Voluntary SG","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-ppo-80-50-50-1000-v-sg.pdf"
"2017","MI","15560","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","Yes","38-2069753","15560MI0680001","Blue Dental EPO 100/80/50 Voluntary SG","15560MI068","7538162760","MIN003","MIS003",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0680001-00","Blue Dental EPO 100/80/50 Voluntary SG","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2017-employer/brochures/blue-dental-epo-100-80-50-1250-v-sg.pdf"
"2017","MI","27093","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","27093MI0010003","KCL EHB Low PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010003-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","69.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","27093","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","27093MI0010005","KCL EHB Low PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010005-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","69.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","27093","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","27093MI0010007","KCL EHB Low PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010007-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","69.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","27093","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","27093MI0010002","KCL EHB High PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","27093","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","27093MI0010004","KCL EHB High PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010004-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","27093","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","27093MI0010006","KCL EHB High PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010006-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540018-05","MyPriority RxPlus - Spectrum Health Partners","87% AV Level Silver Plan","87.47%","0.878929436206818","Yes","Yes","No","100%",,"$300","$0","$1,300","$150","$300","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$600 per person","$600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/A74F5F28229249A99D8090C3E2B41645.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540018-06","MyPriority RxPlus - Spectrum Health Partners","94% AV Level Silver Plan","94.54%","0.948858916759491","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$250","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/60E0E9851CE64C5D8E749668CDFFDC24.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540032","MyPriority RxPlus - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540032-00","MyPriority RxPlus - Bronson Healthcare Partners","Standard Silver Off Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/32794019A58F4FCFA45B9C9FA8D42332.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540032","MyPriority RxPlus - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540032-01","MyPriority RxPlus - Bronson Healthcare Partners","Standard Silver On Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/32794019A58F4FCFA45B9C9FA8D42332.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540032","MyPriority RxPlus - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540032-02","MyPriority RxPlus - Bronson Healthcare Partners","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EDE1727201094D52B7DE997755A46B19.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","27093","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","27093MI0010008","KCL EHB High PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010008-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540039","MyPriority HMO Federal Standard Silver 3500","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540039-00","MyPriority HMO Federal Standard Silver 3500","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$150","$3,500","$200","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E815622DB73E4E45AAEFC26BBCEA8153.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-federal-silver-3500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540039","MyPriority HMO Federal Standard Silver 3500","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540039-01","MyPriority HMO Federal Standard Silver 3500","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$150","$3,500","$200","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E815622DB73E4E45AAEFC26BBCEA8153.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-federal-silver-3500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540039","MyPriority HMO Federal Standard Silver 3500","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540039-02","MyPriority HMO Federal Standard Silver 3500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-federal-silver-3500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540039","MyPriority HMO Federal Standard Silver 3500","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540039-03","MyPriority HMO Federal Standard Silver 3500","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$150","$3,500","$200","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/FEE65CDE5FD7438A9E7FACD3B737D103.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-federal-silver-3500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540039","MyPriority HMO Federal Standard Silver 3500","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540039-04","MyPriority HMO Federal Standard Silver 3500","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$430","$150","$3,000","$320","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E61B66FCA2434C03AD7BAE0023C5B279.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-federal-silver-3500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540039","MyPriority HMO Federal Standard Silver 3500","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540039-05","MyPriority HMO Federal Standard Silver 3500","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$890","$150","$700","$280","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/D5A6F02B514944F68B3165A20752EF75.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-federal-silver-3500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540039","MyPriority HMO Federal Standard Silver 3500","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540039-06","MyPriority HMO Federal Standard Silver 3500","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$980","$150","$250","$170","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/8DD2498E786B4C72A06292C8F5241E44.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-federal-silver-3500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540001-00","MyPriority HMO RxPlus Silver 1900","Standard Silver Off Exchange Plan","71.42%","0.721578121185303","No","Yes","No","100%",,"$1,900","$20","$980","$150","$1,900","$400","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/-/media/97DA2BB22A6445D680C03A439C9E9D8A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1900?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540001-01","MyPriority HMO RxPlus Silver 1900","Standard Silver On Exchange Plan","71.42%","0.721578121185303","No","Yes","No","100%",,"$1,900","$20","$980","$150","$1,900","$400","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/-/media/97DA2BB22A6445D680C03A439C9E9D8A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1900?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540001-02","MyPriority HMO RxPlus Silver 1900","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1900?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540001-03","MyPriority HMO RxPlus Silver 1900","Limited Cost Sharing Plan Variation","71.42%","0.721578121185303","No","Yes","No","100%",,"$1,900","$20","$980","$150","$1,900","$400","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/-/media/26F56C44916E42ACAB63B4E437ECF425.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1900?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540001-04","MyPriority HMO RxPlus Silver 1900","73% AV Level Silver Plan","73.45%","0.741683125495911","No","Yes","No","100%",,"$1,600","$20","$1,070","$150","$1,600","$430","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$3200 per person","$3200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/-/media/6687278A8EE34D11950BB6FFD05D3B8F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1900?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540001-05","MyPriority HMO RxPlus Silver 1900","87% AV Level Silver Plan","87.33%","0.879151344299316","No","Yes","No","100%",,"$250","$0","$1,450","$150","$250","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$250 per person","$250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/-/media/5CDAC85233FC467D9BF796F9B6121818.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1900?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540001-06","MyPriority HMO RxPlus Silver 1900","94% AV Level Silver Plan","94.42%","0.948644161224365","No","Yes","No","100%",,"$100","$0","$400","$150","$100","$230","$170","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/-/media/2E68E4E0EDE7472BBC055E81EA7EF83D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1900?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540028","MyPriority HMO RxPlus Gold 800","29698MI054",,"MIN001","MIS004","MIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540028-00","MyPriority HMO RxPlus Gold 800","Standard Gold Off Exchange Plan",,"0.785541594028473","Yes","Yes","No","100%",,"$800","$20","$870","$150","$800","$540","$530","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$1600 per person","$1600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/3E958F20DA424B17B0C3D9EA599E70E0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-gold-800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540028","MyPriority HMO RxPlus Gold 800","29698MI054",,"MIN001","MIS004","MIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540028-01","MyPriority HMO RxPlus Gold 800","Standard Gold On Exchange Plan",,"0.785541594028473","Yes","Yes","No","100%",,"$800","$20","$870","$150","$800","$540","$530","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$1600 per person","$1600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/3E958F20DA424B17B0C3D9EA599E70E0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-gold-800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540028","MyPriority HMO RxPlus Gold 800","29698MI054",,"MIN001","MIS004","MIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540028-02","MyPriority HMO RxPlus Gold 800","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-gold-800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540028","MyPriority HMO RxPlus Gold 800","29698MI054",,"MIN001","MIS004","MIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540028-03","MyPriority HMO RxPlus Gold 800","Limited Cost Sharing Plan Variation",,"0.785541594028473","Yes","Yes","No","100%",,"$800","$20","$870","$150","$800","$540","$530","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$1600 per person","$1600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7D120E896420441B83803B86217FF05C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-gold-800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540005-00","MyPriority HMO RxPlus Silver 1800","Standard Silver Off Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/4C3F63E0944D481089BF04F31CF37ECA.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540005-01","MyPriority HMO RxPlus Silver 1800","Standard Silver On Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/4C3F63E0944D481089BF04F31CF37ECA.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540005-02","MyPriority HMO RxPlus Silver 1800","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/252F8A6476DC48C09D1203A8FEE7F817.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540005-03","MyPriority HMO RxPlus Silver 1800","Limited Cost Sharing Plan Variation","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/9BD4ABFD0E3C4F98AACAC2F21258273D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540005-04","MyPriority HMO RxPlus Silver 1800","73% AV Level Silver Plan","73.71%","0.742612719535828","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$430","$510","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/2978311FC2044F23BA98DB91E217F7A1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540005-05","MyPriority HMO RxPlus Silver 1800","87% AV Level Silver Plan","87.47%","0.878929436206818","Yes","Yes","No","100%",,"$300","$0","$1,300","$150","$300","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$600 per person","$600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/FCA1744ADAC14851A14735BFF0377BE3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540005-06","MyPriority HMO RxPlus Silver 1800","94% AV Level Silver Plan","94.54%","0.948858916759491","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$250","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/04BBF5AAEB5942A8956D28BC4C238A22.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540018-00","MyPriority RxPlus - Spectrum Health Partners","Standard Silver Off Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/B9100F22BC374AF098E59ACAE23FBF5A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540018-01","MyPriority RxPlus - Spectrum Health Partners","Standard Silver On Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/B9100F22BC374AF098E59ACAE23FBF5A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540018-02","MyPriority RxPlus - Spectrum Health Partners","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/252F8A6476DC48C09D1203A8FEE7F817.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540018-03","MyPriority RxPlus - Spectrum Health Partners","Limited Cost Sharing Plan Variation","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/BE79B86631E344B98768D9B682E66F57.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540018-04","MyPriority RxPlus - Spectrum Health Partners","73% AV Level Silver Plan","73.71%","0.742612719535828","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$430","$510","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/92AC4E31DD604ACAAB3B4C2DC02297D0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540032","MyPriority RxPlus - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540032-03","MyPriority RxPlus - Bronson Healthcare Partners","Limited Cost Sharing Plan Variation","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7ADD91A47DD842D89F6F8071945E06AB.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540032","MyPriority RxPlus - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540032-04","MyPriority RxPlus - Bronson Healthcare Partners","73% AV Level Silver Plan","73.71%","0.742612719535828","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$430","$510","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7A2D518BE41045B490ADC25A2B9A85A6.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540032","MyPriority RxPlus - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540032-05","MyPriority RxPlus - Bronson Healthcare Partners","87% AV Level Silver Plan","87.47%","0.878929436206818","Yes","Yes","No","100%",,"$300","$0","$1,300","$150","$300","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$600 per person","$600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/87285E4B0D314D5DACD08D2DCCA604F0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540032","MyPriority RxPlus - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540032-06","MyPriority RxPlus - Bronson Healthcare Partners","94% AV Level Silver Plan","94.54%","0.948858916759491","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$250","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/6F239CAC093E4A278309967E775B0B20.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-rxplus-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540044","MyPriority HMO RxPlus Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540044-00","MyPriority HMO RxPlus Silver 2500","Standard Silver Off Exchange Plan","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/B8FE9570E0C7424DAA693CA5C54EC9C8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540044","MyPriority HMO RxPlus Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540044-01","MyPriority HMO RxPlus Silver 2500","Standard Silver On Exchange Plan","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/B8FE9570E0C7424DAA693CA5C54EC9C8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540044","MyPriority HMO RxPlus Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540044-02","MyPriority HMO RxPlus Silver 2500","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540044","MyPriority HMO RxPlus Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540044-03","MyPriority HMO RxPlus Silver 2500","Limited Cost Sharing Plan Variation","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/539E6CC0DC894C498B1DB3BD1932B6E8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540044","MyPriority HMO RxPlus Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540044-04","MyPriority HMO RxPlus Silver 2500","73% AV Level Silver Plan","73.71%","0.742612719535828","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$430","$510","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7FF87CBBFA444C8E9EB762DC0479BC5B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540044","MyPriority HMO RxPlus Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540044-05","MyPriority HMO RxPlus Silver 2500","87% AV Level Silver Plan","87.47%","0.878929436206818","Yes","Yes","No","100%",,"$300","$0","$1,300","$150","$300","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$600 per person","$600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/1963911288B54B7AB0578B2DE673E9E9.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540044","MyPriority HMO RxPlus Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540044-06","MyPriority HMO RxPlus Silver 2500","94% AV Level Silver Plan","94.54%","0.948858916759491","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$250","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E7B39E33085C477AA4E9FC9112C29203.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540029","MyPriority HMO RxPlus Bronze 4500","29698MI054",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540029-00","MyPriority HMO RxPlus Bronze 4500","Standard Bronze Off Exchange Plan",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EB5A631AE31A491DBF6964FDA1A99007.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540029","MyPriority HMO RxPlus Bronze 4500","29698MI054",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540029-01","MyPriority HMO RxPlus Bronze 4500","Standard Bronze On Exchange Plan",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EB5A631AE31A491DBF6964FDA1A99007.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540029","MyPriority HMO RxPlus Bronze 4500","29698MI054",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540029-02","MyPriority HMO RxPlus Bronze 4500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540029","MyPriority HMO RxPlus Bronze 4500","29698MI054",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540029-03","MyPriority HMO RxPlus Bronze 4500","Limited Cost Sharing Plan Variation",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/6F543799D41E472C960D65E1CF32D03F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570003-00","MyPriority POS RxPlus Silver 1800","Standard Silver Off Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/40EC268DE08F4D5B8E5470094D697E80.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570003-01","MyPriority POS RxPlus Silver 1800","Standard Silver On Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/40EC268DE08F4D5B8E5470094D697E80.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570003-02","MyPriority POS RxPlus Silver 1800","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570003-03","MyPriority POS RxPlus Silver 1800","Limited Cost Sharing Plan Variation","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7705C40DA8E44483BD2F02EF482C2AF1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570003-04","MyPriority POS RxPlus Silver 1800","73% AV Level Silver Plan","73.71%","0.742612719535828","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$430","$510","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$22800 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E04F531544546F9B3F86B12AD154D9A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570003-05","MyPriority POS RxPlus Silver 1800","87% AV Level Silver Plan","87.47%","0.878929436206818","Yes","Yes","No","100%",,"$300","$0","$1,300","$150","$300","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$600 per person","$600 per group","30.00%",,,,,"$600","$1200 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/76B23D2CB78545B18268E3778BD0A0EC.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540020","MyPriority HMO HSA Bronze 6550","29698MI054",,"MIN001","MIS001","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540020-01","MyPriority HMO HSA Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/8873B3BBA33F4313B9138923A4015E17.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540020","MyPriority HMO HSA Bronze 6550","29698MI054",,"MIN001","MIS001","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540020-02","MyPriority HMO HSA Bronze 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540020","MyPriority HMO HSA Bronze 6550","29698MI054",,"MIN001","MIS001","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540020-03","MyPriority HMO HSA Bronze 6550","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/DC5BC34B83E54644BA68EA3EDDBF0803.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570003-06","MyPriority POS RxPlus Silver 1800","94% AV Level Silver Plan","94.54%","0.948858916759491","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$250","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/31A5236229A345DDAA672076C4E04A71.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570055","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570055-00","MyPriority POS RxPlus Silver 2500","Standard Silver Off Exchange Plan","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/1E72C0AEAB254361A41AD82176908646.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570055","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570055-01","MyPriority POS RxPlus Silver 2500","Standard Silver On Exchange Plan","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/1E72C0AEAB254361A41AD82176908646.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570055","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570055-02","MyPriority POS RxPlus Silver 2500","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570055","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570055-03","MyPriority POS RxPlus Silver 2500","Limited Cost Sharing Plan Variation","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/D972DCA1546943EFA632D2D9E417008F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570055","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570055-04","MyPriority POS RxPlus Silver 2500","73% AV Level Silver Plan","73.71%","0.742612719535828","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$430","$510","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$22800 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/2F98A2EB97CC4042A871FDB3427D8F71.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570055","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570055-05","MyPriority POS RxPlus Silver 2500","87% AV Level Silver Plan","87.47%","0.878929436206818","Yes","Yes","No","100%",,"$300","$0","$1,300","$150","$300","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$600 per person","$600 per group","30.00%",,,,,"$600","$1200 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/76F873AD59944F95A71A8FB367A1FFF3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570055","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570055-06","MyPriority POS RxPlus Silver 2500","94% AV Level Silver Plan","94.54%","0.948858916759491","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$250","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/5523A14AC9BB4821987887CF12560960.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570013-00","MyPriority POS RxPlus Silver 1800","Standard Silver Off Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/40EC268DE08F4D5B8E5470094D697E80.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570013-01","MyPriority POS RxPlus Silver 1800","Standard Silver On Exchange Plan","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/40EC268DE08F4D5B8E5470094D697E80.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570013-02","MyPriority POS RxPlus Silver 1800","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570013-03","MyPriority POS RxPlus Silver 1800","Limited Cost Sharing Plan Variation","71.61%","0.721508264541626","Yes","Yes","No","100%",,"$1,800","$20","$1,010","$150","$1,800","$410","$460","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30.00%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7705C40DA8E44483BD2F02EF482C2AF1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570013-04","MyPriority POS RxPlus Silver 1800","73% AV Level Silver Plan","73.71%","0.742612719535828","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$430","$510","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$22800 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E04F531544546F9B3F86B12AD154D9A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570013-05","MyPriority POS RxPlus Silver 1800","87% AV Level Silver Plan","87.47%","0.878929436206818","Yes","Yes","No","100%",,"$300","$0","$1,300","$150","$300","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$600 per person","$600 per group","30.00%",,,,,"$600","$1200 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/76B23D2CB78545B18268E3778BD0A0EC.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570013-06","MyPriority POS RxPlus Silver 1800","94% AV Level Silver Plan","94.54%","0.948858916759491","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$250","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/31A5236229A345DDAA672076C4E04A71.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-1800?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570056","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570056-00","MyPriority POS RxPlus Silver 2500","Standard Silver Off Exchange Plan","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/1E72C0AEAB254361A41AD82176908646.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570056","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570056-01","MyPriority POS RxPlus Silver 2500","Standard Silver On Exchange Plan","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/1E72C0AEAB254361A41AD82176908646.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570056","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570056-02","MyPriority POS RxPlus Silver 2500","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570056","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570056-03","MyPriority POS RxPlus Silver 2500","Limited Cost Sharing Plan Variation","68.88%","0.694152235984802","Yes","Yes","No","100%",,"$2,500","$20","$800","$150","$2,500","$320","$380","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/D972DCA1546943EFA632D2D9E417008F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570056","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570056-04","MyPriority POS RxPlus Silver 2500","73% AV Level Silver Plan","73.71%","0.742612719535828","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$430","$510","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$22800 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/2F98A2EB97CC4042A871FDB3427D8F71.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570056","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570056-05","MyPriority POS RxPlus Silver 2500","87% AV Level Silver Plan","87.47%","0.878929436206818","Yes","Yes","No","100%",,"$300","$0","$1,300","$150","$300","$600","$560","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$600 per person","$600 per group","30.00%",,,,,"$600","$1200 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/76F873AD59944F95A71A8FB367A1FFF3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570056","MyPriority POS RxPlus Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570056-06","MyPriority POS RxPlus Silver 2500","94% AV Level Silver Plan","94.54%","0.948858916759491","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$250","$230","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/5523A14AC9BB4821987887CF12560960.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570038","MyPriority POS RxPlus Bronze 4500","29698MI057",,"MIN001","MIS003","MIF008","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570038-00","MyPriority POS RxPlus Bronze 4500","Standard Bronze Off Exchange Plan",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"$9,000","$18000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/78A4BAFEB85741CAB565EB1E8B20666F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570038","MyPriority POS RxPlus Bronze 4500","29698MI057",,"MIN001","MIS003","MIF008","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570038-01","MyPriority POS RxPlus Bronze 4500","Standard Bronze On Exchange Plan",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"$9,000","$18000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/78A4BAFEB85741CAB565EB1E8B20666F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2018"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570038","MyPriority POS RxPlus Bronze 4500","29698MI057",,"MIN001","MIS003","MIF008","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570038-02","MyPriority POS RxPlus Bronze 4500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2019"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570038","MyPriority POS RxPlus Bronze 4500","29698MI057",,"MIN001","MIS003","MIF008","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570038-03","MyPriority POS RxPlus Bronze 4500","Limited Cost Sharing Plan Variation",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"$9,000","$18000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/974D50037D654E7E95680DF42CE50870.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2020"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570046","MyPriority POS RxPlus Bronze 4500","29698MI057",,"MIN001","MIS002","MIF008","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570046-00","MyPriority POS RxPlus Bronze 4500","Standard Bronze Off Exchange Plan",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"$9,000","$18000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/78A4BAFEB85741CAB565EB1E8B20666F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2021"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570046","MyPriority POS RxPlus Bronze 4500","29698MI057",,"MIN001","MIS002","MIF008","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570046-01","MyPriority POS RxPlus Bronze 4500","Standard Bronze On Exchange Plan",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"$9,000","$18000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/78A4BAFEB85741CAB565EB1E8B20666F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2022"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570046","MyPriority POS RxPlus Bronze 4500","29698MI057",,"MIN001","MIS002","MIF008","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570046-02","MyPriority POS RxPlus Bronze 4500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2023"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570046","MyPriority POS RxPlus Bronze 4500","29698MI057",,"MIN001","MIS002","MIF008","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570046-03","MyPriority POS RxPlus Bronze 4500","Limited Cost Sharing Plan Variation",,"0.61938488483429","Yes","Yes","No","100%",,"$4,500","$20","$340","$150","$4,500","$310","$90","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7150 per person","$9000 per group","50.00%",,,,,"$9,000","$18000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/974D50037D654E7E95680DF42CE50870.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-rxplus-bronze-4500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2024"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540020","MyPriority HMO HSA Bronze 6550","29698MI054",,"MIN001","MIS001","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540020-00","MyPriority HMO HSA Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/8873B3BBA33F4313B9138923A4015E17.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540021","MyPriority HSA - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540021-00","MyPriority HSA - Spectrum Health Partners","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/6DE26F2AE1B64FE19DB58E995A739E50.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hsa-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540021","MyPriority HSA - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540021-01","MyPriority HSA - Spectrum Health Partners","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/6DE26F2AE1B64FE19DB58E995A739E50.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hsa-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540021","MyPriority HSA - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540021-02","MyPriority HSA - Spectrum Health Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/252F8A6476DC48C09D1203A8FEE7F817.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hsa-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540021","MyPriority HSA - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540021-03","MyPriority HSA - Spectrum Health Partners","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7558B10205CA4F50B98129BF00716120.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hsa-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540033","MyPriority HSA - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540033-00","MyPriority HSA - Bronson Healthcare Partners","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/106698991CE540FDBC0EDB6C91574CFB.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hsa-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540033","MyPriority HSA - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540033-01","MyPriority HSA - Bronson Healthcare Partners","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/106698991CE540FDBC0EDB6C91574CFB.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hsa-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540033","MyPriority HSA - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540033-02","MyPriority HSA - Bronson Healthcare Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EDE1727201094D52B7DE997755A46B19.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hsa-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540033","MyPriority HSA - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540033-03","MyPriority HSA - Bronson Healthcare Partners","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/A0C10A7FFCE14CE68F13886D4A27ED0D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hsa-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540034","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540034-00","MyPriority HMO HSA Silver 1500","Standard Silver Off Exchange Plan",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/242E12E2ABDC46AB83F3EB6139B92B0A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540034","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540034-01","MyPriority HMO HSA Silver 1500","Standard Silver On Exchange Plan",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/242E12E2ABDC46AB83F3EB6139B92B0A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540034","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540034-02","MyPriority HMO HSA Silver 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540034","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540034-03","MyPriority HMO HSA Silver 1500","Limited Cost Sharing Plan Variation",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/D87DE99DF1194EB09BB15D65E4099C52.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540034","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540034-04","MyPriority HMO HSA Silver 1500","73% AV Level Silver Plan",,"0.739665865898132","Yes","Yes","No","100%",,"$1,225","$20","$1,180","$150","$1,225","$720","$680","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,225","$2450 per person","$2450 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/DDDB95399B074F35995B8F83284FD7D6.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540034","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540034-05","MyPriority HMO HSA Silver 1500","87% AV Level Silver Plan",,"0.870294749736786","Yes","Yes","No","100%",,"$500","$0","$900","$150","$500","$360","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/3188F897667845F2A7601DEF4A479DC3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540034","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540034-06","MyPriority HMO HSA Silver 1500","94% AV Level Silver Plan",,"0.941388607025146","Yes","Yes","No","100%",,"$100","$0","$400","$150","$100","$130","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/DBEA86C67BE246C88376CF7804817D23.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570024","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS003","MIF004","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570024-00","MyPriority POS HSA Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/EC9483BA866B4C2B905DA78990DC104D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570024","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS003","MIF004","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570024-01","MyPriority POS HSA Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/EC9483BA866B4C2B905DA78990DC104D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2018"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570024","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS003","MIF004","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570024-02","MyPriority POS HSA Bronze 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2019"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570024","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS003","MIF004","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570024-03","MyPriority POS HSA Bronze 6550","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/58FE795C4DD944F3BD5592B9B138E77B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2020"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570040","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570040-00","MyPriority POS HSA Silver 1500","Standard Silver Off Exchange Plan",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$21000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/F21DA0D68BB7409E90782E8185AC7775.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570040","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570040-01","MyPriority POS HSA Silver 1500","Standard Silver On Exchange Plan",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$21000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/F21DA0D68BB7409E90782E8185AC7775.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2018"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570040","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570040-02","MyPriority POS HSA Silver 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2019"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570040","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570040-03","MyPriority POS HSA Silver 1500","Limited Cost Sharing Plan Variation",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$21000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7E14B69277D04ABEAFF609B7CA6515FB.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2020"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570040","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570040-04","MyPriority POS HSA Silver 1500","73% AV Level Silver Plan",,"0.739665865898132","Yes","Yes","No","100%",,"$1,225","$20","$1,180","$150","$1,225","$720","$680","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$9,400","$18800 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,225","$2450 per person","$2450 per group","30.00%",,,,,"$2,450","$4900 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/6C0E33BFAA984B17A897551C991CCEC1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2021"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570040","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570040-05","MyPriority POS HSA Silver 1500","87% AV Level Silver Plan",,"0.870294749736786","Yes","Yes","No","100%",,"$500","$0","$900","$150","$500","$360","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","30.00%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/AB88830BB2974542A9CAB739DA55E76C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2022"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570040","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570040-06","MyPriority POS HSA Silver 1500","94% AV Level Silver Plan",,"0.941388607025146","Yes","Yes","No","100%",,"$100","$0","$400","$150","$100","$130","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"$200","$400 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/47FFD60870ED415FB4A01D39ABD91671.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2023"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570032","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS002","MIF004","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570032-00","MyPriority POS HSA Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/EC9483BA866B4C2B905DA78990DC104D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570032","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS002","MIF004","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570032-01","MyPriority POS HSA Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/EC9483BA866B4C2B905DA78990DC104D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2018"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570032","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS002","MIF004","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570032-02","MyPriority POS HSA Bronze 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2019"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570032","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS002","MIF004","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570032-03","MyPriority POS HSA Bronze 6550","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/58FE795C4DD944F3BD5592B9B138E77B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-bronze-6550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2020"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570048","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570048-00","MyPriority POS HSA Silver 1500","Standard Silver Off Exchange Plan",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$21000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/F21DA0D68BB7409E90782E8185AC7775.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570043","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570043-03","MyPriority POS Silver 1400","Limited Cost Sharing Plan Variation",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/04B37B9F183C4350A804B0ADE9CE224B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2024"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570048","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570048-01","MyPriority POS HSA Silver 1500","Standard Silver On Exchange Plan",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$21000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/-/media/F21DA0D68BB7409E90782E8185AC7775.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2018"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570048","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570048-02","MyPriority POS HSA Silver 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2019"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570048","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570048-03","MyPriority POS HSA Silver 1500","Limited Cost Sharing Plan Variation",,"0.718864440917969","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$21000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30.00%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7E14B69277D04ABEAFF609B7CA6515FB.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2020"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570048","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570048-04","MyPriority POS HSA Silver 1500","73% AV Level Silver Plan",,"0.739665865898132","Yes","Yes","No","100%",,"$1,225","$20","$1,180","$150","$1,225","$720","$680","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$9,400","$18800 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,225","$2450 per person","$2450 per group","30.00%",,,,,"$2,450","$4900 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/6C0E33BFAA984B17A897551C991CCEC1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2021"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570048","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570048-05","MyPriority POS HSA Silver 1500","87% AV Level Silver Plan",,"0.870294749736786","Yes","Yes","No","100%",,"$500","$0","$900","$150","$500","$360","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","30.00%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/AB88830BB2974542A9CAB739DA55E76C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2022"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570048","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570048-06","MyPriority POS HSA Silver 1500","94% AV Level Silver Plan",,"0.941388607025146","Yes","Yes","No","100%",,"$100","$0","$400","$150","$100","$130","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"$200","$400 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/47FFD60870ED415FB4A01D39ABD91671.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-hsa-silver-1500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2023"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540036","MyPriority HMO Bronze 6700","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540036-00","MyPriority HMO Bronze 6700","Standard Bronze Off Exchange Plan","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/6B2F32C01E6F4756BC0C09A0268A4F31.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540036","MyPriority HMO Bronze 6700","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540036-01","MyPriority HMO Bronze 6700","Standard Bronze On Exchange Plan","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/6B2F32C01E6F4756BC0C09A0268A4F31.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540036","MyPriority HMO Bronze 6700","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540036-02","MyPriority HMO Bronze 6700","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540036","MyPriority HMO Bronze 6700","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540036-03","MyPriority HMO Bronze 6700","Limited Cost Sharing Plan Variation","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EC040AA6D3B343EDBA1CE6C7E77BB3C2.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540037","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540037-00","MyPriority HMO Silver 1400","Standard Silver Off Exchange Plan",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/F88509004CF8482BA4C0DB3D9D79DE2E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1400?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540037","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540037-01","MyPriority HMO Silver 1400","Standard Silver On Exchange Plan",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/F88509004CF8482BA4C0DB3D9D79DE2E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1400?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540037","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540037-02","MyPriority HMO Silver 1400","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1400?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540037","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540037-03","MyPriority HMO Silver 1400","Limited Cost Sharing Plan Variation",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/789195C5187E4DB384D6E58C998AEC13.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1400?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540037","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540037-04","MyPriority HMO Silver 1400","73% AV Level Silver Plan",,"0.739812612533569","Yes","Yes","No","100%",,"$1,250","$20","$1,180","$150","$1,250","$850","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/2A88045481894828AB1033D5459977D0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1400?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540037","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540037-05","MyPriority HMO Silver 1400","87% AV Level Silver Plan",,"0.877590239048004","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$860","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/638A383AFE3E4C87822B87DA3A944048.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1400?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540037","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540037-06","MyPriority HMO Silver 1400","94% AV Level Silver Plan",,"0.934234023094177","Yes","Yes","No","100%",,"$50","$0","$550","$150","$50","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/A1636C8943B24A5AA24AC95E70ED80AF.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-1400?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540047","MyPriority HMO Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540047-00","MyPriority HMO Silver 2000","Standard Silver Off Exchange Plan",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/AEF154CB4D3D470F8562A55086922366.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-2000?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540047","MyPriority HMO Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540047-01","MyPriority HMO Silver 2000","Standard Silver On Exchange Plan",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/AEF154CB4D3D470F8562A55086922366.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-2000?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540047","MyPriority HMO Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540047-02","MyPriority HMO Silver 2000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-2000?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540047","MyPriority HMO Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540047-03","MyPriority HMO Silver 2000","Limited Cost Sharing Plan Variation",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7EE35C1204944FBDAF864F113BA38FF2.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-2000?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540047","MyPriority HMO Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540047-04","MyPriority HMO Silver 2000","73% AV Level Silver Plan",,"0.739812612533569","Yes","Yes","No","100%",,"$1,250","$20","$1,180","$150","$1,250","$850","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/86FA4E3FAEF94F3D9C4A0BF098CC7371.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-2000?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540047","MyPriority HMO Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540047-05","MyPriority HMO Silver 2000","87% AV Level Silver Plan",,"0.877590239048004","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$860","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/ACD1329AFAAB4080A8A6320783CB92EC.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-2000?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540047","MyPriority HMO Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Urgent/Emergency care only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540047-06","MyPriority HMO Silver 2000","94% AV Level Silver Plan",,"0.934234023094177","Yes","Yes","No","100%",,"$50","$0","$550","$150","$50","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/91ED26C33A36474696ACC3D46AF13368.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-silver-2000?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570042","MyPriority POS Bronze 6700","29698MI057",,"MIN001","MIS003","MIF005","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570042-00","MyPriority POS Bronze 6700","Standard Bronze Off Exchange Plan","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"$13,400","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/C637F0607C3B4C0C927D6A54175891CA.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570042","MyPriority POS Bronze 6700","29698MI057",,"MIN001","MIS003","MIF005","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570042-01","MyPriority POS Bronze 6700","Standard Bronze On Exchange Plan","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"$13,400","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/C637F0607C3B4C0C927D6A54175891CA.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2018"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570042","MyPriority POS Bronze 6700","29698MI057",,"MIN001","MIS003","MIF005","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570042-02","MyPriority POS Bronze 6700","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2019"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570042","MyPriority POS Bronze 6700","29698MI057",,"MIN001","MIS003","MIF005","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570042-03","MyPriority POS Bronze 6700","Limited Cost Sharing Plan Variation","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"$13,400","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/080E03BAE08943588279DA46C5D17DED.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2020"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570043","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570043-00","MyPriority POS Silver 1400","Standard Silver Off Exchange Plan",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E2DB6C64D7D7498AA7D4A894799F513F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2021"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570043","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570043-01","MyPriority POS Silver 1400","Standard Silver On Exchange Plan",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E2DB6C64D7D7498AA7D4A894799F513F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2022"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570043","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570043-02","MyPriority POS Silver 1400","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2023"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570043","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570043-04","MyPriority POS Silver 1400","73% AV Level Silver Plan",,"0.739812612533569","Yes","Yes","No","100%",,"$1,250","$20","$1,180","$150","$1,250","$850","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$22800 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","30.00%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/469E5ACD6E414CF795137F591D7EFFFF.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2025"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570043","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570043-05","MyPriority POS Silver 1400","87% AV Level Silver Plan",,"0.877590239048004","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$860","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"$200","$400 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EB89E989369E45D8B93C064A46178929.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2026"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570043","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570043-06","MyPriority POS Silver 1400","94% AV Level Silver Plan",,"0.934234023094177","Yes","Yes","No","100%",,"$50","$0","$550","$150","$50","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$2400 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/02170496B58C44929D06462C479D2277.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2027"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570057","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570057-00","MyPriority POS Silver 2000","Standard Silver Off Exchange Plan",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/DAE9C25963594DDB94D3EAAB4740140F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2028"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570057","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570057-01","MyPriority POS Silver 2000","Standard Silver On Exchange Plan",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/DAE9C25963594DDB94D3EAAB4740140F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2029"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570057","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570057-02","MyPriority POS Silver 2000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2030"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570057","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570057-03","MyPriority POS Silver 2000","Limited Cost Sharing Plan Variation",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/430BCECC591F4FA2986ED9D7F6BBEF4F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2031"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570057","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570057-04","MyPriority POS Silver 2000","73% AV Level Silver Plan",,"0.739812612533569","Yes","Yes","No","100%",,"$1,250","$20","$1,180","$150","$1,250","$850","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$22800 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","30.00%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0B30585D88034AE5A3547CC2D44DA3DE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2032"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570057","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570057-05","MyPriority POS Silver 2000","87% AV Level Silver Plan",,"0.877590239048004","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$860","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"$200","$400 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/21D475326C5F4EC39760ECF3E01C43CD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2033"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570057","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570057-06","MyPriority POS Silver 2000","94% AV Level Silver Plan",,"0.934234023094177","Yes","Yes","No","100%",,"$50","$0","$550","$150","$50","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$2400 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/01FC2FAFF4FE468C9ABD51A5EB9A23F4.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2034"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570050","MyPriority POS Bronze 6700","29698MI057",,"MIN001","MIS002","MIF005","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570050-00","MyPriority POS Bronze 6700","Standard Bronze Off Exchange Plan","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"$13,400","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/C637F0607C3B4C0C927D6A54175891CA.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570050","MyPriority POS Bronze 6700","29698MI057",,"MIN001","MIS002","MIF005","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570050-01","MyPriority POS Bronze 6700","Standard Bronze On Exchange Plan","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"$13,400","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/C637F0607C3B4C0C927D6A54175891CA.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2018"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570050","MyPriority POS Bronze 6700","29698MI057",,"MIN001","MIS002","MIF005","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570050-02","MyPriority POS Bronze 6700","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2019"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570050","MyPriority POS Bronze 6700","29698MI057",,"MIN001","MIS002","MIF005","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570050-03","MyPriority POS Bronze 6700","Limited Cost Sharing Plan Variation","61.89%","0.627333462238312","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$7150 per person","$13400 per group","40.00%",,,,,"$13,400","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/080E03BAE08943588279DA46C5D17DED.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2020"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570051","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570051-00","MyPriority POS Silver 1400","Standard Silver Off Exchange Plan",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E2DB6C64D7D7498AA7D4A894799F513F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2021"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570051","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570051-01","MyPriority POS Silver 1400","Standard Silver On Exchange Plan",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E2DB6C64D7D7498AA7D4A894799F513F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2022"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570051","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570051-02","MyPriority POS Silver 1400","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2023"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570051","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570051-03","MyPriority POS Silver 1400","Limited Cost Sharing Plan Variation",,"0.717689037322998","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30.00%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/04B37B9F183C4350A804B0ADE9CE224B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2024"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570051","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570051-04","MyPriority POS Silver 1400","73% AV Level Silver Plan",,"0.739812612533569","Yes","Yes","No","100%",,"$1,250","$20","$1,180","$150","$1,250","$850","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$22800 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","30.00%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/469E5ACD6E414CF795137F591D7EFFFF.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2025"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570051","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570051-05","MyPriority POS Silver 1400","87% AV Level Silver Plan",,"0.877590239048004","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$860","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"$200","$400 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EB89E989369E45D8B93C064A46178929.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2026"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570051","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570051-06","MyPriority POS Silver 1400","94% AV Level Silver Plan",,"0.934234023094177","Yes","Yes","No","100%",,"$50","$0","$550","$150","$50","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$2400 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/02170496B58C44929D06462C479D2277.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2027"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570058","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570058-00","MyPriority POS Silver 2000","Standard Silver Off Exchange Plan",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/DAE9C25963594DDB94D3EAAB4740140F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2028"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570058","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570058-01","MyPriority POS Silver 2000","Standard Silver On Exchange Plan",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/DAE9C25963594DDB94D3EAAB4740140F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2029"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570058","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570058-02","MyPriority POS Silver 2000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2030"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570058","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570058-03","MyPriority POS Silver 2000","Limited Cost Sharing Plan Variation",,"0.696356475353241","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$710","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/430BCECC591F4FA2986ED9D7F6BBEF4F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2031"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570058","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570058-04","MyPriority POS Silver 2000","73% AV Level Silver Plan",,"0.739812612533569","Yes","Yes","No","100%",,"$1,250","$20","$1,180","$150","$1,250","$850","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$22800 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","30.00%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0B30585D88034AE5A3547CC2D44DA3DE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2032"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570058","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570058-05","MyPriority POS Silver 2000","87% AV Level Silver Plan",,"0.877590239048004","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$860","$540","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$200 per person","$200 per group","30.00%",,,,,"$200","$400 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/21D475326C5F4EC39760ECF3E01C43CD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2033"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570058","MyPriority POS Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570058-06","MyPriority POS Silver 2000","94% AV Level Silver Plan",,"0.934234023094177","Yes","Yes","No","100%",,"$50","$0","$550","$150","$50","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$2400 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/01FC2FAFF4FE468C9ABD51A5EB9A23F4.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-bronze-6700?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2034"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540040","MyPriority HMO Holistic Bronze 5550","29698MI054",,"MIN001","MIS001","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540040-00","MyPriority HMO Holistic Bronze 5550","Standard Bronze Off Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/4379AC187F1745E7A978DDD9EDD7C602.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540040","MyPriority HMO Holistic Bronze 5550","29698MI054",,"MIN001","MIS001","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540040-01","MyPriority HMO Holistic Bronze 5550","Standard Bronze On Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/4379AC187F1745E7A978DDD9EDD7C602.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540040","MyPriority HMO Holistic Bronze 5550","29698MI054",,"MIN001","MIS001","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540040-02","MyPriority HMO Holistic Bronze 5550","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540040","MyPriority HMO Holistic Bronze 5550","29698MI054",,"MIN001","MIS001","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540040-03","MyPriority HMO Holistic Bronze 5550","Limited Cost Sharing Plan Variation","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/989240367CC04E80BB29ACD2AABC3B2D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540041","MyPriority Holistic Bronze - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540041-00","MyPriority Holistic Bronze - Spectrum Health Partners","Standard Bronze Off Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E83A04E3C93646E18B455D2964B8BD8B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-bronze-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540041","MyPriority Holistic Bronze - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540041-01","MyPriority Holistic Bronze - Spectrum Health Partners","Standard Bronze On Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E83A04E3C93646E18B455D2964B8BD8B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-bronze-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540041","MyPriority Holistic Bronze - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540041-02","MyPriority Holistic Bronze - Spectrum Health Partners","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/252F8A6476DC48C09D1203A8FEE7F817.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-bronze-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540041","MyPriority Holistic Bronze - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540041-03","MyPriority Holistic Bronze - Spectrum Health Partners","Limited Cost Sharing Plan Variation","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/4F786CC363614DC5ACDB55B7355EAAD7.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-bronze-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540042","MyPriority Holistic Bronze - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540042-00","MyPriority Holistic Bronze - Bronson Healthcare Partners","Standard Bronze Off Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/76780FEA046E49ADB9DBA6224B8F4E44.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-bronze-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540042","MyPriority Holistic Bronze - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540042-01","MyPriority Holistic Bronze - Bronson Healthcare Partners","Standard Bronze On Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/76780FEA046E49ADB9DBA6224B8F4E44.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-bronze-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540042","MyPriority Holistic Bronze - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540042-02","MyPriority Holistic Bronze - Bronson Healthcare Partners","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EDE1727201094D52B7DE997755A46B19.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-bronze-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540042","MyPriority Holistic Bronze - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540042-03","MyPriority Holistic Bronze - Bronson Healthcare Partners","Limited Cost Sharing Plan Variation","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/7313E9F2C6DC417697195E795E5A9D86.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-bronze-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570044","MyPriority POS Holistic Bronze 5550","29698MI057",,"MIN001","MIS003","MIF007","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570044-00","MyPriority POS Holistic Bronze 5550","Standard Bronze Off Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"$11,100","$22200 per person","$22200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E9E9634017454C94BD80C061C33A2056.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570044","MyPriority POS Holistic Bronze 5550","29698MI057",,"MIN001","MIS003","MIF007","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570044-01","MyPriority POS Holistic Bronze 5550","Standard Bronze On Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"$11,100","$22200 per person","$22200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E9E9634017454C94BD80C061C33A2056.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2018"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570044","MyPriority POS Holistic Bronze 5550","29698MI057",,"MIN001","MIS003","MIF007","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570044-02","MyPriority POS Holistic Bronze 5550","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2019"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570044","MyPriority POS Holistic Bronze 5550","29698MI057",,"MIN001","MIS003","MIF007","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570044-03","MyPriority POS Holistic Bronze 5550","Limited Cost Sharing Plan Variation","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"$11,100","$22200 per person","$22200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/F7FBA38110D44AFC9183BD7D1FF7EA2D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2020"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570053","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570053-06","MyPriority POS Holistic Silver 2500","94% AV Level Silver Plan","94.18%","0.945171594619751","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$220","$160","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/A5CC02F0B81743288F03EA12A293CB8E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570054","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570054-00","MyPriority POS Holistic Silver 2500","Standard Silver Off Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/67BBC70A6AE94E00A7C7C84252B0898C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570054","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570054-01","MyPriority POS Holistic Silver 2500","Standard Silver On Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/67BBC70A6AE94E00A7C7C84252B0898C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570054","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570054-02","MyPriority POS Holistic Silver 2500","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570052","MyPriority POS Holistic Bronze 5550","29698MI057",,"MIN001","MIS002","MIF007","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570052-00","MyPriority POS Holistic Bronze 5550","Standard Bronze Off Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"$11,100","$22200 per person","$22200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E9E9634017454C94BD80C061C33A2056.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2021"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570052","MyPriority POS Holistic Bronze 5550","29698MI057",,"MIN001","MIS002","MIF007","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570052-01","MyPriority POS Holistic Bronze 5550","Standard Bronze On Exchange Plan","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"$11,100","$22200 per person","$22200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/E9E9634017454C94BD80C061C33A2056.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2022"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570052","MyPriority POS Holistic Bronze 5550","29698MI057",,"MIN001","MIS002","MIF007","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570052-02","MyPriority POS Holistic Bronze 5550","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2023"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570052","MyPriority POS Holistic Bronze 5550","29698MI057",,"MIN001","MIS002","MIF007","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570052-03","MyPriority POS Holistic Bronze 5550","Limited Cost Sharing Plan Variation","61.95%","0.63488644361496","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$7150 per person","$11100 per group","50.00%",,,,,"$11,100","$22200 per person","$22200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/F7FBA38110D44AFC9183BD7D1FF7EA2D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-bronze-5550?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2024"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540048","MyPriority HMO Holistic Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540048-00","MyPriority HMO Holistic Silver 2500","Standard Silver Off Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/4DAB32D463D34F9EB8195FCB4490AA27.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540048","MyPriority HMO Holistic Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540048-01","MyPriority HMO Holistic Silver 2500","Standard Silver On Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/4DAB32D463D34F9EB8195FCB4490AA27.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540048","MyPriority HMO Holistic Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540048-02","MyPriority HMO Holistic Silver 2500","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/79C1996321DF4D3B9D678392CE1B3102.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540048","MyPriority HMO Holistic Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540048-03","MyPriority HMO Holistic Silver 2500","Limited Cost Sharing Plan Variation","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/CC922E5053F94137B3C57533D9863CD3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540048","MyPriority HMO Holistic Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540048-04","MyPriority HMO Holistic Silver 2500","73% AV Level Silver Plan","73.59%","0.74114727973938","Yes","Yes","No","100%",,"$1,600","$20","$1,070","$150","$1,600","$480","$460","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/47A498F055B749A9A53B77E2CEF819CD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540048","MyPriority HMO Holistic Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540048-05","MyPriority HMO Holistic Silver 2500","87% AV Level Silver Plan","87.12%","0.875365853309631","Yes","Yes","No","100%",,"$50","$0","$1,350","$150","$50","$700","$650","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/794C090CCFE14AC4B0FEEF7D502C858B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540048","MyPriority HMO Holistic Silver 2500","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540048-06","MyPriority HMO Holistic Silver 2500","94% AV Level Silver Plan","94.18%","0.945171594619751","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$220","$160","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/CD3BD4A3E3E34E1E9347DD318C1D165A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-hmo-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540049","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540049-00","MyPriority Holistic Silver - Spectrum Health Partners","Standard Silver Off Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/440D77AFB74846C1804ACF129B005F56.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540049","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540049-01","MyPriority Holistic Silver - Spectrum Health Partners","Standard Silver On Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/440D77AFB74846C1804ACF129B005F56.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540049","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540049-02","MyPriority Holistic Silver - Spectrum Health Partners","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/252F8A6476DC48C09D1203A8FEE7F817.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540049","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540049-03","MyPriority Holistic Silver - Spectrum Health Partners","Limited Cost Sharing Plan Variation","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/6F0A7CCD662D4162884AC847D6AA01FE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540049","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540049-04","MyPriority Holistic Silver - Spectrum Health Partners","73% AV Level Silver Plan","73.59%","0.74114727973938","Yes","Yes","No","100%",,"$1,600","$20","$1,070","$150","$1,600","$480","$460","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/96026167706D4035A26B3AE1CA905D36.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540049","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540049-05","MyPriority Holistic Silver - Spectrum Health Partners","87% AV Level Silver Plan","87.12%","0.875365853309631","Yes","Yes","No","100%",,"$50","$0","$1,350","$150","$50","$700","$650","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/3A584B67321B427380AFB04F9C108909.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540049","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540049-06","MyPriority Holistic Silver - Spectrum Health Partners","94% AV Level Silver Plan","94.18%","0.945171594619751","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$220","$160","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/C50D61B3097E4501B43AEFE4F1162603.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-spectrum-health-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540043","MyPriority Holistic Silver - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540043-00","MyPriority Holistic Silver - Bronson Healthcare Partners","Standard Silver Off Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EC44FF4072D9442DBEA88EE2ADE26502.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540043","MyPriority Holistic Silver - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540043-01","MyPriority Holistic Silver - Bronson Healthcare Partners","Standard Silver On Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EC44FF4072D9442DBEA88EE2ADE26502.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540043","MyPriority Holistic Silver - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540043-02","MyPriority Holistic Silver - Bronson Healthcare Partners","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/EDE1727201094D52B7DE997755A46B19.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540043","MyPriority Holistic Silver - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540043-03","MyPriority Holistic Silver - Bronson Healthcare Partners","Limited Cost Sharing Plan Variation","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/FBAF8141ACFE4D88B70F22BE09F0A1BD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540043","MyPriority Holistic Silver - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540043-04","MyPriority Holistic Silver - Bronson Healthcare Partners","73% AV Level Silver Plan","73.59%","0.74114727973938","Yes","Yes","No","100%",,"$1,600","$20","$1,070","$150","$1,600","$480","$460","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/6EE42721F2D145A7B01048A262327D89.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540043","MyPriority Holistic Silver - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540043-05","MyPriority Holistic Silver - Bronson Healthcare Partners","87% AV Level Silver Plan","87.12%","0.875365853309631","Yes","Yes","No","100%",,"$50","$0","$1,350","$150","$50","$700","$650","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/67B82DF5165F4E6E8F1F90975BA5D978.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0540043","MyPriority Holistic Silver - Bronson Healthcare Partners","29698MI054",,"MIN004","MIS006","MIF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0540043-06","MyPriority Holistic Silver - Bronson Healthcare Partners","94% AV Level Silver Plan","94.18%","0.945171594619751","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$220","$160","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/979F1FC7BFF54DD48C47A687016F09FD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-holistic-silver-bronson-healthcare-partners?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570053","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570053-00","MyPriority POS Holistic Silver 2500","Standard Silver Off Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/67BBC70A6AE94E00A7C7C84252B0898C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570053","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570053-01","MyPriority POS Holistic Silver 2500","Standard Silver On Exchange Plan","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/67BBC70A6AE94E00A7C7C84252B0898C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570053","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570053-02","MyPriority POS Holistic Silver 2500","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/0E3B3FC6798C4A8C8E705AA9F1D78F08.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570053","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570053-03","MyPriority POS Holistic Silver 2500","Limited Cost Sharing Plan Variation","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/AF95F2148F544C5EB17F87E4212E40A5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570053","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570053-04","MyPriority POS Holistic Silver 2500","73% AV Level Silver Plan","73.59%","0.74114727973938","Yes","Yes","No","100%",,"$1,600","$20","$1,070","$150","$1,600","$480","$460","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$22000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","30.00%",,,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/729C170F94C745D895AC02DFACEE1802.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570053","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS003","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570053-05","MyPriority POS Holistic Silver 2500","87% AV Level Silver Plan","87.12%","0.875365853309631","Yes","Yes","No","100%",,"$50","$0","$1,350","$150","$50","$700","$650","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/FFE767C0FE024E4C904A01732896C5DD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570054","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570054-03","MyPriority POS Holistic Silver 2500","Limited Cost Sharing Plan Variation","69.03%","0.695772647857666","Yes","Yes","No","100%",,"$2,500","$10","$800","$150","$2,500","$240","$380","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$28600 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30.00%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/AF95F2148F544C5EB17F87E4212E40A5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570054","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570054-04","MyPriority POS Holistic Silver 2500","73% AV Level Silver Plan","73.59%","0.74114727973938","Yes","Yes","No","100%",,"$1,600","$20","$1,070","$150","$1,600","$480","$460","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$22000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","30.00%",,,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/729C170F94C745D895AC02DFACEE1802.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570054","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570054-05","MyPriority POS Holistic Silver 2500","87% AV Level Silver Plan","87.12%","0.875365853309631","Yes","Yes","No","100%",,"$50","$0","$1,350","$150","$50","$700","$650","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30.00%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/FFE767C0FE024E4C904A01732896C5DD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","29698","SERFF","2017-04-25 20:15:31","Individual","No","38-2715520","29698MI0570054","MyPriority POS Holistic Silver 2500","29698MI057",,"MIN001","MIS002","MIF001","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9902",,,"2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Alternate/Out of Network Benefit Coverage","Yes","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/-/media/19F9091FCBF246408EB7B43F21596FAD.pdf","29698MI0570054-06","MyPriority POS Holistic Silver 2500","94% AV Level Silver Plan","94.18%","0.945171594619751","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$220","$160","$80","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30.00%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/-/media/A5CC02F0B81743288F03EA12A293CB8E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2017/mypriority-pos-holistic-silver-2500?&utm_source=ffm&utm_medium=website&utm_campaign=oep-2017"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","Individual","Yes","38-2587320","31256MI0010001","DENCAP Senior Value Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In-Network Providers Oustise of Service Area Only","No",,"","31256MI0010001-00","DENCAP Senior Value Dental Plan","Standard High Off Exchange Plan","85.01%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","Yes","38-2589320","31256MI0020001","DENCAP Choice Dental Plan 1 to 2 Lives","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In Network Dentists outside of Service Area","No",,"","31256MI0020001-00","DENCAP Choice Dental Plan 1 to 2 Lives","Standard High Off Exchange Plan","86.24%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","Yes","38-2589320","31256MI0020002","DENCAP Choice Dental Plan 3 + Lives","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In Network Dentists outside of Service Area","No",,"","31256MI0020002-00","DENCAP Choice Dental Plan 3 + Lives","Standard High Off Exchange Plan","86.24%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","Individual","Yes","38-2587320","31256MI0010002","DENCAP Individual Value Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In-Network Dentists outside of Service Area","No",,"","31256MI0010002-00","DENCAP Individual Value Dental Plan","Standard High Off Exchange Plan","85.76%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","Yes","38-2589320","31256MI0020003","DENCAP Hallmark Dental Plan","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In Network Dentists outside of Service Area","No",,"","31256MI0020003-00","DENCAP Hallmark Dental Plan","Standard High Off Exchange Plan","84.63%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","Individual","Yes","38-2587320","31256MI0010003","DENCAP Student Individual Value Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In-Network Dentists outside of Service Area","No",,"","31256MI0010003-00","DENCAP Student Individual Value Dental Plan","Standard High Off Exchange Plan","85.81%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","Yes","38-2589320","31256MI0020004","DENCAP Grand Dental Plan","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In Network Dentists outside of Service Area","No",,"","31256MI0020004-00","DENCAP Grand Dental Plan","Standard High Off Exchange Plan","84.57%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","Individual","Yes","38-2587320","31256MI0010005","DENCAP Select Plus Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In-Network Dentists outside of Service Area","No",,"","31256MI0010005-01","DENCAP Select Plus Dental Plan","Standard High On Exchange Plan","85.65%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.net/docs/Schedule-DSP.PDF","http://www.dencap.net/aca.php"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","Individual","Yes","38-2587320","31256MI0010004","DENCAP Select Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01",,"No",,"Yes","In-Network Dentists outside of Service Area","No",,"","31256MI0010004-01","DENCAP Select Dental Plan","Standard Low On Exchange Plan","69.34%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.net/docs/Schedule-DS.PDF","http://www.dencap.net/aca.php"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","Yes","38-2589320","31256MI0020005","DENCAP Freedom Dental Plan","31256MI002",,"MIN001","MIS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","In Network Dentists outside of Service Area","No",,"","31256MI0020005-01","DENCAP Freedom Dental Plan","Standard Low On Exchange Plan","69.83%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.net/docs/Schedule-DF.PDF","http://www.dencap.net/aca.php"
"2017","MI","31256","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","Yes","38-2589320","31256MI0020006","DENCAP Freedom Plus Dental Plan","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","In Network Dentists outside of Service Area","No",,"","31256MI0020006-01","DENCAP Freedom Plus Dental Plan","Standard High On Exchange Plan","84.61%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.net/docs/Schedule-DFP.PDF","http://www.dencap.net/aca.php"
"2017","MI","34930","SERFF","2016-08-19 03:49:17","Individual","Yes","38-1791480","34930MI0090001","Delta Dental Individual PPO, EHB Certified","34930MI009",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0090001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0100001","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0100001-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0100002","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0100002-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","Individual","Yes","38-1791480","34930MI0090002","Delta Dental Individual PPO, EHB Certified","34930MI009",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0090002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","Individual","Yes","38-1791480","34930MI0150001","Delta Dental Individual PPO, EHB Certified (Exchange)","34930MI015",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0150001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_High_2017","http://www.deltadentalmi.com/MI_EHB_High_2017"
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0100003","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0100003-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0100004","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0100004-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","Individual","Yes","38-1791480","34930MI0150002","Delta Dental Individual PPO, EHB Certified (Exchange)","34930MI015",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0150002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_Low_2017","http://www.deltadentalmi.com/MI_EHB_Low_2017"
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0160001","Delta Dental Group PPO, EHB Certified (Exchange)","34930MI016",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0160001-01","Delta Dental Group PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_Group_High_2017","http://www.deltadentalmi.com/MI_EHB_Group_High_2017"
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0160002","Delta Dental Group PPO, EHB Certified (Exchange)","34930MI016",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0160002-01","Delta Dental Group PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_Group_Low_2017","http://www.deltadentalmi.com/MI_EHB_Group_Low_2017"
"2017","MI","34930","SERFF","2016-08-19 03:49:17","Individual","Yes","38-1791480","34930MI0120001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","34930MI012",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0120001-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0110001","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0110001-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0110002","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0110002-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","Individual","Yes","38-1791480","34930MI0120002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","34930MI012",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0120002-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","Individual","Yes","38-1791480","34930MI0170001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","34930MI017",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0170001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_Ped_High_2017","http://www.deltadentalmi.com/MI_Ped_High_2017"
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0110003","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0110003-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","38-1791480","34930MI0110004","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0110004-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","34930","SERFF","2016-08-19 03:49:17","Individual","Yes","38-1791480","34930MI0170002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","34930MI017",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0170002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_Ped_Low_2017","http://www.deltadentalmi.com/MI_Ped_Low_2017"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010037","BESTDental Premium","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010037-00","BESTDental Premium","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017MI_BESTDental_Premium_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","Individual","Yes","95-6042390","35700MI0020003","BESTOne Advantage Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2017/MI_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","Individual","Yes","95-6042390","35700MI0020003","BESTOne Advantage Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2017/MI_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010037","BESTDental Premium","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010037-01","BESTDental Premium","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017MI_BESTDental_Premium_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010038","BESTDental Standard - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010038-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017/MI_BESTDental_Standard-H_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","Individual","Yes","95-6042390","35700MI0020004","BESTOne Plus Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2017/MI_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","Individual","Yes","95-6042390","35700MI0020004","BESTOne Plus Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2017/MI_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010038","BESTDental Standard - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010038-01","BESTDental Standard - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017/MI_BESTDental_Standard-H_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010040","BESTDental Choice - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010040-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017/MI_BESTDental_Choice-H_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010040","BESTDental Choice - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010040-01","BESTDental Choice - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017/MI_BESTDental_Choice-H_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010039","BEST Dental Standard-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010039-00","BEST Dental Standard-L","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","35700","SERFF","2016-08-19 03:49:17","Individual","Yes","95-6042390","35700MI0020005","BESTOne Plus Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2017/MI_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","Individual","Yes","95-6042390","35700MI0020005","BESTOne Plus Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2017/MI_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010039","BEST Dental Standard-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010039-01","BEST Dental Standard-L","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","35700","SERFF","2016-08-19 03:49:17","Individual","Yes","95-6042390","35700MI0020006","BESTOne Basic Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2017/MI_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010041","BEST Dental Choice-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010041-00","BEST Dental Choice-L","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010041","BEST Dental Choice-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010041-01","BEST Dental Choice-L","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","35700","SERFF","2016-08-19 03:49:17","Individual","Yes","95-6042390","35700MI0020006","BESTOne Basic Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2017/MI_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010042","BEST Dental Value","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010042-00","BEST Dental Value","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","35700","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","95-6042390","35700MI0010042","BEST Dental Value","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010042-01","BEST Dental Value","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190002","HAP Personal Alliance 1000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190002-00","HAP Personal Alliance 1000 HMO Henry Ford Choice","Standard Gold Off Exchange Plan","78.04%","0.777849972248077","Yes","Yes","No","100%",,"$1,000","$50","$1,010","$150","$1,000","$750","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-1000hmo-hfchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190002","HAP Personal Alliance 1000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190002-01","HAP Personal Alliance 1000 HMO Henry Ford Choice","Standard Gold On Exchange Plan","78.04%","0.777849972248077","Yes","Yes","No","100%",,"$1,000","$50","$1,010","$150","$1,000","$750","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-1000hmo-hfchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190002","HAP Personal Alliance 1000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190002-02","HAP Personal Alliance 1000 HMO Henry Ford Choice","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-1000hmo-hfchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190002","HAP Personal Alliance 1000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190002-03","HAP Personal Alliance 1000 HMO Henry Ford Choice","Limited Cost Sharing Plan Variation","78.04%","0.777849972248077","Yes","Yes","No","100%",,"$1,000","$50","$1,010","$150","$1,000","$750","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-1000hmo-hfchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150005-00","HAP Personal Alliance 2500 HMO","Standard Silver Off Exchange Plan","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150005-01","HAP Personal Alliance 2500 HMO","Standard Silver On Exchange Plan","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150005-02","HAP Personal Alliance 2500 HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150005-03","HAP Personal Alliance 2500 HMO","Limited Cost Sharing Plan Variation","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150005-04","HAP Personal Alliance 2500-73% HMO","73% AV Level Silver Plan","73.91%","0.735203683376312","Yes","Yes","No","100%",,"$1,800","$460","$890","$150","$1,800","$750","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-73-hmo.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150005-05","HAP Personal Alliance 2500-87% HMO","87% AV Level Silver Plan","87.85%","0.882858455181122","Yes","Yes","No","100%",,"$100","$370","$830","$150","$100","$940","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-87-hmo.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150005-06","HAP Personal Alliance 2500-94% HMO","94% AV Level Silver Plan","94.76%","0.94933146238327","Yes","Yes","No","100%",,"$0","$320","$430","$150","$0","$540","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-94-hmo.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190004-00","HAP Personal Alliance 2500 HMO Henry Ford Choice","Standard Silver Off Exchange Plan","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-hfchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190004-01","HAP Personal Alliance 2500 HMO Henry Ford Choice","Standard Silver On Exchange Plan","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-hfchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190004-02","HAP Personal Alliance 2500 HMO Henry Ford Choice","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-hfchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190004-03","HAP Personal Alliance 2500 HMO Henry Ford Choice","Limited Cost Sharing Plan Variation","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-hfchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190004-04","HAP Personal Alliance 2500-73% HMO Henry Ford Choice","73% AV Level Silver Plan","73.91%","0.735203683376312","Yes","Yes","No","100%",,"$1,800","$460","$890","$150","$1,800","$750","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-73-hmo-hfchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190004-05","HAP Personal Alliance 2500-87% HMO Henry Ford Choice","87% AV Level Silver Plan","87.85%","0.882858455181122","Yes","Yes","No","100%",,"$100","$370","$830","$150","$100","$940","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-87-hmo-hfchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190004-06","HAP Personal Alliance 2500-94% HMO Henry Ford Choice","94% AV Level Silver Plan","94.76%","0.94933146238327","Yes","Yes","No","100%",,"$0","$320","$430","$150","$0","$540","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-94-hmo-hfchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300004-00","HAP Personal Alliance 2500 HMO Genesys Choice","Standard Silver Off Exchange Plan","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-genchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300004-01","HAP Personal Alliance 2500 HMO Genesys Choice","Standard Silver On Exchange Plan","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-genchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150015","HAP Personal Alliance 6550 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150015-00","HAP Personal Alliance 6550 HMO (HSA)","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150015","HAP Personal Alliance 6550 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150015-01","HAP Personal Alliance 6550 HMO (HSA)","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150015","HAP Personal Alliance 6550 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150015-02","HAP Personal Alliance 6550 HMO (HSA)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150015","HAP Personal Alliance 6550 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150015-03","HAP Personal Alliance 6550 HMO (HSA)","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300004-02","HAP Personal Alliance 2500 HMO Genesys Choice","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-genchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300004-03","HAP Personal Alliance 2500 HMO Genesys Choice","Limited Cost Sharing Plan Variation","70.94%","0.703511118888855","Yes","Yes","No","100%",,"$2,500","$180","$890","$150","$2,500","$600","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500hmo-genchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300004-04","HAP Personal Alliance 2500-73% HMO Genesys Choice","73% AV Level Silver Plan","73.91%","0.735203683376312","Yes","Yes","No","100%",,"$1,800","$460","$890","$150","$1,800","$750","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-73-hmo-genchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190006","HAP Personal Alliance 5000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190006-03","HAP Personal Alliance 5000 HMO Henry Ford Choice","Limited Cost Sharing Plan Variation",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-hfchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300006","HAP Personal Alliance 5000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300006-00","HAP Personal Alliance 5000 HMO Genesys Choice","Standard Bronze Off Exchange Plan",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-genchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300006","HAP Personal Alliance 5000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300006-01","HAP Personal Alliance 5000 HMO Genesys Choice","Standard Bronze On Exchange Plan",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-genchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300006","HAP Personal Alliance 5000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300006-02","HAP Personal Alliance 5000 HMO Genesys Choice","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-genchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300006","HAP Personal Alliance 5000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300006-03","HAP Personal Alliance 5000 HMO Genesys Choice","Limited Cost Sharing Plan Variation",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-genchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150012","HAP Personal Alliance 5500 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150012-00","HAP Personal Alliance 5500 HMO (HSA)","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300004-05","HAP Personal Alliance 2500-87% HMO Genesys Choice","87% AV Level Silver Plan","87.85%","0.882858455181122","Yes","Yes","No","100%",,"$100","$370","$830","$150","$100","$940","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-87-hmo-genchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300004-06","HAP Personal Alliance 2500-94% HMO Genesys Choice","94% AV Level Silver Plan","94.76%","0.94933146238327","Yes","Yes","No","100%",,"$0","$320","$430","$150","$0","$540","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-2500-94-hmo-genchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3250 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150014-00","HAP Personal Alliance 3250 HMO","Standard Silver Off Exchange Plan","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3250 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150014-01","HAP Personal Alliance 3250 HMO","Standard Silver On Exchange Plan","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3250 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150014-02","HAP Personal Alliance 3250 HMO","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3250 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150014-03","HAP Personal Alliance 3250 HMO","Limited Cost Sharing Plan Variation","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3250 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150014-04","HAP Personal Alliance 3250-73% HMO","73% AV Level Silver Plan","73.68%",,"Yes","Yes","No","100%",,"$1,750","$20","$1,650","$150","$1,750","$470","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-73-hmo.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3250 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150014-05","HAP Personal Alliance 3250-87% HMO","87% AV Level Silver Plan","87.77%",,"Yes","Yes","No","100%",,"$100","$0","$1,450","$150","$100","$600","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-87-hmo.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3250 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150014-06","HAP Personal Alliance 3250-94% HMO","94% AV Level Silver Plan","94.60%",,"Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$200","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-94-hmo.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3250 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190009-00","HAP Personal Alliance 3250 HMO Henry Ford Choice","Standard Silver Off Exchange Plan","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-hfchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3250 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190009-01","HAP Personal Alliance 3250 HMO Henry Ford Choice","Standard Silver On Exchange Plan","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-hfchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3250 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190009-02","HAP Personal Alliance 3250 HMO Henry Ford Choice","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-hfchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3250 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190009-03","HAP Personal Alliance 3250 HMO Henry Ford Choice","Limited Cost Sharing Plan Variation","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-hfchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3250 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190009-04","HAP Personal Alliance 3250-73% HMO Henry Ford Choice","73% AV Level Silver Plan","73.68%",,"Yes","Yes","No","100%",,"$1,750","$20","$1,650","$150","$1,750","$470","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-73-hmo-hfchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3250 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190009-05","HAP Personal Alliance 3250-87% HMO Henry Ford Choice","87% AV Level Silver Plan","87.77%",,"Yes","Yes","No","100%",,"$100","$0","$1,450","$150","$100","$600","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-87-hmo-hfchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3250 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190009-06","HAP Personal Alliance 3250-94% HMO Henry Ford Choice","94% AV Level Silver Plan","94.60%",,"Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$200","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-94-hmo-hfchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3250 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300009-00","HAP Personal Alliance 3250 HMO Genesys Choice","Standard Silver Off Exchange Plan","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-genchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3250 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300009-01","HAP Personal Alliance 3250 HMO Genesys Choice","Standard Silver On Exchange Plan","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-genchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3250 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300009-02","HAP Personal Alliance 3250 HMO Genesys Choice","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-genchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3250 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300009-03","HAP Personal Alliance 3250 HMO Genesys Choice","Limited Cost Sharing Plan Variation","68.50%",,"Yes","Yes","No","100%",,"$3,250","$20","$1,200","$150","$3,250","$300","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250hmo-genchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3250 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300009-04","HAP Personal Alliance 3250-73% HMO Genesys Choice","73% AV Level Silver Plan","73.68%",,"Yes","Yes","No","100%",,"$1,750","$20","$1,650","$150","$1,750","$470","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-73-hmo-genchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3250 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300009-05","HAP Personal Alliance 3250-87% HMO Genesys Choice","87% AV Level Silver Plan","87.77%",,"Yes","Yes","No","100%",,"$100","$0","$1,450","$150","$100","$600","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-87-hmo-genchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3250 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300009-06","HAP Personal Alliance 3250-94% HMO Genesys Choice","94% AV Level Silver Plan","94.60%",,"Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$200","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-3250-94-hmo-genchoice.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150007","HAP Personal Alliance 5000 HMO","37651MI015",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150007-00","HAP Personal Alliance 5000 HMO","Standard Bronze Off Exchange Plan",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150007","HAP Personal Alliance 5000 HMO","37651MI015",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150007-01","HAP Personal Alliance 5000 HMO","Standard Bronze On Exchange Plan",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150007","HAP Personal Alliance 5000 HMO","37651MI015",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150007-02","HAP Personal Alliance 5000 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150007","HAP Personal Alliance 5000 HMO","37651MI015",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150007-03","HAP Personal Alliance 5000 HMO","Limited Cost Sharing Plan Variation",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190006","HAP Personal Alliance 5000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190006-00","HAP Personal Alliance 5000 HMO Henry Ford Choice","Standard Bronze Off Exchange Plan",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-hfchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190006","HAP Personal Alliance 5000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190006-01","HAP Personal Alliance 5000 HMO Henry Ford Choice","Standard Bronze On Exchange Plan",,"0.617332220077515","No","Yes","No","100%",,"$5,020","$0","$680","$150","$4,420","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-hfchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190006","HAP Personal Alliance 5000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190006-02","HAP Personal Alliance 5000 HMO Henry Ford Choice","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2017-pa-5000hmo-hfchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150012","HAP Personal Alliance 5500 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150012-01","HAP Personal Alliance 5500 HMO (HSA)","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150012","HAP Personal Alliance 5500 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150012-02","HAP Personal Alliance 5500 HMO (HSA)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150012","HAP Personal Alliance 5500 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150012-03","HAP Personal Alliance 5500 HMO (HSA)","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190007","HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190007-00","HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-hfchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190007","HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190007-01","HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-hfchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190007","HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190007-02","HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-hfchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190007","HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190007-03","HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-hfchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300007","HAP Personal Alliance 5500 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300007-00","HAP Personal Alliance 5500 HMO (HSA) Genesys Choice","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-genchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300007","HAP Personal Alliance 5500 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300007-01","HAP Personal Alliance 5500 HMO (HSA) Genesys Choice","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-genchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300007","HAP Personal Alliance 5500 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300007-02","HAP Personal Alliance 5500 HMO (HSA) Genesys Choice","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-genchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300007","HAP Personal Alliance 5500 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300007-03","HAP Personal Alliance 5500 HMO (HSA) Genesys Choice","Limited Cost Sharing Plan Variation",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$360","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-5500hmo-hsa-genchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190010","HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190010-00","HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-hfchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190010","HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190010-01","HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-hfchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190010","HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190010-02","HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-hfchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300008","HAP Personal Alliance 7150 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300008-01","HAP Personal Alliance 7150 HMO Genesys Choice","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-7150hmo-genchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190010","HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190010-03","HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-hfchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300010","HAP Personal Alliance 6550 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300010-00","HAP Personal Alliance 6550 HMO (HSA) Genesys Choice","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-genchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300010","HAP Personal Alliance 6550 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300010-01","HAP Personal Alliance 6550 HMO (HSA) Genesys Choice","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-genchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300010","HAP Personal Alliance 6550 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300010-02","HAP Personal Alliance 6550 HMO (HSA) Genesys Choice","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-genchoice-naanzero.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300010","HAP Personal Alliance 6550 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300010-03","HAP Personal Alliance 6550 HMO (HSA) Genesys Choice","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.hap.org/sbc/2017-pa-6550hmo-hsa-genchoice-naanltd.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150013","HAP Personal Alliance 7150 HMO","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150013-00","HAP Personal Alliance 7150 HMO","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-7150hmo-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0150013","HAP Personal Alliance 7150 HMO","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0150013-01","HAP Personal Alliance 7150 HMO","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-7150hmo-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190008","HAP Personal Alliance 7150 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190008-00","HAP Personal Alliance 7150 HMO Henry Ford Choice","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-7150hmo-hfchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0190008","HAP Personal Alliance 7150 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0190008-01","HAP Personal Alliance 7150 HMO Henry Ford Choice","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-7150hmo-hfchoice-on.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","37651","SERFF","2016-10-19 03:51:02","Individual","No","38-2242827","37651MI0300008","HAP Personal Alliance 7150 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9977",,,"2017-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2017drugformulary.pdf","37651MI0300008-00","HAP Personal Alliance 7150 HMO Genesys Choice","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.hap.org/sbc/2017-pa-7150hmo-genchoice-off.pdf","https://www.hap.org/healthinsurance/personalalliance/pdf/2017sales.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070001-05","Molina Marketplace Options Silver Plan","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,010","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070001-06","Molina Marketplace Options Silver Plan","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070002","Molina Marketplace Options Bronze Plan","40047MI007",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070002-00","Molina Marketplace Options Bronze Plan","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070002","Molina Marketplace Options Bronze Plan","40047MI007",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070002-01","Molina Marketplace Options Bronze Plan","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070002","Molina Marketplace Options Bronze Plan","40047MI007",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070002-02","Molina Marketplace Options Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070002","Molina Marketplace Options Bronze Plan","40047MI007",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070002-03","Molina Marketplace Options Bronze Plan","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010018","Humana Silver 3550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010018-02","Humana Silver 3550/Michigan HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846987",
"2017","MI","38791","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","38791MI0040002","EHB High PPO","38791MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0040002-00","EHB High PPO","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","MI","38791","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","38791MI0040001","EHB Low PPO","38791MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010016","Humana Basic 7150/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010016-00","Humana Basic 7150/Michigan HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846532",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010016","Humana Basic 7150/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010016-01","Humana Basic 7150/Michigan HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846532",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010002","Humana Bronze 6550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010002-00","Humana Bronze 6550/Detroit HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846558",
"2017","MI","38791","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","38791MI0030002","EHB High Passive","38791MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0030002-00","EHB High Passive","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","MI","38791","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","38791MI0030001","EHB Low Passive","38791MI003",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010001-00","Molina Marketplace Gold Plan","Standard Gold Off Exchange Plan",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010001-01","Molina Marketplace Gold Plan","Standard Gold On Exchange Plan",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010001-02","Molina Marketplace Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010001-03","Molina Marketplace Gold Plan","Limited Cost Sharing Plan Variation",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010002-00","Molina Marketplace Silver Plan","Standard Silver Off Exchange Plan",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010002-01","Molina Marketplace Silver Plan","Standard Silver On Exchange Plan",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010002-02","Molina Marketplace Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010002-03","Molina Marketplace Silver Plan","Limited Cost Sharing Plan Variation",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010002-04","Molina Marketplace Silver Plan","73% AV Level Silver Plan",,"0.739960968494415","No","Yes","No","100%",,"$2,270","$290","$1,340","$150","$2,270","$400","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,275","$2275 per person","$4550 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,275","$2275 per person","$4550 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010002-05","Molina Marketplace Silver Plan","87% AV Level Silver Plan",,"0.879880011081696","No","Yes","No","100%",,"$500","$180","$890","$150","$500","$320","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010002-06","Molina Marketplace Silver Plan","94% AV Level Silver Plan",,"0.9497309923172","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010003-00","Molina Marketplace Bronze Plan","Standard Bronze Off Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010003-01","Molina Marketplace Bronze Plan","Standard Bronze On Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010003-02","Molina Marketplace Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0010003-03","Molina Marketplace Bronze Plan","Limited Cost Sharing Plan Variation",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070001-00","Molina Marketplace Options Silver Plan","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070001-01","Molina Marketplace Options Silver Plan","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070001-02","Molina Marketplace Options Silver Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070001-03","Molina Marketplace Options Silver Plan","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","40047","SERFF","2016-08-23 04:37:23","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2017.pdf","40047MI0070001-04","Molina Marketplace Options Silver Plan","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2016.pdf"
"2017","MI","41183","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","93-0242990","41183MI0040002","EHB High PPO","41183MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0040002-00","EHB High PPO","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","MI","41183","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","93-0242990","41183MI0040001","EHB Low PPO","41183MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","MI","41183","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","93-0242990","41183MI0030002","EHB High Passive","41183MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0030002-00","EHB High Passive","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","MI","41183","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","93-0242990","41183MI0030001","EHB Low Passive","41183MI003",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","MI","46016","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","46016MI0040002","EHB High PPO","46016MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0040002-00","EHB High PPO","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","MI","46016","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","46016MI0040001","EHB Low PPO","46016MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","MI","46016","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","46016MI0030002","EHB High Passive","46016MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0030002-00","EHB High Passive","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","MI","46016","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","46016MI0030001","EHB Low Passive","46016MI003",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010001","Humana Basic 7150/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010001-00","Humana Basic 7150/Detroit HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846506",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010001","Humana Basic 7150/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010001-01","Humana Basic 7150/Detroit HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846506",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010002","Humana Bronze 6550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010002-01","Humana Bronze 6550/Detroit HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846558",
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-06","Meridian Smart Silver","94% AV Level Silver Plan",,"0.948270797729492","Yes","Yes","No","100%",,"$0","$0","$500","$150","$0","$0","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=KPzAI7v743IkZ2W/NZK4PEDXMcqmOSMirMMwYSvIw8Kl5rq8PUnBCweymKSQTqGgSCNU/rIi8gJNQevDuCBENw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020024","Meridian Standard Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020024-00","Meridian Standard Silver","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$260","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=laSX06DdZD/AjmMc+ablJFcUSrZkQbrt4S62TNFXYRmV43Na50sTxcVwIBIg6aFIrozJzOTOPsB+up7pUpnbfQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020024","Meridian Standard Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020024-01","Meridian Standard Silver","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$260","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=laSX06DdZD/AjmMc+ablJFcUSrZkQbrt4S62TNFXYRmV43Na50sTxcVwIBIg6aFIrozJzOTOPsB+up7pUpnbfQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020024","Meridian Standard Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020024-02","Meridian Standard Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=ejIg63yZQcCjoJ2dK/Z4xbJHuR37ieHPeYiPulxLYl0t0086xi0uAwdJ5pGhucKu3S0bz9d0mV1wXaVvaPP/YA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020024","Meridian Standard Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020024-03","Meridian Standard Silver","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$260","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=laSX06DdZD/AjmMc+ablJFcUSrZkQbrt4S62TNFXYRmV43Na50sTxcVwIBIg6aFIrozJzOTOPsB+up7pUpnbfQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020024","Meridian Standard Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020024-04","Meridian Standard Silver","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$200","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=W/nWu8qpXtsgjMuXvJv//bWUlrd/UwH3w8paUf5LrLB31HfRzgVjefwDJTGcu0/A5aYs8knHj8iGiq6tIPVC2g==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020024","Meridian Standard Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020024-05","Meridian Standard Silver","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$150","$700","$180","$420","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=aMcJydBoTTmVAK6/lT0Oktnvv576ZsSyICoLUch4h5IO+G+o21Q2rr2MnDRywCTDdcZOsuPMMcpTs1dc7mSb6g==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010002","Humana Bronze 6550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010002-02","Humana Bronze 6550/Detroit HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846571",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010002","Humana Bronze 6550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010002-03","Humana Bronze 6550/Detroit HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846584",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010017","Humana Bronze 6550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010017-00","Humana Bronze 6550/Michigan HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846610",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010017","Humana Bronze 6550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010017-01","Humana Bronze 6550/Michigan HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2846610",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010017","Humana Bronze 6550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010017-02","Humana Bronze 6550/Michigan HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846792",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010017","Humana Bronze 6550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-EHB","46275MI0010017-03","Humana Bronze 6550/Michigan HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2846805",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010003","Humana Silver 3550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010003-00","Humana Silver 3550/Detroit HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846922",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010003","Humana Silver 3550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010003-01","Humana Silver 3550/Detroit HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846922",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010003","Humana Silver 3550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010003-02","Humana Silver 3550/Detroit HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846935",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010003","Humana Silver 3550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010003-03","Humana Silver 3550/Detroit HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846948",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010003","Humana Silver 3550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010003-04","Humana Silver 3000/Detroit HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846896",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010003","Humana Silver 3550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010003-05","Humana Silver 900/Detroit HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847026",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010003","Humana Silver 3550/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010003-06","Humana Silver 2550/Detroit HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846870",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010018","Humana Silver 3550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010018-00","Humana Silver 3550/Michigan HMOx","Standard Silver Off Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846974",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010018","Humana Silver 3550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010018-01","Humana Silver 3550/Michigan HMOx","Standard Silver On Exchange Plan",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846974",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010018","Humana Silver 3550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010018-03","Humana Silver 3550/Michigan HMOx","Limited Cost Sharing Plan Variation",,"0.680584013462067","No","Yes","Yes","97%","3%","$3,550","$20","$740","$30","$3,550","$250","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,550","$3550 per person","$7100 per group","20.00%","$3,550","$3550 per person","$7100 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847000",
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020007-00","Meridian Healthy Bronze","Standard Bronze Off Exchange Plan",,"0.616049110889435","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020007-01","Meridian Healthy Bronze","Standard Bronze On Exchange Plan",,"0.616049110889435","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020007-02","Meridian Healthy Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020007-03","Meridian Healthy Bronze","Limited Cost Sharing Plan Variation",,"0.616049110889435","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-00","Meridian Healthy Silver","Standard Silver Off Exchange Plan",,"0.680218040943146","No","Yes","No","100%",,"$5,420","$0","$370","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-01","Meridian Healthy Silver","Standard Silver On Exchange Plan",,"0.680218040943146","No","Yes","No","100%",,"$5,420","$0","$370","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-02","Meridian Healthy Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=R2AHsUMdgkhBMEGnJJ8fGyzUqJLEeB1qiEX/Xuw6NQSnun6/dB4A0LWZgiNpsS4Of7J485sB8JLz0QXcECMJ9w==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010018","Humana Silver 3550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010018-04","Humana Silver 3000/Michigan HMOx","73% AV Level Silver Plan",,"0.720863997936249","No","Yes","Yes","97%","3%","$3,000","$10","$850","$30","$3,000","$280","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%","$500","$500 per person","$1000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846909",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010018","Humana Silver 3550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010018-05","Humana Silver 900/Michigan HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2847039",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010018","Humana Silver 3550/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010018-06","Humana Silver 250/Michigan HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846883",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010021","Humana Gold 1250/Michigan HMOx","46275MI001",,"MIN002","MIS003","MIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010021-00","Humana Gold 1250/Michigan HMOx","Standard Gold Off Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846831",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010021","Humana Gold 1250/Michigan HMOx","46275MI001",,"MIN002","MIS003","MIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010021-01","Humana Gold 1250/Michigan HMOx","Standard Gold On Exchange Plan",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846831",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010021","Humana Gold 1250/Michigan HMOx","46275MI001",,"MIN002","MIS003","MIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010021-02","Humana Gold 1250/Michigan HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846844",
"2017","MI","46275","SERFF","2017-01-25 20:15:24","Individual","No","27-3991410","46275MI0010021","Humana Gold 1250/Michigan HMOx","46275MI001",,"MIN002","MIS003","MIF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus","46275MI0010021-03","Humana Gold 1250/Michigan HMOx","Limited Cost Sharing Plan Variation",,"0.784651756286621","No","Yes","Yes","97%","3%","$1,250","$10","$1,200","$30","$1,250","$450","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%","$1,250","$1250 per person","$2500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%","$500","$500 per person","$1000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2846857",
"2017","MI","47007","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","42-0127290","47007MI0040001","Principal Plan Dental 70","47007MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"0.72","Estimated Rate","2017-01-01","2017-12-31","Yes","Same as any other","Yes","Same as any other","Yes",,"","47007MI0040001-00","Principal Plan Dental 70","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47638","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","Yes","20-3805292","47638MI0010001","Retailers Insurance Company - EHB","47638MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47638MI0010001-00","Retailers Insurance Company - EHB","Standard High Off Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47638","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","Yes","20-3805292","47638MI0010002","Retailers Insurance Company - EHB","47638MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47638MI0010002-00","Retailers Insurance Company - EHB","Standard Low Off Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0010001","Securian Dental with Essential Health Benefits - Employer Paid D-1","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $1000",,"No","Allows Adult and Child-Only",,,,,"0.9","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010001-00","Securian Dental with Essential Health Benefits - Employer Paid D-1","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0010003","Securian Dental with Essential Health Benefits - Employer Paid D-3","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $1500",,"No","Allows Adult and Child-Only",,,,,"0.826","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010003-00","Securian Dental with Essential Health Benefits - Employer Paid D-3","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0010005","Securian Dental with Essential Health Benefits - Employer Paid D-5","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $2000",,"No","Allows Adult and Child-Only",,,,,"0.75","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010005-00","Securian Dental with Essential Health Benefits - Employer Paid D-5","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0020001","Securian Dental with Essential Health Benefits -Voluntary D-1","47822MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $1000",,"No","Allows Adult and Child-Only",,,,,"0.933","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0020001-00","Securian Dental with Essential Health Benefits -Voluntary D-1","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0020003","Securian Dental with Essential Health Benefits -Voluntary D-3","47822MI002",,"MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $1500",,"No","Allows Adult and Child-Only",,,,,"0.856","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0020003-00","Securian Dental with Essential Health Benefits -Voluntary D-3","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0010002","Securian Dental with Essential Health Benefits - Employer Paid D-2","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $1000",,"No","Allows Adult and Child-Only",,,,,"0.9","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010002-00","Securian Dental with Essential Health Benefits - Employer Paid D-2","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0010004","Securian Dental with Essential Health Benefits - Employer Paid D-4","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $1500",,"No","Allows Adult and Child-Only",,,,,"0.826","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010004-00","Securian Dental with Essential Health Benefits - Employer Paid D-4","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0010006","Securian Dental with Essential Health Benefits - Employer Paid D-6","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $2000",,"No","Allows Adult and Child-Only",,,,,"0.75","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010006-00","Securian Dental with Essential Health Benefits - Employer Paid D-6","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0020002","Securian Dental with Essential Health Benefits -Voluntary D-2","47822MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $1000",,"No","Allows Adult and Child-Only",,,,,"0.933","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0020002-00","Securian Dental with Essential Health Benefits -Voluntary D-2","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","47822","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","41-1412669","47822MI0020004","Securian Dental with Essential Health Benefits -Voluntary D-4","47822MI002",,"MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Annual Maximum $1500",,"No","Allows Adult and Child-Only",,,,,"0.856","Estimated Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0020004-00","Securian Dental with Essential Health Benefits -Voluntary D-4","Standard High Off Exchange Plan","84.15%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","53678","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","72-0977315","53678MI0040001","AlwaysCare Small Group – Child","53678MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0040001-00","AlwaysCare Small Group – Child","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",
"2017","MI","53678","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","72-0977315","53678MI0040002","AlwaysCare Small Group – Child","53678MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0040002-00","AlwaysCare Small Group – Child","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",
"2017","MI","53678","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","72-0977315","53678MI0030001","AlwaysCare Small Group Dental – Adults","53678MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0030001-00","AlwaysCare Small Group Dental – Adults","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",
"2017","MI","53678","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","72-0977315","53678MI0030002","AlwaysCare Small Group Dental – Adults","53678MI003",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0030002-00","AlwaysCare Small Group Dental – Adults","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020001","Meridian Catastrophic","58594MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020001-00","Meridian Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=IKJ25dEKsHg0INidkhnV2hEBR2wMf25zNDcE1JjLmuQNWTG5S3genMZPpltOMMKJfsR+Bv2wzIKnyzo21UHzBA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020001","Meridian Catastrophic","58594MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020001-01","Meridian Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=IKJ25dEKsHg0INidkhnV2hEBR2wMf25zNDcE1JjLmuQNWTG5S3genMZPpltOMMKJfsR+Bv2wzIKnyzo21UHzBA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-03","Meridian Healthy Silver","Limited Cost Sharing Plan Variation",,"0.680218040943146","No","Yes","No","100%",,"$5,420","$0","$370","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-04","Meridian Healthy Silver","73% AV Level Silver Plan",,"0.738557755947113","No","Yes","No","100%",,"$1,920","$0","$1,070","$150","$2,400","$590","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=2pogkqx4ad9PyM/JMHJYEA7ifdSTfcRjgpOHXVtjc9Ou1bf0YGDloCgOfweQeJgJ2v9hNqHz/PzoVXoCcPGj2A==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-05","Meridian Healthy Silver","87% AV Level Silver Plan",,"0.879471659660339","No","Yes","No","100%",,"$470","$0","$680","$150","$600","$390","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=+9RUTAH3djmVzlCalNzs3E4vLpWcVNT+oVJA1bl908ClK/CBgRUqa79V0Bik3t0UNa3BUyiEopSlOsO/2+xFxg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-06","Meridian Healthy Silver","94% AV Level Silver Plan",,"0.949854493141174","No","Yes","No","100%",,"$150","$10","$0","$150","$150","$160","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=uSuc8Jya8W5kyaBoLEDn+f0h3woXfREOrbEajPZOvBlMCGoxanAgcA4d1XDjPCWocGsLaYLZ/YPQ21MULkjdpA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020009-00","Meridian Healthy Gold","Standard Gold Off Exchange Plan",,"0.780237793922424","No","Yes","No","100%",,"$2,220","$0","$1,010","$150","$3,200","$220","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020009-01","Meridian Healthy Gold","Standard Gold On Exchange Plan",,"0.780237793922424","No","Yes","No","100%",,"$2,220","$0","$1,010","$150","$3,200","$220","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020009-02","Meridian Healthy Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=4j4lpRFf7qnX8VaJXG6wKLgMYQEUpsiE+q4wlAFa1eSBTJeIjfAudXCv5vG03v1aqz5SRKo9SUY7+f5sDg4WnQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020009-03","Meridian Healthy Gold","Limited Cost Sharing Plan Variation",,"0.780237793922424","No","Yes","No","100%",,"$2,220","$0","$1,010","$150","$3,200","$220","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-00","Meridian Smart Silver","Standard Silver Off Exchange Plan",,"0.701747357845306","Yes","Yes","No","100%",,"$0","$20","$3,630","$150","$0","$800","$1,210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=EXAugUt5YTr1FTap6cF5/7Y6MIjSJPjl5S54faTApSlKtDJNW2nTffogkY7Gi5ZcusQGmNzT7xumQw7530afqA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-01","Meridian Smart Silver","Standard Silver On Exchange Plan",,"0.701747357845306","Yes","Yes","No","100%",,"$0","$20","$3,630","$150","$0","$800","$1,210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=EXAugUt5YTr1FTap6cF5/7Y6MIjSJPjl5S54faTApSlKtDJNW2nTffogkY7Gi5ZcusQGmNzT7xumQw7530afqA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-02","Meridian Smart Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=91uNVLJoNMgTf8I/8bCYretCrrMe2A3ufeKXjJQjcGyJ1tVRJ6OFduIw/3uudi6ZYf9t8W44nYcP5FwlOqHITw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-03","Meridian Smart Silver","Limited Cost Sharing Plan Variation",,"0.701747357845306","Yes","Yes","No","100%",,"$0","$20","$3,630","$150","$0","$800","$1,210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=EXAugUt5YTr1FTap6cF5/7Y6MIjSJPjl5S54faTApSlKtDJNW2nTffogkY7Gi5ZcusQGmNzT7xumQw7530afqA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-04","Meridian Smart Silver","73% AV Level Silver Plan",,"0.739848077297211","Yes","Yes","No","100%",,"$0","$20","$3,630","$150","$0","$600","$1,210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=J6ty9f2qBfXnbv6ohdzUN948FHTPx/K0MyB4Gc0QO7iJDFJwWOtxeGtABZYWdWA7qETKxWuADpOZhnvmonLDqw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-05","Meridian Smart Silver","87% AV Level Silver Plan",,"0.879416227340698","Yes","Yes","No","100%",,"$0","$0","$1,500","$150","$0","$200","$730","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=0OJO1he8gbg6zTojajCTTF1Dzzl3+SpkJ9ct+P3UaN/htcg8xh6Cy0yIErlZsUJzPFJyaGESx6IaM9mqCBGVBQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","58594","SERFF","2017-01-25 20:15:24","Individual","No","38-3253977","58594MI0020024","Meridian Standard Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Design 1","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020024-06","Meridian Standard Silver","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$350","$150","$250","$120","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=B3s5LUb92DK9CjREB78PhApx/sqdJzJQ1dd/tfM/qajZQcgW6Y6HlXNdR1znXWJFRZ8uA4M3nG3KFbiFJ9AJ8w==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ=="
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum 250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200001-00","Sparrow PHP Platinum 250 HMO","Standard Platinum Off Exchange Plan",,"0.906604647636414","No","Yes","No","100%",,"$250","$15","$985","$150","$250","$968","$32","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200001_Ind2017S_Platinum250HMO_OffBase_PFA00100RX08F365.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200001_Ind2017C_Platinum250HMO_OffBase_PFA00100RX08F365.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum 250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200001-01","Sparrow PHP Platinum 250 HMO","Standard Platinum On Exchange Plan",,"0.906604647636414","No","Yes","No","100%",,"$250","$15","$985","$150","$250","$968","$32","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200001_Ind2017S_Platinum250HMO_OnBase_PNA00100RX08E365.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200001_Ind2017C_Platinum250HMO_OnBase_PNA00100RX08E365.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum 250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200001-02","Sparrow PHP Platinum 250 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200001_Ind2017S_Platinum250HMO_OnZero_PNA00300RX08E366.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200001_Ind2017C_Platinum250HMO_OnZero_PNA00300RX08E366.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum 250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200001-03","Sparrow PHP Platinum 250 HMO","Limited Cost Sharing Plan Variation",,"0.906604647636414","No","Yes","No","100%",,"$250","$15","$985","$150","$250","$968","$32","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200001_Ind2017S_Platinum250HMO_OnNAspec_PNA00200RX08E367.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200001_Ind2017C_Platinum250HMO_OnNAspec_PNA00200RX08E367.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200006","Sparrow PHP Platinum 500-100Percent HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200006-00","Sparrow PHP Platinum 500-100Percent HMO","Standard Platinum Off Exchange Plan",,"0.881839871406555","No","Yes","No","100%",,"$500","$15","$0","$150","$412","$1,259","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200006_Ind2017S_Platinum500100HMO_OffBase_PFA00700RX08F368.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200006_Ind2017C_Platinum500100HMO_OffBase_PFA00700RX08F368.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200006","Sparrow PHP Platinum 500-100Percent HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200006-01","Sparrow PHP Platinum 500-100Percent HMO","Standard Platinum On Exchange Plan",,"0.881839871406555","No","Yes","No","100%",,"$500","$15","$0","$150","$412","$1,259","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200001_Ind2017S_Platinum500100HMO_OnBase_PNA00700RX08E368.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200001_Ind2017C_Platinum500100HMO_OnBase_PNA00700RX08E368.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200006","Sparrow PHP Platinum 500-100Percent HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200006-02","Sparrow PHP Platinum 500-100Percent HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200006_Ind2017S_Platinum500100HMO_OnZero_PNA00800RX08E369.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200006_Ind2017C_Platinum500100HMO_OnZero_PNA00800RX08E369.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200006","Sparrow PHP Platinum 500-100Percent HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200006-03","Sparrow PHP Platinum 500-100Percent HMO","Limited Cost Sharing Plan Variation",,"0.881839871406555","No","Yes","No","100%",,"$500","$15","$0","$150","$412","$1,259","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200006_Ind2017S_Platinum500100HMO_OnNAspec_PNA00900RX08E370.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200006_Ind2017C_Platinum500100HMO_OnNAspec_PNA00900RX08E370.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190006","Sparrow PHP Platinum 250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190006-00","Sparrow PHP Platinum 250 Exclusive","Standard Platinum Off Exchange Plan",,"0.906604647636414","No","Yes","No","100%",,"$250","$15","$985","$150","$250","$968","$32","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190006_Ind2017S_Platinum250Exc_OffBase_PFN00100RX08F365.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190006_Ind2017C_Platinum250Exc_OffBase_PFN00100RX08F365.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190006","Sparrow PHP Platinum 250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190006-01","Sparrow PHP Platinum 250 Exclusive","Standard Platinum On Exchange Plan",,"0.906604647636414","No","Yes","No","100%",,"$250","$15","$985","$150","$250","$968","$32","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190006_Ind2017S_Platinum250Exc_OnBase_PNN00100RX08E365.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190006_Ind2017C_Platinum250Exc_OnBase_PNN00100RX08E365.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190006","Sparrow PHP Platinum 250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190006-02","Sparrow PHP Platinum 250 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190006_Ind2017S_Platinum250Exc_OnZero_PNN00300RX08E366.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190006_Ind2017C_Platinum250Exc_OnZero_PNN00300RX08E366.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190006","Sparrow PHP Platinum 250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190006-03","Sparrow PHP Platinum 250 Exclusive","Limited Cost Sharing Plan Variation",,"0.906604647636414","No","Yes","No","100%",,"$250","$15","$985","$150","$250","$968","$32","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190006_Ind2017S_Platinum250Exc_OnNAspec_PNN00200RX08E367.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190006_Ind2017C_Platinum250Exc_OnNAspec_PNN00200RX08E367.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold 1000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190001-03","Sparrow PHP Gold 1000 Exclusive","Limited Cost Sharing Plan Variation",,"0.79235053062439","No","Yes","No","100%",,"$1,000","$23","$1,225","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190001_Ind2017S_Gold1000Exc_OnNAspec_GNN02100RX08E379.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190001_Ind2017C_Gold1000Exc_OnNAspec_GNN02100RX08E379.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190010","Sparrow PHP Gold 1250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF014","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190010-00","Sparrow PHP Gold 1250 Exclusive","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$15","$1,175","$150","$412","$1,169","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190010_Ind2017S_Gold1250Exc_OffBase_GFN01600RX08F362.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190010_Ind2017C_Gold1250Exc_OffBase_GFN01600RX08F362.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190010","Sparrow PHP Gold 1250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF014","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190010-01","Sparrow PHP Gold 1250 Exclusive","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$15","$1,175","$150","$412","$1,169","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190010_Ind2017S_Gold1250Exc_OnBase_GNN01600RX08E362.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190010_Ind2017C_Gold1250Exc_OnBase_GNN01600RX08E362.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190008","Sparrow PHP Gold 500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190008-03","Sparrow PHP Gold 500 Exclusive","Limited Cost Sharing Plan Variation",,"0.819181740283966","No","Yes","No","100%",,"$500","$23","$1,325","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190008_Ind2017S_Gold500Exc_OnNAspec_GNN00200RX08E373.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190008_Ind2017C_Gold500Exc_OnNAspec_GNN00200RX08E373.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190009","Sparrow PHP Gold 500 Basic Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190009-00","Sparrow PHP Gold 500 Basic Exclusive","Standard Gold Off Exchange Plan",,"0.780882000923157","No","Yes","No","100%",,"$500","$23","$1,987","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190009_Ind2017S_Gold500BasicExc_OffBase_GFN01000RX08F374.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190009_Ind2017C_Gold500BasicExc_OffBase_GFN01000RX08F374.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190009","Sparrow PHP Gold 500 Basic Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190009-01","Sparrow PHP Gold 500 Basic Exclusive","Standard Gold On Exchange Plan",,"0.780882000923157","No","Yes","No","100%",,"$500","$23","$1,987","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190009_Ind2017S_Gold500BasicExc_OnBase_GNN01000RX08E374.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190009_Ind2017C_Gold500BasicExc_OnBase_GNN01000RX08E374.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190009","Sparrow PHP Gold 500 Basic Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190009-02","Sparrow PHP Gold 500 Basic Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190009_Ind2017S_Gold500BasicExc_OnZero_GNN01100RX08E375.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190009_Ind2017C_Gold500BasicExc_OnZero_GNN01100RX08E375.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190009","Sparrow PHP Gold 500 Basic Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190009-03","Sparrow PHP Gold 500 Basic Exclusive","Limited Cost Sharing Plan Variation",,"0.780882000923157","No","Yes","No","100%",,"$500","$23","$1,987","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190009_Ind2017S_Gold500BasicExc_OnNAspec_GNN01200RX08E376.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190009_Ind2017C_Gold500BasicExc_OnNAspec_GNN01200RX08E376.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold 1000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190001-00","Sparrow PHP Gold 1000 Exclusive","Standard Gold Off Exchange Plan",,"0.79235053062439","No","Yes","No","100%",,"$1,000","$23","$1,225","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190001_Ind2017S_Gold1000Esc_OffBase_GFN01900RX08F377.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190001_Ind2017C_Gold1000Esc_OffBase_GFN01900RX08F377.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190007","Sparrow PHP Platinum 500-100Percent Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190007-00","Sparrow PHP Platinum 500-100Percent Exclusive","Standard Platinum Off Exchange Plan",,"0.881839871406555","No","Yes","No","100%",,"$500","$15","$0","$150","$412","$1,259","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190007_Ind2017S_Platinum500100Exc_OffBase_PFN00700RX08F368.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190007_Ind2017C_Platinum500100Exc_OffBase_PFN00700RX08F368.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190007","Sparrow PHP Platinum 500-100Percent Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190007-01","Sparrow PHP Platinum 500-100Percent Exclusive","Standard Platinum On Exchange Plan",,"0.881839871406555","No","Yes","No","100%",,"$500","$15","$0","$150","$412","$1,259","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190007_Ind2017S_Platinum500100Exc_OnBase_PNN00700RX08E368.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190007_Ind2017C_Platinum500100Exc_OnBase_PNN00700RX08E368.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190007","Sparrow PHP Platinum 500-100Percent Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190007-02","Sparrow PHP Platinum 500-100Percent Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190007_Ind2017S_Platinum500100Exc_OnZero_PNN00800RX08E369.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190007_Ind2017C_Platinum500100Exc_OnZero_PNN00800RX08E369.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190007","Sparrow PHP Platinum 500-100Percent Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190007-03","Sparrow PHP Platinum 500-100Percent Exclusive","Limited Cost Sharing Plan Variation",,"0.881839871406555","No","Yes","No","100%",,"$500","$15","$0","$150","$412","$1,259","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190007_Ind2017S_Platinum500100Exc_OnNAspec_PNN00900RX08E370.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190007_Ind2017C_Platinum500100Exc_OnNAspec_PNN00900RX08E370.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200002","Sparrow PHP Gold 500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200002-00","Sparrow PHP Gold 500 HMO","Standard Gold Off Exchange Plan",,"0.819181740283966","No","Yes","No","100%",,"$500","$23","$1,325","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200002_Ind2017S_Gold500HMO_OffBase_GFA00100RX08F371.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200002_Ind2017C_Gold500HMO_OffBase_GFA00100RX08F371.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200002","Sparrow PHP Gold 500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200002-01","Sparrow PHP Gold 500 HMO","Standard Gold On Exchange Plan",,"0.819181740283966","No","Yes","No","100%",,"$500","$23","$1,325","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200002_Ind2017S_Gold500HMO_OnBase_GNA00100RX08E371.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200002_Ind2017C_Gold500HMO_OnBase_GNA00100RX08E371.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200002","Sparrow PHP Gold 500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200002-02","Sparrow PHP Gold 500 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200002_Ind2017S_Gold500HMO_OnZero_GNA00300RX08E372.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200002_Ind2017C_Gold500HMO_OnZero_GNA00300RX08E372.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200002","Sparrow PHP Gold 500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200002-03","Sparrow PHP Gold 500 HMO","Limited Cost Sharing Plan Variation",,"0.819181740283966","No","Yes","No","100%",,"$500","$23","$1,325","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200002_Ind2017S_Gold500HMO_OnNAspec_GNA00200RX08E373.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200002_Ind2017C_Gold500HMO_OnNAspec_GNA00200RX08E373.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200007","Sparrow PHP Gold 500 Basic HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200007-00","Sparrow PHP Gold 500 Basic HMO","Standard Gold Off Exchange Plan",,"0.780882000923157","No","Yes","No","100%",,"$500","$23","$1,987","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200007_Ind2017S_Gold500BasicHMO_OffBase_GFA01000RX08F374.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200007_Ind2017C_Gold500BasicHMO_OffBase_GFA01000RX08F374.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200007","Sparrow PHP Gold 500 Basic HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200007-01","Sparrow PHP Gold 500 Basic HMO","Standard Gold On Exchange Plan",,"0.780882000923157","No","Yes","No","100%",,"$500","$23","$1,987","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200007_Ind2017S_Gold500BasicHMO_OnBase_GNA01000RX08E374.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200007_Ind2017C_Gold500BasicHMO_OnBase_GNA01000RX08E374.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200007","Sparrow PHP Gold 500 Basic HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200007-02","Sparrow PHP Gold 500 Basic HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200007_Ind2017S_Gold500BasicHMO_OnZero_GNA01100RX08E375.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200007_Ind2017C_Gold500BasicHMO_OnZero_GNA01100RX08E375.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200007","Sparrow PHP Gold 500 Basic HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200007-03","Sparrow PHP Gold 500 Basic HMO","Limited Cost Sharing Plan Variation",,"0.780882000923157","No","Yes","No","100%",,"$500","$23","$1,987","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200007_Ind2017S_Gold500BasicHMO_OnNAspec_GNA01200RX08E376.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200007_Ind2017C_Gold500BasicHMO_OnNAspec_GNA01200RX08E376.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200008","Sparrow PHP Gold 1000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200008-00","Sparrow PHP Gold 1000 HMO","Standard Gold Off Exchange Plan",,"0.79235053062439","No","Yes","No","100%",,"$1,000","$23","$1,225","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200008_Ind2017S_Gold1000HMO_OffBase_GFA01900RX08F377.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200008_Ind2017C_Gold1000HMO_OffBase_GFA01900RX08F377.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200008","Sparrow PHP Gold 1000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200008-01","Sparrow PHP Gold 1000 HMO","Standard Gold On Exchange Plan",,"0.79235053062439","No","Yes","No","100%",,"$1,000","$23","$1,225","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200008_Ind2017S_Gold1000HMO_OnBase_GNA01900RX08E377.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200008_Ind2017C_Gold1000HMO_OnBase_GNA01900RX08E377.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200008","Sparrow PHP Gold 1000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200008-02","Sparrow PHP Gold 1000 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200008_Ind2017S_Gold1000HMO_OnZero_GNA02000RX08E378.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200008_Ind2017C_Gold1000HMO_OnZero_GNA02000RX08E378.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200008","Sparrow PHP Gold 1000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200008-03","Sparrow PHP Gold 1000 HMO","Limited Cost Sharing Plan Variation",,"0.79235053062439","No","Yes","No","100%",,"$1,000","$23","$1,225","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200008_Ind2017S_Gold1000HMO_OnNAspec_GNA02100RX08E379.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200008_Ind2017C_Gold1000HMO_OnNAspec_GNA02100RX08E379.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200009","Sparrow PHP Gold 1250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF014","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200009-00","Sparrow PHP Gold 1250 HMO","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$15","$1,175","$150","$412","$1,169","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200009_Ind2017S_Gold1250HMO_OffBase_GFA01600RX08F362.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200009_Ind2017C_Gold1250HMO_OffBase_GFA01600RX08F362.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200009","Sparrow PHP Gold 1250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF014","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200009-01","Sparrow PHP Gold 1250 HMO","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$15","$1,175","$150","$412","$1,169","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200009_Ind2017S_Gold1250HMO_OnBase_GNA01600RX08E362.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200009_Ind2017C_Gold1250HMO_OnBase_GNA01600RX08E362.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200009","Sparrow PHP Gold 1250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF014","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200009-02","Sparrow PHP Gold 1250 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200009_Ind2017S_Gold1250HMO_OnZero_GNA01700RX08E342.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200009_Ind2017C_Gold1250HMO_OnZero_GNA01700RX08E342.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200009","Sparrow PHP Gold 1250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF014","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200009-03","Sparrow PHP Gold 1250 HMO","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$15","$1,175","$150","$412","$1,169","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200009_Ind2017S_Gold1250HMO_OnNAspec_GNA01800RX08E346.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200009_Ind2017C_Gold1250HMO_OnNAspec_GNA01800RX08E346.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190008","Sparrow PHP Gold 500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190008-00","Sparrow PHP Gold 500 Exclusive","Standard Gold Off Exchange Plan",,"0.819181740283966","No","Yes","No","100%",,"$500","$23","$1,325","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190008_Ind2017S_Gold500Exc_OffBase_GFN00100RX08F371.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190008_Ind2017C_Gold500Exc_OffBase_GFN00100RX08F371.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190008","Sparrow PHP Gold 500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190008-01","Sparrow PHP Gold 500 Exclusive","Standard Gold On Exchange Plan",,"0.819181740283966","No","Yes","No","100%",,"$500","$23","$1,325","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190008_Ind2017S_Gold500Exc_OnBase_GNN00100RX08E371.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190008_Ind2017C_Gold500Exc_OnBase_GNN00100RX08E371.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190008","Sparrow PHP Gold 500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190008-02","Sparrow PHP Gold 500 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190008_Ind2017S_Gold500Exc_OnZero_GNN00300RX08E372.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190008_Ind2017C_Gold500Exc_OnZero_GNN00300RX08E372.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold 1000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190001-01","Sparrow PHP Gold 1000 Exclusive","Standard Gold On Exchange Plan",,"0.79235053062439","No","Yes","No","100%",,"$1,000","$23","$1,225","$150","$412","$1,799","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190001_Ind2017S_Gold1000Exc_OnBase_GNN01900RX08E377.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190001_Ind2017C_Gold1000Exc_OnBase_GNN01900RX08E377.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold 1000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190001-02","Sparrow PHP Gold 1000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190001_Ind2017S_Gold1000Exc_OnZero_GNN02000RX08E378.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190001_Ind2017C_Gold1000Exc_OnZero_GNN02000RX08E378.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190010","Sparrow PHP Gold 1250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF014","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190010-02","Sparrow PHP Gold 1250 Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190010_Ind2017S_Gold1250Exc_OnZero_GNN01700RX08E342.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190010_Ind2017C_Gold1250Exc_OnZero_GNN01700RX08E342.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190010","Sparrow PHP Gold 1250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF014","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190010-03","Sparrow PHP Gold 1250 Exclusive","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$15","$1,175","$150","$412","$1,169","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190010_Ind2017S_Gold1250Exc_OnNAspec_GNN01800RX08E346.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190010_Ind2017C_Gold1250Exc_OnNAspec_GNN01800RX08E346.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200010","Sparrow PHP Silver 2000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200010-00","Sparrow PHP Silver 2000 HMO","Standard Silver Off Exchange Plan",,"0.719502449035645","No","Yes","No","100%",,"$2,000","$23","$1,537","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200010_Ind2017S_Silver2000HMO_OffBase_SFA02600RX08F383.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200010_Ind2017C_Silver2000HMO_OffBase_SFA02600RX08F383.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200010","Sparrow PHP Silver 2000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200010-01","Sparrow PHP Silver 2000 HMO","Standard Silver On Exchange Plan",,"0.719502449035645","No","Yes","No","100%",,"$2,000","$23","$1,537","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200010_Ind2017S_Silver2000HMO_OnBase_SNA02600RX08E383.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200010_Ind2017C_Silver2000HMO_OnBase_SNA02600RX08E383.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200010","Sparrow PHP Silver 2000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200010-02","Sparrow PHP Silver 2000 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200010_Ind2017S_Silver2000HMO_OnZero_SFA02700RX08F384.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200010_Ind2017C_Silver2000HMO_OnZero_SFA02700RX08F384.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200010","Sparrow PHP Silver 2000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200010-03","Sparrow PHP Silver 2000 HMO","Limited Cost Sharing Plan Variation",,"0.719502449035645","No","Yes","No","100%",,"$2,000","$23","$1,537","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200010_Ind2017S_Silver2000HMO_OnNAspec_SNA02800RX08EF385.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200010_Ind2017C_Silver2000HMO_OnNAspec_SNA02800RX08EF385.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200010","Sparrow PHP Silver 2000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200010-04","Sparrow PHP Silver 2000 HMO","73% AV Level Silver Plan",,"0.739934384822845","No","Yes","No","100%",,"$2,000","$23","$1,537","$150","$412","$2,224","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200010_Ind2017S_Silver2000HMO_On73CSR_SNA03100RX08E388.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200010_Ind2017C_Silver2000HMO_On73CSR_SNA03100RX08E388.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200010","Sparrow PHP Silver 2000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200010-05","Sparrow PHP Silver 2000 HMO","87% AV Level Silver Plan",,"0.862152755260468","No","Yes","No","100%",,"$1,000","$23","$977","$150","$412","$1,579","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200010_Ind2017S_Silver2000HMO_On87CSR_SNA03000RX08E387.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200010_Ind2017C_Silver2000HMO_On87CSR_SNA03000RX08E387.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200010","Sparrow PHP Silver 2000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200010-06","Sparrow PHP Silver 2000 HMO","94% AV Level Silver Plan",,"0.930220544338226","No","Yes","No","100%",,"$500","$10","$0","$150","$412","$519","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200010_Ind2017S_Silver2000HMO_On94CSR_SNA02900RX08E386.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200010_Ind2017C_Silver2000HMO_On94CSR_SNA02900RX08E386.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver 2500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200003-00","Sparrow PHP Silver 2500 HMO","Standard Silver Off Exchange Plan",,"0.715035140514374","No","Yes","No","100%",,"$2,500","$23","$925","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200003_Ind2017S_Silver2500HMO_OffBase_SFA00100RX08F389.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200003_Ind2017C_Silver2500HMO_OffBase_SFA00100RX08F389.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200013","Sparrow PHP Silver 5000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200013-03","Sparrow PHP Silver 5000 HMO","Limited Cost Sharing Plan Variation",,"0.68191933631897","No","Yes","No","100%",,"$5,000","$23","$637","$150","$412","$2,014","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200013_Ind2017S_Silver5000HMO_OnNAspec_SNA04000RX08E414.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200013_Ind2017C_Silver5000HMO_OnNAspec_SNA04000RX08E414.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200013","Sparrow PHP Silver 5000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200013-04","Sparrow PHP Silver 5000 HMO","73% AV Level Silver Plan",,"0.720493137836456","No","Yes","No","100%",,"$3,500","$23","$1,087","$150","$412","$2,014","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200013_Ind2017S_Silver5000HMO_On73CSR_SNA04300RX08E417.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200013_Ind2017C_Silver5000HMO_On73CSR_SNA04300RX08E417.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200013","Sparrow PHP Silver 5000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200013-05","Sparrow PHP Silver 5000 HMO","87% AV Level Silver Plan",,"0.878801345825195","No","Yes","No","100%",,"$750","$0","$750","$150","$412","$1,088","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200013_Ind2017S_Silver5000HMO_On87CSR_SNA04200RX08E416.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200013_Ind2017C_Silver5000HMO_On87CSR_SNA04200RX08E416.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200013","Sparrow PHP Silver 5000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200013-06","Sparrow PHP Silver 5000 HMO","94% AV Level Silver Plan",,"0.941896855831146","No","Yes","No","100%",,"$250","$20","$0","$150","$232","$268","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200013_Ind2017S_Silver5000HMO_On94CSR_SNA04100RX08E415.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200013_Ind2017C_Silver5000HMO_On94CSR_SNA04100RX08E415.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210007","Sparrow PHP Gold 1400 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210007-00","Sparrow PHP Gold 1400 H.S.A. HMO","Standard Gold Off Exchange Plan",,"0.784638047218323","Yes","Yes","No","100%",,"$1,400","$23","$1,145","$150","$1,400","$1,317","$97","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210007_Ind2017S_Gold1400HSAHMO_OffBase_GFB00100RX09F340.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210007_Ind2017C_Gold1400HSAHMO_OffBase_GFB00100RX09F340.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210007","Sparrow PHP Gold 1400 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210007-01","Sparrow PHP Gold 1400 H.S.A. HMO","Standard Gold On Exchange Plan",,"0.784638047218323","Yes","Yes","No","100%",,"$1,400","$23","$1,145","$150","$1,400","$1,317","$97","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210007_Ind2017S_Gold1400HSAHMO_OnBase_GNB00100RX09E340.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210007_Ind2017C_Gold1400HSAHMO_OnBase_GNB00100RX09E340.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200012","Sparrow PHP Silver 3500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF019","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200012-02","Sparrow PHP Silver 3500 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200012_Ind2017S_Silver3500HMO_OnZero_SNA05100RX08E402.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200012_Ind2017C_Silver3500HMO_OnZero_SNA05100RX08E402.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver 2500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200003-01","Sparrow PHP Silver 2500 HMO","Standard Silver On Exchange Plan",,"0.715035140514374","No","Yes","No","100%",,"$2,500","$23","$925","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200003_Ind2017S_Silver2500HMO_OnBase_SNA00100RX08E389.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200003_Ind2017C_Silver2500HMO_OnBase_SNA00100RX08E389.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver 2500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200003-02","Sparrow PHP Silver 2500 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200003_Ind2017S_Silver2500HMO_OnZero_SNA00300RX08E390.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200003_Ind2017C_Silver2500HMO_OnZero_SNA00300RX08E390.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver 2500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200003-03","Sparrow PHP Silver 2500 HMO","Limited Cost Sharing Plan Variation",,"0.715035140514374","No","Yes","No","100%",,"$2,500","$23","$925","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200003_Ind2017S_Silver2500HMO_OnNAspec_SNA00200RX08E391.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200003_Ind2017C_Silver2500HMO_OnNAspec_SNA00200RX08E391.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver 2500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200003-04","Sparrow PHP Silver 2500 HMO","73% AV Level Silver Plan",,"0.735337257385254","No","Yes","No","100%",,"$2,500","$23","$925","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200003_Ind2017S_Silver2500HMO_On73CSR_SNA00400RX08E394.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200003_Ind2017C_Silver2500HMO_On73CSR_SNA00400RX08E394.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver 2500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200003-05","Sparrow PHP Silver 2500 HMO","87% AV Level Silver Plan",,"0.866619408130646","No","Yes","No","100%",,"$500","$23","$1,325","$150","$412","$1,588","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200003_Ind2017S_Silver2500HMO_On87CSR_SNA00500RX08E393.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200003_Ind2017C_Silver2500HMO_On87CSR_SNA00500RX08E393.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver 2500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200003-06","Sparrow PHP Silver 2500 HMO","94% AV Level Silver Plan",,"0.93573522567749","No","Yes","No","100%",,"$250","$10","$0","$150","$250","$559","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200003_Ind2017S_Silver2500HMO_On94CSR_SNA00600RX08E392.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200003_Ind2017C_Silver2500HMO_On94CSR_SNA00600RX08E392.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-00","Sparrow PHP Silver 3000 HMO","Standard Silver Off Exchange Plan",,"0.703446686267853","No","Yes","No","100%",,"$3,000","$23","$1,237","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200004_Ind2017S_Silver3000HMO_OffBase_SFA01300RX08F395.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200004_Ind2017C_Silver3000HMO_OffBase_SFA01300RX08F395.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-01","Sparrow PHP Silver 3000 HMO","Standard Silver On Exchange Plan",,"0.703446686267853","No","Yes","No","100%",,"$3,000","$23","$1,237","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200004_Ind2017S_Silver3000HMO_OnBase_SNA01300RX08E395.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200004_Ind2017C_Silver3000HMO_OnBase_SNA01300RX08E395.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-02","Sparrow PHP Silver 3000 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200004_Ind2017S_Silver3000HMO_OnZero_SNA01500RX08E396.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200004_Ind2017C_Silver3000HMO_OnZero_SNA01500RX08E396.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-03","Sparrow PHP Silver 3000 HMO","Limited Cost Sharing Plan Variation",,"0.703446686267853","No","Yes","No","100%",,"$3,000","$23","$1,237","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200004_Ind2017S_Silver3000HMO_OnNAspec_SNA01400RX08E397.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200004_Ind2017C_Silver3000HMO_OnNAspec_SNA01400RX08E397.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-04","Sparrow PHP Silver 3000 HMO","73% AV Level Silver Plan",,"0.73469877243042","No","Yes","No","100%",,"$2,000","$23","$1,025","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200004_Ind2017S_Silver3000HMO_On73CSR_SNA01600RX08E400.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200004_Ind2017C_Silver3000HMO_On73CSR_SNA01600RX08E400.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-05","Sparrow PHP Silver 3000 HMO","87% AV Level Silver Plan",,"0.864542901515961","No","Yes","No","100%",,"$1,000","$20","$980","$150","$412","$1,304","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200004_Ind2017S_Silver3000HMO_On87CSR_SNA01700RX08E399.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200004_Ind2017C_Silver3000HMO_On87CSR_SNA01700RX08E399.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-06","Sparrow PHP Silver 3000 HMO","94% AV Level Silver Plan",,"0.930729448795319","No","Yes","No","100%",,"$250","$15","$0","$150","$250","$750","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200004_Ind2017S_Silver3000HMO_On94CSR_SNA01800RX08E398.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200004_Ind2017C_Silver3000HMO_On94CSR_SNA01800RX08E398.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200012","Sparrow PHP Silver 3500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF019","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200012-00","Sparrow PHP Silver 3500 HMO","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$725","$150","$412","$1,684","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200012_Ind2017S_Silver3500HMO_OffBase_SFA05000RX08F401.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200012_Ind2017C_Silver3500HMO_OffBase_SFA05000RX08F401.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200012","Sparrow PHP Silver 3500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF019","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200012-01","Sparrow PHP Silver 3500 HMO","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$725","$150","$412","$1,684","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200012_Ind2017S_Silver3500HMO_OnBase_SNA05000RX08E401.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200012_Ind2017C_Silver3500HMO_OnBase_SNA05000RX08E401.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200012","Sparrow PHP Silver 3500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF019","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200012-03","Sparrow PHP Silver 3500 HMO","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$725","$150","$412","$1,684","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200012_Ind2017S_Silver3500HMO_OnNAspec_SNA05200RX08E403.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200012_Ind2017C_Silver3500HMO_OnNAspec_SNA05200RX08E403.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200012","Sparrow PHP Silver 3500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF019","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200012-04","Sparrow PHP Silver 3500 HMO","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$15","$825","$150","$412","$1,499","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200012_Ind2017S_Silver3500HMO_On73CSR_SNA05500RX08E406.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200012_Ind2017C_Silver3500HMO_On73CSR_SNA05500RX08E406.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200012","Sparrow PHP Silver 3500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF019","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200012-05","Sparrow PHP Silver 3500 HMO","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,285","$150","$412","$779","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200012_Ind2017S_Silver3500HMO_On87CSR_SNA05400RX08E405.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200012_Ind2017C_Silver3500HMO_On87CSR_SNA05400RX08E405.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200012","Sparrow PHP Silver 3500 HMO","60829MI020","7639172866","MIN001","MIS001","MIF019","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200012-06","Sparrow PHP Silver 3500 HMO","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$6","$344","$150","$250","$323","$8","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200012_Ind2017S_Silver3500HMO_On94CSR_SNA05300RX08E404.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200012_Ind2017C_Silver3500HMO_On94CSR_SNA05300RX08E404.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200011","Sparrow PHP Silver 4000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200011-00","Sparrow PHP Silver 4000 HMO","Standard Silver Off Exchange Plan",,"0.692357003688812","No","Yes","No","100%",,"$4,000","$23","$937","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200011_Ind2017S_Silver4000HMO_OffBase_SFA04400RX08F395.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200011_Ind2017C_Silver4000HMO_OffBase_SFA04400RX08F395.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200011","Sparrow PHP Silver 4000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200011-01","Sparrow PHP Silver 4000 HMO","Standard Silver On Exchange Plan",,"0.692357003688812","No","Yes","No","100%",,"$4,000","$23","$937","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200011_Ind2017S_Silver4000HMO_OnBase_SNA04400RX08E395.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200011_Ind2017C_Silver4000HMO_OnBase_SNA04400RX08E395.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200011","Sparrow PHP Silver 4000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200011-02","Sparrow PHP Silver 4000 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200011_Ind2017S_Silver4000HMO_OnZero_SNA04500RX08E407.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200011_Ind2017C_Silver4000HMO_OnZero_SNA04500RX08E407.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200011","Sparrow PHP Silver 4000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200011-03","Sparrow PHP Silver 4000 HMO","Limited Cost Sharing Plan Variation",,"0.692357003688812","No","Yes","No","100%",,"$4,000","$23","$937","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200011_Ind2017S_Silver4000HMO_OnNAspec_SNA04600RX08E408.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200011_Ind2017C_Silver4000HMO_OnNAspec_SNA04600RX08E408.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200011","Sparrow PHP Silver 4000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200011-04","Sparrow PHP Silver 4000 HMO","73% AV Level Silver Plan",,"0.729874312877655","No","Yes","No","100%",,"$4,000","$23","$937","$150","$412","$1,619","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200011_Ind2017S_Silver4000HMO_On73CSR_SNA04900RX08E411.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200011_Ind2017C_Silver4000HMO_On73CSR_SNA04900RX08E411.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200011","Sparrow PHP Silver 4000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200011-05","Sparrow PHP Silver 4000 HMO","87% AV Level Silver Plan",,"0.864403307437897","No","Yes","No","100%",,"$1,000","$15","$1,225","$150","$412","$949","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200011_Ind2017S_Silver4000HMO_On87CSR_SNA04800RX08E410.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200011_Ind2017C_Silver4000HMO_On87CSR_SNA04800RX08E410.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200011","Sparrow PHP Silver 4000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200011-06","Sparrow PHP Silver 4000 HMO","94% AV Level Silver Plan",,"0.941026926040649","No","Yes","No","100%",,"$250","$10","$0","$150","$250","$559","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200011_Ind2017S_Silver4000HMO_On94CSR_SNA04700RX08E409.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200011_Ind2017C_Silver4000HMO_On94CSR_SNA04700RX08E409.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200013","Sparrow PHP Silver 5000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200013-00","Sparrow PHP Silver 5000 HMO","Standard Silver Off Exchange Plan",,"0.68191933631897","No","Yes","No","100%",,"$5,000","$23","$637","$150","$412","$2,014","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200013_Ind2017S_Silver5000HMO_OffBase_SFA03800RX08F412.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200013_Ind2017C_Silver5000HMO_OffBase_SFA03800RX08F412.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200013","Sparrow PHP Silver 5000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200013-01","Sparrow PHP Silver 5000 HMO","Standard Silver On Exchange Plan",,"0.68191933631897","No","Yes","No","100%",,"$5,000","$23","$637","$150","$412","$2,014","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200013_Ind2017S_Silver5000HMO_OnBase_SNA03800RX08E412.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200013_Ind2017C_Silver5000HMO_OnBase_SNA03800RX08E412.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200013","Sparrow PHP Silver 5000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200013-02","Sparrow PHP Silver 5000 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200013_Ind2017S_Silver5000HMO_OnZero_SNA03900RX08E413.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200013_Ind2017C_Silver5000HMO_OnZero_SNA03900RX08E413.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210007","Sparrow PHP Gold 1400 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210007-02","Sparrow PHP Gold 1400 H.S.A. HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210007_Ind2017S_Gold1400HSAHMO_OnZero_GNB00200RX09E341.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210007_Ind2017C_Gold1400HSAHMO_OnZero_GNB00200RX09E341.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210007","Sparrow PHP Gold 1400 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210007-03","Sparrow PHP Gold 1400 H.S.A. HMO","Limited Cost Sharing Plan Variation",,"0.784638047218323","Yes","Yes","No","100%",,"$1,400","$23","$1,145","$150","$1,400","$1,317","$97","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210007_Ind2017S_Gold1400HSAHMO_OnNAspec_GNB00300RX09E342.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210007_Ind2017C_Gold1400HSAHMO_OnNAspec_GNB00300RX09E342.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210005","Sparrow PHP Silver HDHP HMO","60829MI021","7639172866","MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210005-00","Sparrow PHP Silver HDHP HMO","Standard Silver Off Exchange Plan",,"0.716407299041748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210005_Ind2017S_SilverHDHPHMO_OffBase_SFY00700RX09F520.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210005_Ind2017C_SilverHDHPHMO_OffBase_SFY00700RX09F520.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210005","Sparrow PHP Silver HDHP HMO","60829MI021","7639172866","MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210005-01","Sparrow PHP Silver HDHP HMO","Standard Silver On Exchange Plan",,"0.716407299041748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210005_Ind2017S_SilverHDHPHMO_OnBase_SNY00700RX09E520.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210005_Ind2017C_SilverHDHPHMO_OnBase_SNY00700RX09E520.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210005","Sparrow PHP Silver HDHP HMO","60829MI021","7639172866","MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210005-02","Sparrow PHP Silver HDHP HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210005_Ind2017S_SilverHDHPHMO_OnZero_SNY00800RX08E418.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210005_Ind2017C_SilverHDHPHMO_OnZero_SNY00800RX08E418.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210005","Sparrow PHP Silver HDHP HMO","60829MI021","7639172866","MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210005-03","Sparrow PHP Silver HDHP HMO","Limited Cost Sharing Plan Variation",,"0.716407299041748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210005_Ind2017S_SilverHDHPHMO_OnNAspec_SNY00900RX09E521.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210005_Ind2017C_SilverHDHPHMO_OnNAspec_SNY00900RX09E521.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210005","Sparrow PHP Silver HDHP HMO","60829MI021","7639172866","MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210005-04","Sparrow PHP Silver HDHP HMO","73% AV Level Silver Plan",,"0.739405870437622","Yes","Yes","No","100%",,"$1,900","$23","$1,045","$150","$1,900","$1,257","$97","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210005_Ind2017S_SilverHDHPHMO_On73CSR_SNY01200RX09E524.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210005_Ind2017C_SilverHDHPHMO_On73CSR_SNY01200RX09E524.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210005","Sparrow PHP Silver HDHP HMO","60829MI021","7639172866","MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210005-05","Sparrow PHP Silver HDHP HMO","87% AV Level Silver Plan",,"0.865624606609344","Yes","Yes","No","100%",,"$750","$23","$637","$150","$750","$692","$58","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210005_Ind2017S_SilverHDHPHMO_On87CSR_SNY01100RX09E523.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210005_Ind2017C_SilverHDHPHMO_On87CSR_SNY01100RX09E523.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200014","Sparrow PHP Bronze 6650 HMO","60829MI020","7639172866","MIN001","MIS001","MIF021","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200014-01","Sparrow PHP Bronze 6650 HMO","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$23","$237","$150","$2,539","$1,487","$0","$97","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200014_Ind2017S_Bronze6650HMO_OnBase_BNA00100RX08E419.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200014_Ind2017C_Bronze6650HMO_OnBase_BNA00100RX08E419.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200014","Sparrow PHP Bronze 6650 HMO","60829MI020","7639172866","MIN001","MIS001","MIF021","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200014-02","Sparrow PHP Bronze 6650 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200014_Ind2017S_Bronze6650HMO_OnZero_BNA00200RX08E420.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200014_Ind2017C_Bronze6650HMO_OnZero_BNA00200RX08E420.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200014","Sparrow PHP Bronze 6650 HMO","60829MI020","7639172866","MIN001","MIS001","MIF021","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200014-03","Sparrow PHP Bronze 6650 HMO","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$23","$237","$150","$2,539","$1,487","$0","$97","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200014_Ind2017S_Bronze6650HMO_OnNAspec_BNA00300RX08E421.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200014_Ind2017C_Bronze6650HMO_OnNAspec_BNA00300RX08E421.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190015","Sparrow PHP Bronze 6650 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF021","New","HMO","Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190015-00","Sparrow PHP Bronze 6650 Exclusive","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$23","$237","$150","$2,539","$1,487","$0","$97","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190015_Ind2017S_Bronze6650Exc_OffBase_BFN00100RX08F419.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190015_Ind2017C_Bronze6650Exc_OffBase_BFN00100RX08F419.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210005","Sparrow PHP Silver HDHP HMO","60829MI021","7639172866","MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210005-06","Sparrow PHP Silver HDHP HMO","94% AV Level Silver Plan",,"0.945243299007416","Yes","Yes","No","100%",,"$250","$15","$0","$150","$250","$856","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210005_Ind2017S_SilverHDHPHMO_On94CSR_SNY01000RX09E522.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210005_Ind2017C_SilverHDHPHMO_On94CSR_SNY01000RX09E522.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210003","Sparrow PHP Bronze 5500 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF020","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210003-00","Sparrow PHP Bronze 5500 H.S.A. HMO","Standard Bronze Off Exchange Plan",,"0.619276702404022","Yes","Yes","No","100%",,"$5,500","$0","$658","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210003_Ind2017S_Bronze5500HSAHMO_OffBase_BFY00100RX09F525.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210003_Ind2017C_Bronze5500HSAHMO_OffBase_BFY00100RX09F525.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210003","Sparrow PHP Bronze 5500 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF020","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210003-01","Sparrow PHP Bronze 5500 H.S.A. HMO","Standard Bronze On Exchange Plan",,"0.619276702404022","Yes","Yes","No","100%",,"$5,500","$0","$658","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210003_Ind2017S_Bronze5500HSAHMO_OnBase_BNY00100RX09E525.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210003_Ind2017C_Bronze5500HSAHMO_OnBase_BNY00100RX09E525.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210003","Sparrow PHP Bronze 5500 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF020","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210003-02","Sparrow PHP Bronze 5500 H.S.A. HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210003_Ind2017S_Bronze5500HSAHMO_OnZero_BNB00500RX08E422.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210003_Ind2017C_Bronze5500HSAHMO_OnZero_BNB00500RX08E422.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210003","Sparrow PHP Bronze 5500 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF020","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210003-03","Sparrow PHP Bronze 5500 H.S.A. HMO","Limited Cost Sharing Plan Variation",,"0.619276702404022","Yes","Yes","No","100%",,"$5,500","$0","$658","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210003_Ind2017S_Bronze5500HSAHMO_OnNAspec_BNY00200RX09E526.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210003_Ind2017C_Bronze5500HSAHMO_OnNAspec_BNY00200RX09E526.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210006","Sparrow PHP Bronze 6550 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF022","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210006-00","Sparrow PHP Bronze 6550 H.S.A. HMO","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210006_Ind2017S_Bronze6550HSAHMO_OffBase_BFY00500RX09F527.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210006_Ind2017C_Bronze6550HSAHMO_OffBase_BFY00500RX09F527.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210006","Sparrow PHP Bronze 6550 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF022","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210006-01","Sparrow PHP Bronze 6550 H.S.A. HMO","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210006_Ind2017S_Bronze6550HSAHMO_OnBase_BNY00500RX09E527.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210006_Ind2017C_Bronze6550HSAHMO_OnBase_BNY00500RX09E527.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210006","Sparrow PHP Bronze 6550 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF022","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210006-02","Sparrow PHP Bronze 6550 H.S.A. HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210006_Ind2017S_Bronze6550HSAHMO_OnZero_BNY00700RX08E423.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210006_Ind2017C_Bronze6550HSAHMO_OnZero_BNY00700RX08E423.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0210006","Sparrow PHP Bronze 6550 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF022","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210006-03","Sparrow PHP Bronze 6550 H.S.A. HMO","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0210006_Ind2017S_Bronze6550HSAHMO_OnNAspec_BNY00600RX09E528.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0210006_Ind2017C_Bronze6550HSAHMO_OnNAspec_BNY00600RX09E528.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200005","Sparrow PHP Healthy HMO","60829MI020","7639172866","MIN001","MIS001","MIF022","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200005-00","Sparrow PHP Healthy HMO","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,146","$0","$0","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200005_Ind2017S_HealthyHMO_OffBase_XFY00100RX09F529.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200005_Ind2017C_HealthyHMO_OffBase_XFY00100RX09F529.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200005","Sparrow PHP Healthy HMO","60829MI020","7639172866","MIN001","MIS001","MIF022","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200005-01","Sparrow PHP Healthy HMO","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,146","$0","$0","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200005_Ind2017S_HealthyHMO_OnBase_XNY00100RX09E529.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200005_Ind2017C_HealthyHMO_OnBase_XNY00100RX09E529.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220003","Sparrow PHP Gold 1400 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220003-00","Sparrow PHP Gold 1400 H.S.A. Exclusive","Standard Gold Off Exchange Plan",,"0.784638047218323","Yes","Yes","No","100%",,"$1,400","$23","$1,145","$150","$1,400","$1,317","$97","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220003_Ind2017S_Gold1400HSAExc_OffBase_GFP00100RX09F340.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220003_Ind2017C_Gold1400HSAExc_OffBase_GFP00100RX09F340.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220003","Sparrow PHP Gold 1400 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220003-01","Sparrow PHP Gold 1400 H.S.A. Exclusive","Standard Gold On Exchange Plan",,"0.784638047218323","Yes","Yes","No","100%",,"$1,400","$23","$1,145","$150","$1,400","$1,317","$97","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220003_Ind2017S_Gold1400HSAExc_OnBase_GNP00100RX09E340.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220003_Ind2017C_Gold1400HSAExc_OnBase_GNP00100RX09E340.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220003","Sparrow PHP Gold 1400 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220003-02","Sparrow PHP Gold 1400 H.S.A. Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220003_Ind2017S_Gold1400HSAExc_OnZero_GNP00200RX09E341.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220003_Ind2017C_Gold1400HSAExc_OnZero_GNP00200RX09E341.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220003","Sparrow PHP Gold 1400 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220003-03","Sparrow PHP Gold 1400 H.S.A. Exclusive","Limited Cost Sharing Plan Variation",,"0.784638047218323","Yes","Yes","No","100%",,"$1,400","$23","$1,145","$150","$1,400","$1,317","$97","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220003_Ind2017S_Gold1400HSAExc_OnNAspec_GNP00300RX09E342.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220003_Ind2017C_Gold1400HSAExc_OnNAspec_GNP00300RX09E342.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-00","Sparrow PHP Silver HDHP Exclusive","Standard Silver Off Exchange Plan",,"0.716407299041748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220001_Ind2017S_SilverHDHPExc_OffBase_SFR00700RX09F520.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220001_Ind2017C_SilverHDHPExc_OffBase_SFR00700RX09F520.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-01","Sparrow PHP Silver HDHP Exclusive","Standard Silver On Exchange Plan",,"0.716407299041748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220001_Ind2017S_SilverHDHPExc_OnBase_SNR00700RX09E520.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220001_Ind2017C_SilverHDHPExc_OnBase_SNR00700RX09E520.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-02","Sparrow PHP Silver HDHP Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220001_Ind2017S_SilverHDHPExc_OnZero_SNR00800RX08E418.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220001_Ind2017C_SilverHDHPExc_OnZero_SNR00800RX08E418.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-03","Sparrow PHP Silver HDHP Exclusive","Limited Cost Sharing Plan Variation",,"0.716407299041748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220001_Ind2017S_SilverHDHPExc_OnNAspec_SNR00900RX09E521.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220001_Ind2017C_SilverHDHPExc_OnNAspec_SNR00900RX09E521.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-04","Sparrow PHP Silver HDHP Exclusive","73% AV Level Silver Plan",,"0.739405870437622","Yes","Yes","No","100%",,"$1,900","$23","$1,045","$150","$1,900","$1,257","$97","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220001_Ind2017S_SilverHDHPExc_On73CSR_SNR01200RX09E524.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220001_Ind2017C_SilverHDHPExc_On73CSR_SNR01200RX09E524.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-05","Sparrow PHP Silver HDHP Exclusive","87% AV Level Silver Plan",,"0.865624606609344","Yes","Yes","No","100%",,"$750","$23","$637","$150","$750","$692","$58","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220001_Ind2017S_SilverHDHPExc_On87CSR_SNR01100RX09E523.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220001_Ind2017C_SilverHDHPExc_On87CSR_SNR01100RX09E523.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-06","Sparrow PHP Silver HDHP Exclusive","94% AV Level Silver Plan",,"0.945243299007416","Yes","Yes","No","100%",,"$250","$15","$0","$150","$250","$856","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220001_Ind2017S_SilverHDHPExc_On94CSR_SNR01000RX09E522.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220001_Ind2017C_SilverHDHPExc_On94CSR_SNR01000RX09E522.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220004","Sparrow PHP Bronze 5500 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF020","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220004-00","Sparrow PHP Bronze 5500 H.S.A. Exclusive","Standard Bronze Off Exchange Plan",,"0.619276702404022","Yes","Yes","No","100%",,"$5,500","$0","$658","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220004_Ind2017S_Bronze5500HSAExc_OffBase_BFR00100RX09F525.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220004_Ind2017C_Bronze5500HSAExc_OffBase_BFR00100RX09F525.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220004","Sparrow PHP Bronze 5500 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF020","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220004-01","Sparrow PHP Bronze 5500 H.S.A. Exclusive","Standard Bronze On Exchange Plan",,"0.619276702404022","Yes","Yes","No","100%",,"$5,500","$0","$658","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220004_Ind2017S_Bronze5500HSAExc_OnBase_BNR00100RX09E525.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220004_Ind2017C_Bronze5500HSAExc_OnBase_BNR00100RX09E525.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220004","Sparrow PHP Bronze 5500 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF020","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220004-02","Sparrow PHP Bronze 5500 H.S.A. Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220004_Ind2017S_Bronze5500HSAExc_OnZero_BNR00500RX08E422.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220004_Ind2017C_Bronze5500HSAExc_OnZero_BNR00500RX08E422.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220004","Sparrow PHP Bronze 5500 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF020","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220004-03","Sparrow PHP Bronze 5500 H.S.A. Exclusive","Limited Cost Sharing Plan Variation",,"0.619276702404022","Yes","Yes","No","100%",,"$5,500","$0","$658","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220004_Ind2017S_Bronze5500HSAExc_OnNAspec_BNR00200RX09E526.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220004_Ind2017C_Bronze5500HSAExc_OnNAspec_BNR00200RX09E526.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze 6550 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF022","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220002-00","Sparrow PHP Bronze 6550 H.S.A. Exclusive","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220002_Ind2017S_Bronze6550HSAExc_OffBase_BFR00800RX09F527.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220002_Ind2017C_Bronze6550HSAExc_OffBase_BFR00800RX09F527.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze 6550 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF022","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220002-01","Sparrow PHP Bronze 6550 H.S.A. Exclusive","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220002_Ind2017S_Bronze6550HSAExc_OnBase_BNR00800RX09E527.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220002_Ind2017C_Bronze6550HSAExc_OnBase_BNR00800RX09E527.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze 6550 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF022","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220002-02","Sparrow PHP Bronze 6550 H.S.A. Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220002_Ind2017S_Bronze6550HSAExc_OnZero_BNR00700RX08E423.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220002_Ind2017C_Bronze6550HSAExc_OnZero_BNR00700RX08E423.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze 6550 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF022","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220002-03","Sparrow PHP Bronze 6550 H.S.A. Exclusive","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0220002_Ind2017S_Bronze6550HSAExc_OnNAspec_BNR00600RX09E528.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0220002_Ind2017C_Bronze6550HSAExc_OnNAspec_BNR00600RX09E528.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0200014","Sparrow PHP Bronze 6650 HMO","60829MI020","7639172866","MIN001","MIS001","MIF021","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200014-00","Sparrow PHP Bronze 6650 HMO","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$23","$237","$150","$2,539","$1,487","$0","$97","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0200014_Ind2017S_Bronze6650HMO_OffBase_BFA00100RX08F419.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0200014_Ind2017C_Bronze6650HMO_OffBase_BFA00100RX08F419.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190015","Sparrow PHP Bronze 6650 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF021","New","HMO","Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190015-01","Sparrow PHP Bronze 6650 Exclusive","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$23","$237","$150","$2,539","$1,487","$0","$97","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190015_Ind2017S_Bronze6650Exc_OnBase_BNN00100RX08E419.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190015_Ind2017C_Bronze6650Exc_OnBase_BNN00100RX08E419.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190015","Sparrow PHP Bronze 6650 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF021","New","HMO","Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190015-02","Sparrow PHP Bronze 6650 Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190015_Ind2017S_Bronze6650Exc_OnZero_BNN00200RX08E420.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190015_Ind2017C_Bronze6650Exc_OnZero_BNN00200RX08E420.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190015","Sparrow PHP Bronze 6650 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF021","New","HMO","Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190015-03","Sparrow PHP Bronze 6650 Exclusive","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$23","$237","$150","$2,539","$1,487","$0","$97","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190015_Ind2017S_Bronze6650Exc_OnNAspec_BNN00300RX08E421.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190015_Ind2017C_Bronze6650Exc_OnNAspec_BNN00300RX08E421.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-00","Sparrow PHP Silver 2000 Exclusive","Standard Silver Off Exchange Plan",,"0.719502449035645","No","Yes","No","100%",,"$2,000","$23","$1,537","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190002_Ind2017S_Silver2000Exc_OffBase_SFN02600RX08F383.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190002_Ind2017C_Silver2000Exc_OffBase_SFN02600RX08F383.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-01","Sparrow PHP Silver 2000 Exclusive","Standard Silver On Exchange Plan",,"0.719502449035645","No","Yes","No","100%",,"$2,000","$23","$1,537","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190002_Ind2017S_Silver2000Exc_OnBase_SNN02600RX08E383.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190002_Ind2017C_Silver2000Exc_OnBase_SNN02600RX08E383.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-02","Sparrow PHP Silver 2000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190002_Ind2017S_Silver2000Exc_OnZero_SFN02700RX08F384.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190002_Ind2017C_Silver2000Exc_OnZero_SFN02700RX08F384.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-03","Sparrow PHP Silver 2000 Exclusive","Limited Cost Sharing Plan Variation",,"0.719502449035645","No","Yes","No","100%",,"$2,000","$23","$1,537","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190002_Ind2017S_Silver2000Exc_OnNAspec_SNN02800RX08EF385.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190002_Ind2017C_Silver2000Exc_OnNAspec_SNN02800RX08EF385.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-04","Sparrow PHP Silver 2000 Exclusive","73% AV Level Silver Plan",,"0.739934384822845","No","Yes","No","100%",,"$2,000","$23","$1,537","$150","$412","$2,224","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190002_Ind2017S_Silver2000Exc_On73CSR_SNN03100RX08E388.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190002_Ind2017C_Silver2000Exc_On73CSR_SNN03100RX08E388.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-05","Sparrow PHP Silver 2000 Exclusive","87% AV Level Silver Plan",,"0.862152755260468","No","Yes","No","100%",,"$1,000","$23","$977","$150","$412","$1,579","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190002_Ind2017S_Silver2000Exc_On87CSR_SNN03000RX08E387.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190002_Ind2017C_Silver2000Exc_On87CSR_SNN03000RX08E387.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-01","Sparrow PHP Silver 5000 Exclusive","Standard Silver On Exchange Plan",,"0.68191933631897","No","Yes","No","100%",,"$5,000","$23","$637","$150","$412","$2,014","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190014_Ind2017S_Silver5000Exc_OnBase_SNN03800RX08E412.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190014_Ind2017C_Silver5000Exc_OnBase_SNN03800RX08E412.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-02","Sparrow PHP Silver 5000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190014_Ind2017S_Silver5000Exc_OnZero_SNN03900RX08E413.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190014_Ind2017C_Silver5000Exc_OnZero_SNN03900RX08E413.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF019","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-00","Sparrow PHP Silver 3500 Exclusive","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$725","$150","$412","$1,684","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190013_Ind2017S_Silver3500Exc_OffBase_SFN05000RX08F401.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190013_Ind2017C_Silver3500Exc_OffBase_SFN05000RX08F401.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF019","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-01","Sparrow PHP Silver 3500 Exclusive","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$725","$150","$412","$1,684","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190013_Ind2017S_Silver3500Exc_OnBase_SNN05000RX08E401.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190013_Ind2017C_Silver3500Exc_OnBase_SNN05000RX08E401.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF019","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-02","Sparrow PHP Silver 3500 Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190013_Ind2017S_Silver3500Exc_OnZero_SNN05100RX08E402.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190013_Ind2017C_Silver3500Exc_OnZero_SNN05100RX08E402.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF019","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-03","Sparrow PHP Silver 3500 Exclusive","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$725","$150","$412","$1,684","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190013_Ind2017S_Silver3500Exc_OnNAspec_SNN05200RX08E403.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190013_Ind2017C_Silver3500Exc_OnNAspec_SNN05200RX08E403.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF019","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-04","Sparrow PHP Silver 3500 Exclusive","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$15","$825","$150","$412","$1,499","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190013_Ind2017S_Silver3500Exc_On73CSR_SNN05500RX08E406.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190013_Ind2017C_Silver3500Exc_On73CSR_SNN05500RX08E406.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF019","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-05","Sparrow PHP Silver 3500 Exclusive","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,285","$150","$412","$779","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190013_Ind2017S_Silver3500Exc_On87CSR_SNN05400RX08E405.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190013_Ind2017C_Silver3500Exc_On87CSR_SNN05400RX08E405.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF019","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-06","Sparrow PHP Silver 3500 Exclusive","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$6","$344","$150","$250","$323","$8","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190013_Ind2017S_Silver3500Exc_On94CSR_SNN05300RX08E404.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190013_Ind2017C_Silver3500Exc_On94CSR_SNN05300RX08E404.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-06","Sparrow PHP Silver 2000 Exclusive","94% AV Level Silver Plan",,"0.936236500740051","No","Yes","No","100%",,"$500","$10","$0","$150","$412","$519","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190002_Ind2017S_Silver2000Exc_On94CSR_SNN02900RX08E386.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190002_Ind2017C_Silver2000Exc_On94CSR_SNN02900RX08E386.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-00","Sparrow PHP Silver 2500 Exclusive","Standard Silver Off Exchange Plan",,"0.715035140514374","No","Yes","No","100%",,"$2,500","$23","$925","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190011_Ind2017S_Silver2500Exc_OffBase_SFN00100RX08F389.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190011_Ind2017C_Silver2500Exc_OffBase_SFN00100RX08F389.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-01","Sparrow PHP Silver 2500 Exclusive","Standard Silver On Exchange Plan",,"0.715035140514374","No","Yes","No","100%",,"$2,500","$23","$925","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190011_Ind2017S_Silver2500Exc_OnBase_SNN00100RX08E389.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190011_Ind2017C_Silver2500Exc_OnBase_SNN00100RX08E389.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-02","Sparrow PHP Silver 2500 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190011_Ind2017S_Silver2500Exc_OnZero_SNN00300RX08E390.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190011_Ind2017C_Silver2500Exc_OnZero_SNN00300RX08E390.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-03","Sparrow PHP Silver 2500 Exclusive","Limited Cost Sharing Plan Variation",,"0.715035140514374","No","Yes","No","100%",,"$2,500","$23","$925","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190011_Ind2017S_Silver2500Exc_OnNAspec_SNN00200RX08E391.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190011_Ind2017C_Silver2500Exc_OnNAspec_SNN00200RX08E391.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-04","Sparrow PHP Silver 2500 Exclusive","73% AV Level Silver Plan",,"0.735337257385254","No","Yes","No","100%",,"$2,500","$23","$925","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190011_Ind2017S_Silver2500Exc_On73CSR_SNN00400RX08E394.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190011_Ind2017C_Silver2500Exc_On73CSR_SNN00400RX08E394.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-05","Sparrow PHP Silver 2500 Exclusive","87% AV Level Silver Plan",,"0.866619408130646","No","Yes","No","100%",,"$500","$23","$1,325","$150","$412","$1,588","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190011_Ind2017S_Silver2500Exc_On87CSR_SNN00500RX08E393.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190011_Ind2017C_Silver2500Exc_On87CSR_SNN00500RX08E393.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-06","Sparrow PHP Silver 2500 Exclusive","94% AV Level Silver Plan",,"0.94754034280777","No","Yes","No","100%",,"$250","$10","$0","$150","$250","$559","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190011_Ind2017S_Silver2500Exc_On94CSR_SNN00600RX08E392.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190011_Ind2017C_Silver2500Exc_On94CSR_SNN00600RX08E392.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-00","Sparrow PHP Silver 3000 Exclusive","Standard Silver Off Exchange Plan",,"0.703446686267853","No","Yes","No","100%",,"$3,000","$23","$1,237","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190012_Ind2017S_Silver3000Exc_OffBase_SFN01300RX08F395.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190012_Ind2017C_Silver3000Exc_OffBase_SFN01300RX08F395.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-01","Sparrow PHP Silver 3000 Exclusive","Standard Silver On Exchange Plan",,"0.703446686267853","No","Yes","No","100%",,"$3,000","$23","$1,237","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190012_Ind2017S_Silver3000Exc_OnBase_SNN01300RX08E395.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190012_Ind2017C_Silver3000Exc_OnBase_SNN01300RX08E395.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-02","Sparrow PHP Silver 3000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190012_Ind2017S_Silver3000Exc_OnZero_SNN01500RX08E396.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190012_Ind2017C_Silver3000Exc_OnZero_SNN01500RX08E396.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-03","Sparrow PHP Silver 3000 Exclusive","Limited Cost Sharing Plan Variation",,"0.703446686267853","No","Yes","No","100%",,"$3,000","$23","$1,237","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190012_Ind2017S_Silver3000Exc_OnNAspec_SNN01400RX08E397.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190012_Ind2017C_Silver3000Exc_OnNAspec_SNN01400RX08E397.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-04","Sparrow PHP Silver 3000 Exclusive","73% AV Level Silver Plan",,"0.73469877243042","No","Yes","No","100%",,"$2,000","$23","$1,025","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190012_Ind2017S_Silver3000Exc_On73CSR_SNN01600RX08E400.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190012_Ind2017C_Silver3000Exc_On73CSR_SNN01600RX08E400.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-05","Sparrow PHP Silver 3000 Exclusive","87% AV Level Silver Plan",,"0.864542901515961","No","Yes","No","100%",,"$1,000","$20","$980","$150","$412","$1,304","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190012_Ind2017S_Silver3000Exc_On87CSR_SNN01700RX08E399.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190012_Ind2017C_Silver3000Exc_On87CSR_SNN01700RX08E399.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-06","Sparrow PHP Silver 3000 Exclusive","94% AV Level Silver Plan",,"0.940750598907471","No","Yes","No","100%",,"$250","$15","$0","$150","$250","$750","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190012_Ind2017S_Silver3000Exc_On94CSR_SNN01800RX08E398.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190012_Ind2017C_Silver3000Exc_On94CSR_SNN01800RX08E398.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-00","Sparrow PHP Silver 4000 Exclusive","Standard Silver Off Exchange Plan",,"0.692357003688812","No","Yes","No","100%",,"$4,000","$23","$937","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190005_Ind2017S_Silver4000Exc_OffBase_SFN04400RX08F395.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190005_Ind2017C_Silver4000Exc_OffBase_SFN04400RX08F395.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-01","Sparrow PHP Silver 4000 Exclusive","Standard Silver On Exchange Plan",,"0.692357003688812","No","Yes","No","100%",,"$4,000","$23","$937","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190005_Ind2017S_Silver4000Exc_OnBase_SNN04400RX08E395.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190005_Ind2017C_Silver4000Exc_OnBase_SNN04400RX08E395.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-02","Sparrow PHP Silver 4000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190005_Ind2017S_Silver4000Exc_OnZero_SNN04500RX08E407.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190005_Ind2017C_Silver4000Exc_OnZero_SNN04500RX08E407.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-03","Sparrow PHP Silver 4000 Exclusive","Limited Cost Sharing Plan Variation",,"0.692357003688812","No","Yes","No","100%",,"$4,000","$23","$937","$150","$412","$2,244","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190005_Ind2017S_Silver4000Exc_OnNAspec_SNN04600RX08E408.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190005_Ind2017C_Silver4000Exc_OnNAspec_SNN04600RX08E408.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-04","Sparrow PHP Silver 4000 Exclusive","73% AV Level Silver Plan",,"0.729874312877655","No","Yes","No","100%",,"$4,000","$23","$937","$150","$412","$1,619","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190005_Ind2017S_Silver4000Exc_On73CSR_SNN04900RX08E411.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190005_Ind2017C_Silver4000Exc_On73CSR_SNN04900RX08E411.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-05","Sparrow PHP Silver 4000 Exclusive","87% AV Level Silver Plan",,"0.864403307437897","No","Yes","No","100%",,"$1,000","$15","$1,225","$150","$412","$949","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190005_Ind2017S_Silver4000Exc_On87CSR_SNN04800RX08E410.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190005_Ind2017C_Silver4000Exc_On87CSR_SNN04800RX08E410.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-06","Sparrow PHP Silver 4000 Exclusive","94% AV Level Silver Plan",,"0.941026926040649","No","Yes","No","100%",,"$250","$10","$0","$150","$250","$559","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190005_Ind2017S_Silver4000Exc_On94CSR_SNN04700RX08E409.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190005_Ind2017C_Silver4000Exc_On94CSR_SNN04700RX08E409.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-00","Sparrow PHP Silver 5000 Exclusive","Standard Silver Off Exchange Plan",,"0.68191933631897","No","Yes","No","100%",,"$5,000","$23","$637","$150","$412","$2,014","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190014_Ind2017S_Silver5000Exc_OffBase_SFN03800RX08F412.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190014_Ind2017C_Silver5000Exc_OffBase_SFN03800RX08F412.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-03","Sparrow PHP Silver 5000 Exclusive","Limited Cost Sharing Plan Variation",,"0.68191933631897","No","Yes","No","100%",,"$5,000","$23","$637","$150","$412","$2,014","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190014_Ind2017S_Silver5000Exc_OnNAspec_SNN04000RX08E414.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190014_Ind2017C_Silver5000Exc_OnNAspec_SNN04000RX08E414.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-04","Sparrow PHP Silver 5000 Exclusive","73% AV Level Silver Plan",,"0.720493137836456","No","Yes","No","100%",,"$3,500","$23","$1,087","$150","$412","$2,014","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190014_Ind2017S_Silver5000Exc_On73CSR_SNN04300RX08E417.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190014_Ind2017C_Silver5000Exc_On73CSR_SNN04300RX08E417.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-05","Sparrow PHP Silver 5000 Exclusive","87% AV Level Silver Plan",,"0.878801345825195","No","Yes","No","100%",,"$750","$0","$750","$150","$412","$1,088","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190014_Ind2017S_Silver5000Exc_On87CSR_SNN04200RX08E416.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190014_Ind2017C_Silver5000Exc_On87CSR_SNN04200RX08E416.pdf"
"2017","MI","60829","SERFF","2016-11-18 20:15:51","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF018","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-06","Sparrow PHP Silver 5000 Exclusive","94% AV Level Silver Plan",,"0.941896855831146","No","Yes","No","100%",,"$250","$20","$0","$150","$232","$268","$0","$97","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2017Plans/60829MI0190014_Ind2017S_Silver5000Exc_On94CSR_SNN04100RX08E415.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2017Plans/60829MI0190014_Ind2017C_Silver5000Exc_On94CSR_SNN04100RX08E415.pdf"
"2017","MI","62294","SERFF","2016-08-19 03:49:17","Individual","Yes","39-1263473","62294MI0420001","Humana Dental Smart Choice","62294MI042",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9179","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","62294MI0420001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857075"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-01","Totally You","Standard Silver On Exchange Plan",,"0.711146295070648","No","Yes","No","100%",,"$3,000","$18","$1,232","$60","$134","$1,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030002-01.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030005","Total Saver Plus","67183MI003",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030005-02","Total Saver Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030005-02.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030005","Total Saver Plus","67183MI003",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030005-03","Total Saver Plus","Limited Cost Sharing Plan Variation",,"0.618685364723206","Yes","Yes","No","100%",,"$5,500","$18","$1,097","$60","$3,716","$430","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030005-03.pdf","http://brochure.thcmi.com/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","Individual","Yes","13-5123390","66587MI0080001","Guardian Select for Families and Individuals","66587MI008",,"MIN002","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","66587MI0080001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5123390","66587MI0010004","Guardian Pediatric Advantage","66587MI001",,"MIN001","MIS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","66587MI0010004-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5123390","66587MI0020004","Guardian Pediatric Essentials","66587MI002",,"MIN001","MIS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","66587MI0020004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","Individual","Yes","13-5123390","66587MI0080001","Guardian Select for Families and Individuals","66587MI008",,"MIN002","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","66587MI0080001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","Individual","Yes","13-5123390","66587MI0070002","Guardian Essentials for Families and Individuals","66587MI007",,"MIN002","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","66587MI0070002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5123390","66587MI0040004","Guardian Family Advantage","66587MI004",,"MIN001","MIS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","66587MI0040004-01","Guardian Family Advantage","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5123390","66587MI0060004","Guardian Family Essentials","66587MI006",,"MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","66587MI0060004-01","Guardian Family Essentials","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","Individual","Yes","13-5123390","66587MI0070002","Guardian Essentials for Families and Individuals","66587MI007",,"MIN002","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","66587MI0070002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5123390","66587MI0040005","Guardian Family Advantage","66587MI004",,"MIN001","MIS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","66587MI0040005-00","Guardian Family Advantage","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MI","66587","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","13-5123390","66587MI0060005","Guardian Family Essentials","66587MI006",,"MIN001","MIS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","66587MI0060005-00","Guardian Family Essentials","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-00","Total HMO Standard","Standard Gold Off Exchange Plan",,"0.8195521235466","No","Yes","No","100%",,"$765","$0","$0","$60","$134","$1,130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030001-00.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-01","Total HMO Standard","Standard Gold On Exchange Plan",,"0.8195521235466","No","Yes","No","100%",,"$765","$0","$0","$60","$134","$1,130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030001-01.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-02","Total HMO Standard","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030001-02.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-03","Total HMO Standard","Limited Cost Sharing Plan Variation",,"0.8195521235466","No","Yes","No","100%",,"$765","$0","$0","$60","$134","$1,130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030001-03.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-00","Totally You","Standard Silver Off Exchange Plan",,"0.711146295070648","No","Yes","No","100%",,"$3,000","$18","$1,232","$60","$134","$1,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030002-00.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-02","Totally You","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030002-02.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-03","Totally You","Limited Cost Sharing Plan Variation",,"0.711146295070648","No","Yes","No","100%",,"$3,000","$18","$1,232","$60","$134","$1,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030002-03.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-04","Totally You","73% AV Level Silver Plan",,"0.738104343414307","No","Yes","No","100%",,"$2,500","$18","$1,332","$60","$134","$1,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030002-04.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-05","Totally You","87% AV Level Silver Plan",,"0.87470668554306","No","Yes","No","100%",,"$750","$18","$841","$60","$134","$570","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030002-05.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-06","Totally You","94% AV Level Silver Plan",,"0.94630753993988","No","Yes","No","100%",,"$0","$0","$458","$60","$134","$300","$7","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030002-06.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-00","Totally You - Complete","Standard Silver Off Exchange Plan",,"0.681148111820221","Yes","Yes","No","100%",,"$4,000","$18","$1,032","$60","$3,989","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030003-00.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-01","Totally You - Complete","Standard Silver On Exchange Plan",,"0.681148111820221","Yes","Yes","No","100%",,"$4,000","$18","$1,032","$60","$3,989","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030003-01.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-02","Totally You - Complete","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030003-02.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-03","Totally You - Complete","Limited Cost Sharing Plan Variation",,"0.681148111820221","Yes","Yes","No","100%",,"$4,000","$18","$1,032","$60","$3,989","$320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030003-03.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-04","Totally You - Complete","73% AV Level Silver Plan",,"0.737252652645111","Yes","Yes","No","100%",,"$2,500","$18","$1,032","$60","$134","$1,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030003-04.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-05","Totally You - Complete","87% AV Level Silver Plan",,"0.862556576728821","Yes","Yes","No","100%",,"$750","$18","$1,332","$60","$134","$570","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030003-05.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-06","Totally You - Complete","94% AV Level Silver Plan",,"0.948833465576172","Yes","Yes","No","100%",,"$0","$0","$841","$60","$134","$300","$7","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030003-06.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030004","Totally You - Standardized","67183MI003",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-00","Totally You - Standardized","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$18","$1,132","$60","$134","$1,113","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030004-00.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030004","Totally You - Standardized","67183MI003",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-01","Totally You - Standardized","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$18","$1,132","$60","$134","$1,113","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030004-01.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030004","Totally You - Standardized","67183MI003",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-02","Totally You - Standardized","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030004-02.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030004","Totally You - Standardized","67183MI003",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-03","Totally You - Standardized","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$18","$1,132","$60","$134","$1,113","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030004-03.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030004","Totally You - Standardized","67183MI003",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-04","Totally You - Standardized","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$18","$1,232","$60","$134","$1,113","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030004-04.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030004","Totally You - Standardized","67183MI003",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-05","Totally You - Standardized","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$60","$134","$565","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030004-05.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030004","Totally You - Standardized","67183MI003",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-06","Totally You - Standardized","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$12","$445","$60","$134","$208","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030004-06.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030005","Total Saver Plus","67183MI003",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030005-00","Total Saver Plus","Standard Bronze Off Exchange Plan",,"0.618685364723206","Yes","Yes","No","100%",,"$5,500","$18","$1,097","$60","$3,716","$430","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030005-00.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030005","Total Saver Plus","67183MI003",,"MIN001","MIS001","MIF005","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030005-01","Total Saver Plus","Standard Bronze On Exchange Plan",,"0.618685364723206","Yes","Yes","No","100%",,"$5,500","$18","$1,097","$60","$3,716","$430","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030005-01.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030006","Total Saver Complete","67183MI003",,"MIN001","MIS001","MIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030006-00","Total Saver Complete","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$18","$1,097","$60","$5,456","$430","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030006-00.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030006","Total Saver Complete","67183MI003",,"MIN001","MIS001","MIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030006-01","Total Saver Complete","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$18","$1,097","$60","$5,456","$430","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030006-01.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030006","Total Saver Complete","67183MI003",,"MIN001","MIS001","MIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030006-02","Total Saver Complete","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030006-02.pdf","http://brochure.thcmi.com/"
"2017","MI","67183","SERFF","2016-08-24 05:44:16","Individual","No","38-3240485","67183MI0030006","Total Saver Complete","67183MI003",,"MIN001","MIS001","MIF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9994",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030006-03","Total Saver Complete","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$18","$1,097","$60","$5,456","$430","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2017/67183MI0030006-03.pdf","http://brochure.thcmi.com/"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020001","McLaren Rewards Platinum","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020001-00","McLaren Rewards Platinum","Standard Platinum Off Exchange Plan",,"0.907174646854401","No","Yes","Yes","67%","33%","$500","$25","$0","$1,250","$500","$25","$0","$1,250","$500","$25","$0","$1,250",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$500","$500 per person","$1000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualPlatinumRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010001","Platinum Rewards","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010001-00","Platinum Rewards","Standard Platinum Off Exchange Plan",,"0.907241880893707","No","Yes","Yes","67%","33%","$500","$25","$0","$0","$500","$25","$0","$0","$500","$25","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$500","$500 per person","$1000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityPlatinumRewardsSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010001","Platinum Rewards","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010001-01","Platinum Rewards","Standard Platinum On Exchange Plan",,"0.907241880893707","No","Yes","Yes","67%","33%","$500","$25","$0","$0","$500","$25","$0","$0","$500","$25","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$500","$500 per person","$1000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityPlatinumRewardsSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020001","McLaren Rewards Platinum","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020001-01","McLaren Rewards Platinum","Standard Platinum On Exchange Plan",,"0.907174646854401","No","Yes","Yes","67%","33%","$500","$25","$0","$1,250","$500","$25","$0","$1,250","$500","$25","$0","$1,250",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$500","$500 per person","$1000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualPlatinumRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020001","McLaren Rewards Platinum","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020001-02","McLaren Rewards Platinum","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualPlatinumZeroCostSharingRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010002","Gold Rewards","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010002-00","Gold Rewards","Standard Gold Off Exchange Plan","81.53%","0.815288424491882","No","Yes","Yes","67%","33%","$1,400","$40","$0","$0","$1,400","$40","$0","$0","$1,400","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","25.00%","$1,400","$1400 per person","$2800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityGoldRewardsSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010002","Gold Rewards","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010002-01","Gold Rewards","Standard Gold On Exchange Plan","81.53%","0.815288424491882","No","Yes","Yes","67%","33%","$1,400","$40","$0","$0","$1,400","$40","$0","$0","$1,400","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","25.00%","$1,400","$1400 per person","$2800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityGoldRewardsSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020001","McLaren Rewards Platinum","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020001-03","McLaren Rewards Platinum","Limited Cost Sharing Plan Variation",,"0.907174646854401","No","Yes","Yes","67%","33%","$500","$25","$0","$0","$500","$25","$0","$0","$500","$25","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$500","$500 per person","$1000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualPlatinumLimitedCostSharingRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020002","McLaren Rewards Gold","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020002-00","McLaren Rewards Gold","Standard Gold Off Exchange Plan","81.51%","0.815074622631073","No","Yes","Yes","67%","33%","$1,400","$40","$0","$0","$1,400","$40","$0","$0","$1,400","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","25.00%","$1,400","$1400 per person","$2800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualGoldRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010003","Silver Rewards","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010003-00","Silver Rewards","Standard Silver Off Exchange Plan","71.59%","0.717165529727936","No","Yes","Yes","67%","33%","$3,100","$55","$0","$0","$3,100","$55","$0","$0","$3,100","$55","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%","$3,100","$3100 per person","$6200 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunitySilverRewardsSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010003","Silver Rewards","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010003-01","Silver Rewards","Standard Silver On Exchange Plan","71.59%","0.717165529727936","No","Yes","Yes","67%","33%","$3,100","$55","$0","$0","$3,100","$55","$0","$0","$3,100","$55","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%","$3,100","$3100 per person","$6200 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunitySilverRewardsSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020002","McLaren Rewards Gold","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020002-01","McLaren Rewards Gold","Standard Gold On Exchange Plan","81.51%","0.815074622631073","No","Yes","Yes","67%","33%","$1,400","$40","$0","$0","$1,400","$40","$0","$0","$1,400","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","25.00%","$1,400","$1400 per person","$2800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualGoldRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020002","McLaren Rewards Gold","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020002-02","McLaren Rewards Gold","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","67%","33%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualGoldZeroCostSharingRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020002","McLaren Rewards Gold","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020002-03","McLaren Rewards Gold","Limited Cost Sharing Plan Variation","81.51%","0.815074622631073","No","Yes","Yes","67%","33%","$1,400","$40","$0","$0","$1,400","$40","$0","$0","$1,400","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","25.00%","$1,400","$1400 per person","$2800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualGoldLimitedCostSharingRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020011-00","McLaren Bronze","Standard Bronze Off Exchange Plan",,"0.619022488594055","No","Yes","No","100%",,"$6,000","$0","$0","$0","$6,000","$0","$0","$0","$6,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualBronzeRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010004","Platinum","74917MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010004-00","Platinum","Standard Platinum Off Exchange Plan",,"0.880990624427795","No","Yes","No","100%",,"$750","$25","$0","$0","$750","$25","$0","$0","$750","$25","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityPlatinumSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010004","Platinum","74917MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010004-01","Platinum","Standard Platinum On Exchange Plan",,"0.880990624427795","No","Yes","No","100%",,"$750","$25","$0","$0","$750","$25","$0","$0","$750","$25","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityPlatinumSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020011-01","McLaren Bronze","Standard Bronze On Exchange Plan",,"0.619022488594055","No","Yes","No","100%",,"$6,000","$0","$0","$0","$6,000","$0","$0","$0","$6,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualBronzeRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020011-02","McLaren Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualBronzeZeroCostSharingRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010005","Gold","74917MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010005-00","Gold","Standard Gold Off Exchange Plan",,"0.780122935771942","No","Yes","No","100%",,"$1,250","$30","$0","$0","$1,250","$30","$0","$0","$1,250","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityGoldSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010005","Gold","74917MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010005-01","Gold","Standard Gold On Exchange Plan",,"0.780122935771942","No","Yes","No","100%",,"$1,250","$30","$0","$0","$1,250","$30","$0","$0","$1,250","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityGoldSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020011-03","McLaren Bronze","Limited Cost Sharing Plan Variation",,"0.619022488594055","No","Yes","No","100%",,"$6,000","$0","$0","$0","$6,000","$0","$0","$0","$6,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualBronzeLimitedCostSharingRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010006","Silver","74917MI001",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010006-00","Silver","Standard Silver Off Exchange Plan",,"0.6807000041008","No","Yes","No","100%",,"$3,500","$40","$0","$0","$3,500","$40","$0","$0","$3,500","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunitySilverSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010006","Silver","74917MI001",,"MIN001","MIS001","MIF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010006-01","Silver","Standard Silver On Exchange Plan",,"0.6807000041008","No","Yes","No","100%",,"$3,500","$40","$0","$0","$3,500","$40","$0","$0","$3,500","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunitySilverSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010007","Bronze","74917MI001",,"MIN001","MIS001","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010007-00","Bronze","Standard Bronze Off Exchange Plan",,"0.615216434001923","No","Yes","No","100%",,"$5,000","$0","$0","$0","$5,000","$0","$0","$0","$5,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityBronzeSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","27-2204037","74917MI0010007","Bronze","74917MI001",,"MIN001","MIS001","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010007-01","Bronze","Standard Bronze On Exchange Plan",,"0.615216434001923","No","Yes","No","100%",,"$5,000","$0","$0","$0","$5,000","$0","$0","$0","$5,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/MHPCommunityBronzeSmallGroup.pdf","https://www.mclaren.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020004","McLaren Young Adult/Catastrophic","74917MI002",,"MIN001","MIS001","MIF010","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020004-00","McLaren Young Adult/Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$7,150","$0","$0","$0","$7,150","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualCatastrophicRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020004","McLaren Young Adult/Catastrophic","74917MI002",,"MIN001","MIS001","MIF010","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020004-01","McLaren Young Adult/Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$7,150","$0","$0","$0","$7,150","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualCatastrophicRewards.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020005","Silver Standard Plan","74917MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020005-00","Silver Standard Plan","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0","$3,500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualSilver.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020005","Silver Standard Plan","74917MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020005-01","Silver Standard Plan","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0","$3,500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualSilver.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020005","Silver Standard Plan","74917MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020005-02","Silver Standard Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualSilverZeroCostSharing.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020005","Silver Standard Plan","74917MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020005-03","Silver Standard Plan","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0","$3,500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualSilverLimitedCostSharing.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020005","Silver Standard Plan","74917MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020005-04","Silver Standard Plan","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0","$3,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualSilver73.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020005","Silver Standard Plan","74917MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020005-05","Silver Standard Plan","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$0","$0","$700","$0","$0","$0","$700","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualSilver87.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020005","Silver Standard Plan","74917MI002",,"MIN001","MIS001","MIF005","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020005-06","Silver Standard Plan","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$0","$0","$250","$0","$0","$0","$250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualSilver94.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020006","Gold Standard Plan","74917MI002",,"MIN001","MIS001","MIF006","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020006-00","Gold Standard Plan","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$0","$0","$1,250","$0","$0","$0","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualGold.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020006","Gold Standard Plan","74917MI002",,"MIN001","MIS001","MIF006","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020006-01","Gold Standard Plan","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$0","$0","$1,250","$0","$0","$0","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualGold.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020006","Gold Standard Plan","74917MI002",,"MIN001","MIS001","MIF006","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020006-02","Gold Standard Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualGoldZeroCostSharing.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","74917","SERFF","2017-04-25 20:15:31","Individual","No","27-2204037","74917MI0020006","Gold Standard Plan","74917MI002",,"MIN001","MIS001","MIF006","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9981",,,"2017-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/commercial-rewards-member/marketplace-mhp.aspx","74917MI0020006-03","Gold Standard Plan","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$0","$0","$0","$1,250","$0","$0","$0","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclaren.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2017/IndividualGoldLimitedCostSharing.pdf","http://www.mclarenhealthplan.org/uploads/public/documents/healthplan/documents/Exchange/rewardsproductinfo.pdf"
"2017","MI","75936","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0397286","75936MI0030001","Renaissance Group Dental PPO, EHB Certified","75936MI003",,"MIN001","MIS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","75936MI0030001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.82%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","75936","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","75936MI0010001","Delta Dental Individual PPO, EHB Certified","75936MI001",,"MIN002","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","75936MI0010001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.39%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","75936","SERFF","2016-08-19 03:49:17","Individual","Yes","47-0397286","75936MI0010002","Delta Dental Individual PPO, EHB Certified","75936MI001",,"MIN002","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","75936MI0010002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","71.88%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","75936","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0397286","75936MI0030002","Renaissance Group Dental PPO, EHB Certified","75936MI003",,"MIN001","MIS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","75936MI0030002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","69.51%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MI","86217","SERFF","2016-08-19 03:49:17","Individual","Yes","38-2724203","86217MI0010001","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS001",,"Existing","EPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","https://www.goldendentalplans.com/plans/select/hfmax/buy","","86217MI0010001-01","Select Dental Healthy Family Max","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/hfmax/summary","http://www.goldendentalplans.com/plans/select/hfmax"
"2017","MI","86217","SERFF","2016-08-19 03:49:17","Individual","Yes","38-2724203","86217MI0020001","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","https://www.goldendentalplans.com/plans/select/hfvalue/buy","","86217MI0020001-01","Select Dental Healthy Family Value","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.goldendentalplans.com/plans/select/hfvalue/summary","http://www.goldendentalplans.com/plans/select/hfvalue"
"2017","MI","86217","SERFF","2016-08-19 03:49:17","Individual","Yes","38-2724203","86217MI0030001","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS001",,"Existing","EPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","https://www.goldendentalplans.com/plans/select/hkmax/buy","","86217MI0030001-01","Select Dental Healthy Kids Max","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.goldendentalplans.com/plans/select/hkmax/summary","http://www.goldendentalplans.com/plans/select/hkmax"
"2017","MI","86217","SERFF","2016-08-19 03:49:17","Individual","Yes","38-2724203","86217MI0040001","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","https://www.goldendentalplans.com/plans/select/hkvalue/buy","","86217MI0040001-01","Select Dental Healthy Kids Value","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.goldendentalplans.com/plans/select/hkvalue/summary","http://www.goldendentalplans.com/plans/select/hkvalue"
"2017","MI","86217","SERFF","2016-08-19 03:49:17","Individual","Yes","38-2724203","86217MI0070001","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS001",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","https://www.goldendentalplans.com/plans/select/oe/hfmax/buy","","86217MI0070001-00","Select Dental Healthy Family Max","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.goldendentalplans.com/plans/select/oe/hfmax/summary","http://www.goldendentalplans.com/plans/select/oe/hfmax"
"2017","MI","86217","SERFF","2016-08-19 03:49:17","Individual","Yes","38-2724203","86217MI0080001","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS001",,"Existing","EPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","https://www.goldendentalplans.com/plans/select/oe/hfvalue/buy","","86217MI0080001-00","Select Dental Healthy Family Value","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.goldendentalplans.com/plans/select/oe/hfvalue/summary","http://www.goldendentalplans.com/plans/select/oe/hfvalue"
"2017","MI","86217","SERFF","2016-08-19 03:49:17","Individual","Yes","38-2724203","86217MI0090001","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS001",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","https://www.goldendentalplans.com/plans/select/oe/hkmax/buy","","86217MI0090001-00","Select Dental Healthy Kids Max","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.goldendentalplans.com/plans/select/oe/hkmax/summary","http://www.goldendentalplans.com/plans/select/oe/hkmax"
"2017","MI","86217","SERFF","2016-08-19 03:49:17","Individual","Yes","38-2724203","86217MI0100001","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS001",,"Existing","EPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","https://www.goldendentalplans.com/plans/select/oe/hkvalue/buy","","86217MI0100001-00","Select Dental Healthy Kids Value","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.goldendentalplans.com/plans/select/oe/hkvalue/summary","http://www.goldendentalplans.com/plans/select/oe/hkvalue"
"2017","MI","94523","SERFF","2016-08-19 03:49:17","Individual","Yes","75-1233841","94523MI0010001","Dentegra Dental PPO Pediatric Basic Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010001-17"
"2017","MI","94523","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","75-1233841","94523MI0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","94523MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0020001-17"
"2017","MI","94523","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","75-1233841","94523MI0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","94523MI002",,"MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0020007-17"
"2017","MI","94523","SERFF","2016-08-19 03:49:17","Individual","Yes","75-1233841","94523MI0010007","Dentegra Dental PPO Family Basic Plan","94523MI001",,"MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010007-17"
"2017","MI","94523","SERFF","2016-08-19 03:49:17","Individual","Yes","75-1233841","94523MI0010008","Dentegra Dental PPO Family Preferred Plan","94523MI001",,"MIN001","MIS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010008-17"
"2017","MI","94523","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","75-1233841","94523MI0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","94523MI002",,"MIN001","MIS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0020008-17"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180001","Blue Cross® Select HMO Value","98185MI018",,"MIN006","MIS004","MIF032","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180001-00","Blue Cross® Select HMO Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/catastrophic/select-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180001","Blue Cross® Select HMO Value","98185MI018",,"MIN006","MIS004","MIF032","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180001-01","Blue Cross® Select HMO Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/catastrophic/select-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180004-00","Blue Cross® Select HMO Silver","Standard Silver Off Exchange Plan","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180004-01","Blue Cross® Select HMO Silver","Standard Silver On Exchange Plan","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred HMO Gold","98185MI018",,"MIN005","MIS003","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180009-02","Blue Cross® Preferred HMO Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-gold-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred HMO Gold","98185MI018",,"MIN005","MIS003","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180009-03","Blue Cross® Preferred HMO Gold","Limited Cost Sharing Plan Variation","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-gold-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180010","Blue Cross® Partnered HMO Gold","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180010-00","Blue Cross® Partnered HMO Gold","Standard Gold Off Exchange Plan","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/partnered-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS003","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180015-00","Blue Cross® Preferred HMO Silver Saver","Standard Silver Off Exchange Plan","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-saver.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS003","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180015-01","Blue Cross® Preferred HMO Silver Saver","Standard Silver On Exchange Plan","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-saver.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS003","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180015-02","Blue Cross® Preferred HMO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180004-02","Blue Cross® Select HMO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180004-03","Blue Cross® Select HMO Silver","Limited Cost Sharing Plan Variation","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","38-2359234","98185MI0130025","BCN Gold $1500","98185MI013","7457354687","MIN001","MIS001","MIF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/customselectdruglist","98185MI0130025-00","BCN Gold $1500","Standard Gold Off Exchange Plan","81.06%","0.785365283489227","No","Yes","No","100%",,"$1,500","$10","$1,010","$150","$1,150","$160","$250","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/bcn-hmo-gold-130025.pdf",
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180004-04","Blue Cross® Select HMO Silver","73% AV Level Silver Plan","73.82%","0.760705828666687","Yes","Yes","No","100%",,"$1,500","$40","$1,390","$150","$1,500","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180004-05","Blue Cross® Select HMO Silver","87% AV Level Silver Plan","87.79%","0.891303479671478","Yes","Yes","No","100%",,"$450","$40","$460","$150","$450","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","38-2359234","98185MI0130025","BCN Gold $1500","98185MI013","7457354687","MIN001","MIS001","MIF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/customselectdruglist","98185MI0130025-01","BCN Gold $1500","Standard Gold On Exchange Plan","81.06%","0.785365283489227","No","Yes","No","100%",,"$1,500","$10","$1,010","$150","$1,150","$160","$250","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/bcn-hmo-gold-130025.pdf",
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180011-02","Blue Cross® Metro Detroit HMO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180011-03","Blue Cross® Metro Detroit HMO Silver","Limited Cost Sharing Plan Variation","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180004-06","Blue Cross® Select HMO Silver","94% AV Level Silver Plan","94.92%","0.954824328422546","Yes","Yes","No","100%",,"$180","$10","$320","$150","$180","$130","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180005-00","Blue Cross® Preferred HMO Silver","Standard Silver Off Exchange Plan","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180005-01","Blue Cross® Preferred HMO Silver","Standard Silver On Exchange Plan","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180005-02","Blue Cross® Preferred HMO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","38-2359234","98185MI0130033","BCN Silver $3000","98185MI013","7457354687","MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/customselectdruglist","98185MI0130033-00","BCN Silver $3000","Standard Silver Off Exchange Plan","71.96%","0.722634255886078","No","Yes","No","100%",,"$3,000","$20","$850","$150","$1,150","$400","$250","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/bcn-hmo-silver-130033.pdf",
"2017","MI","98185","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","38-2359234","98185MI0130033","BCN Silver $3000","98185MI013","7457354687","MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/customselectdruglist","98185MI0130033-01","BCN Silver $3000","Standard Silver On Exchange Plan","71.96%","0.722634255886078","No","Yes","No","100%",,"$3,000","$20","$850","$150","$1,150","$400","$250","$80","$0","$0","$0","$0","$200","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/bcn-hmo-silver-130033.pdf",
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180005-03","Blue Cross® Preferred HMO Silver","Limited Cost Sharing Plan Variation","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180005-04","Blue Cross® Preferred HMO Silver","73% AV Level Silver Plan","73.82%","0.760705828666687","Yes","Yes","No","100%",,"$1,500","$40","$1,390","$150","$1,500","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180005-05","Blue Cross® Preferred HMO Silver","87% AV Level Silver Plan","87.79%","0.891303479671478","Yes","Yes","No","100%",,"$450","$40","$460","$150","$450","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180005-06","Blue Cross® Preferred HMO Silver","94% AV Level Silver Plan","94.92%","0.954824328422546","Yes","Yes","No","100%",,"$180","$10","$320","$150","$180","$130","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered HMO Silver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180007-00","Blue Cross® Partnered HMO Silver","Standard Silver Off Exchange Plan","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered HMO Silver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180007-01","Blue Cross® Partnered HMO Silver","Standard Silver On Exchange Plan","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered HMO Silver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180007-02","Blue Cross® Partnered HMO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered HMO Silver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180007-03","Blue Cross® Partnered HMO Silver","Limited Cost Sharing Plan Variation","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered HMO Silver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180007-04","Blue Cross® Partnered HMO Silver","73% AV Level Silver Plan","73.82%","0.760705828666687","Yes","Yes","No","100%",,"$1,500","$40","$1,390","$150","$1,500","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered HMO Silver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180007-05","Blue Cross® Partnered HMO Silver","87% AV Level Silver Plan","87.79%","0.891303479671478","Yes","Yes","No","100%",,"$450","$40","$460","$150","$450","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered HMO Silver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180007-06","Blue Cross® Partnered HMO Silver","94% AV Level Silver Plan","94.92%","0.954824328422546","Yes","Yes","No","100%",,"$180","$10","$320","$150","$180","$130","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180008","Blue Cross® Select HMO Gold","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180008-00","Blue Cross® Select HMO Gold","Standard Gold Off Exchange Plan","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/select-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180008","Blue Cross® Select HMO Gold","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180008-01","Blue Cross® Select HMO Gold","Standard Gold On Exchange Plan","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/select-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180008","Blue Cross® Select HMO Gold","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180008-02","Blue Cross® Select HMO Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-gold-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180008","Blue Cross® Select HMO Gold","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180008-03","Blue Cross® Select HMO Gold","Limited Cost Sharing Plan Variation","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-gold-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred HMO Gold","98185MI018",,"MIN005","MIS003","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180009-00","Blue Cross® Preferred HMO Gold","Standard Gold Off Exchange Plan","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/preferred-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred HMO Gold","98185MI018",,"MIN005","MIS003","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180009-01","Blue Cross® Preferred HMO Gold","Standard Gold On Exchange Plan","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/preferred-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180010","Blue Cross® Partnered HMO Gold","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180010-01","Blue Cross® Partnered HMO Gold","Standard Gold On Exchange Plan","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/gold/partnered-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180010","Blue Cross® Partnered HMO Gold","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180010-02","Blue Cross® Partnered HMO Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-gold-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180010","Blue Cross® Partnered HMO Gold","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180010-03","Blue Cross® Partnered HMO Gold","Limited Cost Sharing Plan Variation","79.83%","0.833597302436829","Yes","Yes","No","100%",,"$250","$40","$930","$150","$250","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-gold-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180011-00","Blue Cross® Metro Detroit HMO Silver","Standard Silver Off Exchange Plan","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180011-01","Blue Cross® Metro Detroit HMO Silver","Standard Silver On Exchange Plan","70.41%","0.731645703315735","Yes","Yes","No","100%",,"$1,650","$40","$1,390","$150","$1,650","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180011-04","Blue Cross® Metro Detroit HMO Silver","73% AV Level Silver Plan","73.82%","0.760705828666687","Yes","Yes","No","100%",,"$1,500","$40","$1,390","$150","$1,500","$280","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180011-05","Blue Cross® Metro Detroit HMO Silver","87% AV Level Silver Plan","87.79%","0.891303479671478","Yes","Yes","No","100%",,"$450","$40","$460","$150","$450","$460","$520","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180011-06","Blue Cross® Metro Detroit HMO Silver","94% AV Level Silver Plan","94.92%","0.954824328422546","Yes","Yes","No","100%",,"$180","$10","$320","$150","$180","$130","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180012-00","Blue Cross® Select HMO Silver Saver","Standard Silver Off Exchange Plan","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-saver.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180012-01","Blue Cross® Select HMO Silver Saver","Standard Silver On Exchange Plan","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-saver.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180012-02","Blue Cross® Select HMO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180012-03","Blue Cross® Select HMO Silver Saver","Limited Cost Sharing Plan Variation","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180012-04","Blue Cross® Select HMO Silver Saver","73% AV Level Silver Plan","73.09%","0.745011568069458","Yes","Yes","No","100%",,"$1,800","$40","$1,390","$150","$1,800","$270","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-saver.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180012-05","Blue Cross® Select HMO Silver Saver","87% AV Level Silver Plan","87.80%","0.887996554374695","Yes","Yes","No","100%",,"$600","$40","$460","$150","$600","$440","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-saver.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180012-06","Blue Cross® Select HMO Silver Saver","94% AV Level Silver Plan","93.65%","0.941951036453247","Yes","Yes","No","100%",,"$300","$10","$340","$150","$300","$130","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-saver.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered HMO Silver Saver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180013-00","Blue Cross® Partnered HMO Silver Saver","Standard Silver Off Exchange Plan","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-saver.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered HMO Silver Saver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180013-01","Blue Cross® Partnered HMO Silver Saver","Standard Silver On Exchange Plan","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-saver.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered HMO Silver Saver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180013-02","Blue Cross® Partnered HMO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered HMO Silver Saver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180013-03","Blue Cross® Partnered HMO Silver Saver","Limited Cost Sharing Plan Variation","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered HMO Silver Saver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180013-04","Blue Cross® Partnered HMO Silver Saver","73% AV Level Silver Plan","73.09%","0.745011568069458","Yes","Yes","No","100%",,"$1,800","$40","$1,390","$150","$1,800","$270","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-saver.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered HMO Silver Saver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180013-05","Blue Cross® Partnered HMO Silver Saver","87% AV Level Silver Plan","87.80%","0.887996554374695","Yes","Yes","No","100%",,"$600","$40","$460","$150","$600","$440","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-saver.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered HMO Silver Saver","98185MI018",,"MIN003","MIS005","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180013-06","Blue Cross® Partnered HMO Silver Saver","94% AV Level Silver Plan","93.65%","0.941951036453247","Yes","Yes","No","100%",,"$300","$10","$340","$150","$300","$130","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-saver.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180014-00","Blue Cross® Metro Detroit HMO Silver Saver","Standard Silver Off Exchange Plan","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-saver.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180014-01","Blue Cross® Metro Detroit HMO Silver Saver","Standard Silver On Exchange Plan","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-saver.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180014-02","Blue Cross® Metro Detroit HMO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180014-03","Blue Cross® Metro Detroit HMO Silver Saver","Limited Cost Sharing Plan Variation","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180014-04","Blue Cross® Metro Detroit HMO Silver Saver","73% AV Level Silver Plan","73.09%","0.745011568069458","Yes","Yes","No","100%",,"$1,800","$40","$1,390","$150","$1,800","$270","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-saver.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180014-05","Blue Cross® Metro Detroit HMO Silver Saver","87% AV Level Silver Plan","87.80%","0.887996554374695","Yes","Yes","No","100%",,"$600","$40","$460","$150","$600","$440","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-saver.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180014-06","Blue Cross® Metro Detroit HMO Silver Saver","94% AV Level Silver Plan","93.65%","0.941951036453247","Yes","Yes","No","100%",,"$300","$10","$340","$150","$300","$130","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-saver.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS003","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180015-03","Blue Cross® Preferred HMO Silver Saver","Limited Cost Sharing Plan Variation","69.16%","0.68214875459671","Yes","Yes","No","100%",,"$4,500","$10","$670","$150","$4,500","$30","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS003","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180015-04","Blue Cross® Preferred HMO Silver Saver","73% AV Level Silver Plan","73.09%","0.745011568069458","Yes","Yes","No","100%",,"$1,800","$40","$1,390","$150","$1,800","$270","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-saver.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS003","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180015-05","Blue Cross® Preferred HMO Silver Saver","87% AV Level Silver Plan","87.80%","0.887996554374695","Yes","Yes","No","100%",,"$600","$40","$460","$150","$600","$440","$460","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-saver.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS003","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0180015-06","Blue Cross® Preferred HMO Silver Saver","94% AV Level Silver Plan","93.65%","0.941951036453247","Yes","Yes","No","100%",,"$300","$10","$340","$150","$300","$130","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-saver.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select HMO Bronze HSA","98185MI044",,"MIN006","MIS004","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440001-00","Blue Cross® Select HMO Bronze HSA","Standard Bronze Off Exchange Plan","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/select-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select HMO Bronze HSA","98185MI044",,"MIN006","MIS004","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440001-01","Blue Cross® Select HMO Bronze HSA","Standard Bronze On Exchange Plan","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/select-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select HMO Bronze HSA","98185MI044",,"MIN006","MIS004","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440001-02","Blue Cross® Select HMO Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select HMO Bronze HSA","98185MI044",,"MIN006","MIS004","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440001-03","Blue Cross® Select HMO Bronze","Limited Cost Sharing Plan Variation","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440002","Blue Cross® Preferred HMO Bronze HSA","98185MI044",,"MIN005","MIS001","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440002-00","Blue Cross® Preferred HMO Bronze HSA","Standard Bronze Off Exchange Plan","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/preferred-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440002","Blue Cross® Preferred HMO Bronze HSA","98185MI044",,"MIN005","MIS001","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440002-01","Blue Cross® Preferred HMO Bronze HSA","Standard Bronze On Exchange Plan","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/preferred-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440002","Blue Cross® Preferred HMO Bronze HSA","98185MI044",,"MIN005","MIS001","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440002-02","Blue Cross® Preferred HMO Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-bronze-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550002-02","Blue Cross® Preferred HMO Silver Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","38-2359234","98185MI0160011","BCN HSA Bronze $5500 ($0)","98185MI016","7457354687","MIN001","MIS001","MIF015","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/customselectdruglist","98185MI0160011-00","BCN HSA Bronze $5500 ($0)","Standard Bronze Off Exchange Plan","61.87%","0.618724405765533","Yes","Yes","No","100%",,"$5,500","$0","$530","$150","$2,420","$0","$850","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/bcn-hsa-bronze-240006.pdf",
"2017","MI","98185","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","38-2359234","98185MI0160011","BCN HSA Bronze $5500 ($0)","98185MI016","7457354687","MIN001","MIS001","MIF015","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/customselectdruglist","98185MI0160011-01","BCN HSA Bronze $5500 ($0)","Standard Bronze On Exchange Plan","61.87%","0.618724405765533","Yes","Yes","No","100%",,"$5,500","$0","$530","$150","$2,420","$0","$850","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/bcn-hsa-bronze-240007.pdf",
"2017","MI","98185","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","38-2359234","98185MI0160007","BCN HSA Bronze $6350 ($0)","98185MI016","7457354687","MIN001","MIS001","MIF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/customselectdruglist","98185MI0160007-00","BCN HSA Bronze $6350 ($0)","Standard Bronze Off Exchange Plan","61.86%","0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/bcn-hsa-bronze-240004.pdf",
"2017","MI","98185","SERFF","2017-04-24 20:15:32","SHOP (Small Group)","No","38-2359234","98185MI0160007","BCN HSA Bronze $6350 ($0)","98185MI016","7457354687","MIN001","MIS001","MIF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/customselectdruglist","98185MI0160007-01","BCN HSA Bronze $6350 ($0)","Standard Bronze On Exchange Plan","61.86%","0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2017-employer/sbc/bcn-hsa-bronze-240005.pdf",
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440002","Blue Cross® Preferred HMO Bronze HSA","98185MI044",,"MIN005","MIS001","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440002-03","Blue Cross® Preferred HMO Bronze","Limited Cost Sharing Plan Variation","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-bronze-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440004","Blue Cross® Partnered HMO Bronze HSA","98185MI044",,"MIN003","MIS005","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440004-00","Blue Cross® Partnered HMO Bronze HSA","Standard Bronze Off Exchange Plan","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/partnered-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440004","Blue Cross® Partnered HMO Bronze HSA","98185MI044",,"MIN003","MIS005","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440004-01","Blue Cross® Partnered HMO Bronze HSA","Standard Bronze On Exchange Plan","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/partnered-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440004","Blue Cross® Partnered HMO Bronze HSA","98185MI044",,"MIN003","MIS005","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440004-02","Blue Cross® Partnered HMO Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440004","Blue Cross® Partnered HMO Bronze HSA","98185MI044",,"MIN003","MIS005","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440004-03","Blue Cross® Partnered HMO Bronze","Limited Cost Sharing Plan Variation","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze HSA","98185MI044",,"MIN004","MIS006","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440005-00","Blue Cross® Metro Detroit HMO Bronze HSA","Standard Bronze Off Exchange Plan","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/metro-detroit-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze HSA","98185MI044",,"MIN004","MIS006","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440005-01","Blue Cross® Metro Detroit HMO Bronze HSA","Standard Bronze On Exchange Plan","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/metro-detroit-hmo.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze HSA","98185MI044",,"MIN004","MIS006","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440005-02","Blue Cross® Metro Detroit HMO Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze HSA","98185MI044",,"MIN004","MIS006","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440005-03","Blue Cross® Metro Detroit HMO Bronze","Limited Cost Sharing Plan Variation","61.82%","0.621779143810272","Yes","Yes","No","100%",,"$5,950","$0","$400","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS004","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440006-00","Blue Cross® Select HMO Bronze Saver HSA","Standard Bronze Off Exchange Plan","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/select-hmo-saver.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS004","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440006-01","Blue Cross® Select HMO Bronze Saver HSA","Standard Bronze On Exchange Plan","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/select-hmo-saver.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS004","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440006-02","Blue Cross® Select HMO Bronze Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-saver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS004","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440006-03","Blue Cross® Select HMO Bronze Saver","Limited Cost Sharing Plan Variation","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-saver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver HSA","98185MI044",,"MIN004","MIS006","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440008-03","Blue Cross® Metro Detroit HMO Bronze Saver","Limited Cost Sharing Plan Variation","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-saver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440007","Blue Cross® Partnered HMO Bronze Saver HSA","98185MI044",,"MIN003","MIS005","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440007-00","Blue Cross® Partnered HMO Bronze Saver HSA","Standard Bronze Off Exchange Plan","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/partnered-hmo-saver.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440007","Blue Cross® Partnered HMO Bronze Saver HSA","98185MI044",,"MIN003","MIS005","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440007-01","Blue Cross® Partnered HMO Bronze Saver HSA","Standard Bronze On Exchange Plan","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/partnered-hmo-saver.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440007","Blue Cross® Partnered HMO Bronze Saver HSA","98185MI044",,"MIN003","MIS005","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440007-02","Blue Cross® Partnered HMO Bronze Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-saver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440007","Blue Cross® Partnered HMO Bronze Saver HSA","98185MI044",,"MIN003","MIS005","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440007-03","Blue Cross® Partnered HMO Bronze Saver","Limited Cost Sharing Plan Variation","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-saver-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver HSA","98185MI044",,"MIN004","MIS006","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440008-00","Blue Cross® Metro Detroit HMO Bronze Saver HSA","Standard Bronze Off Exchange Plan","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/metro-detroit-hmo-saver.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver HSA","98185MI044",,"MIN004","MIS006","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440008-01","Blue Cross® Metro Detroit HMO Bronze Saver HSA","Standard Bronze On Exchange Plan","61.88%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/metro-detroit-hmo-saver.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver HSA","98185MI044",,"MIN004","MIS006","MIF030","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0440008-02","Blue Cross® Metro Detroit HMO Bronze Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-saver-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550001-00","Blue Cross® Select HMO Silver Extra","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-extra.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550001-01","Blue Cross® Select HMO Silver Extra","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-extra.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550001-02","Blue Cross® Select HMO Silver Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550001-03","Blue Cross® Select HMO Silver Extra","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550001-04","Blue Cross® Select HMO Silver Extra","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-extra.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550001-05","Blue Cross® Select HMO Silver Extra","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,010","$150","$700","$280","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-extra.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550001-06","Blue Cross® Select HMO Silver Extra","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/select-hmo-extra.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550002-00","Blue Cross® Preferred HMO Silver Extra","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-extra.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550002-01","Blue Cross® Preferred HMO Silver Extra","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-extra.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550002-03","Blue Cross® Preferred HMO Silver Extra","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550002-04","Blue Cross® Preferred HMO Silver Extra","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-extra.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550002-05","Blue Cross® Preferred HMO Silver Extra","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,010","$150","$700","$280","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-extra.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550002-06","Blue Cross® Preferred HMO Silver Extra","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/preferred-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/preferred-hmo-extra.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered HMO Silver Extra","98185MI055",,"MIN003","MIS005","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550003-06","Blue Cross® Partnered HMO Silver Extra","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-extra.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550004-00","Blue Cross® Metro Detroit HMO Silver Extra","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-extra.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550004-01","Blue Cross® Metro Detroit HMO Silver Extra","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-extra.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550004-02","Blue Cross® Metro Detroit HMO Silver Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered HMO Silver Extra","98185MI055",,"MIN003","MIS005","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550003-00","Blue Cross® Partnered HMO Silver Extra","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-extra.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered HMO Silver Extra","98185MI055",,"MIN003","MIS005","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550003-01","Blue Cross® Partnered HMO Silver Extra","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-extra.html?costshare=70"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered HMO Silver Extra","98185MI055",,"MIN003","MIS005","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550003-02","Blue Cross® Partnered HMO Silver Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered HMO Silver Extra","98185MI055",,"MIN003","MIS005","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550003-03","Blue Cross® Partnered HMO Silver Extra","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered HMO Silver Extra","98185MI055",,"MIN003","MIS005","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550003-04","Blue Cross® Partnered HMO Silver Extra","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-extra.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered HMO Silver Extra","98185MI055",,"MIN003","MIS005","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550003-05","Blue Cross® Partnered HMO Silver Extra","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,010","$150","$700","$280","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/partnered-hmo-extra.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550004-03","Blue Cross® Metro Detroit HMO Silver Extra","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550004-04","Blue Cross® Metro Detroit HMO Silver Extra","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-extra.html?costshare=73"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550004-05","Blue Cross® Metro Detroit HMO Silver Extra","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,010","$150","$700","$280","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-extra.html?costshare=87"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF034","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0550004-06","Blue Cross® Metro Detroit HMO Silver Extra","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$530","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/silver/metro-detroit-hmo-extra.html?costshare=94"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750001","Blue Cross® Select HMO Bronze Extra","98185MI075",,"MIN006","MIS004","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750001-00","Blue Cross® Select HMO Bronze Extra","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/select-hmo-extra.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750001","Blue Cross® Select HMO Bronze Extra","98185MI075",,"MIN006","MIS004","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750001-01","Blue Cross® Select HMO Bronze Extra","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/select-hmo-extra.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750001","Blue Cross® Select HMO Bronze Extra","98185MI075",,"MIN006","MIS004","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750001-02","Blue Cross® Select HMO Bronze Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-extra-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750001","Blue Cross® Select HMO Bronze Extra","98185MI075",,"MIN006","MIS004","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750001-03","Blue Cross® Select HMO Bronze Extra","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/select-bronze-extra-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750002","Blue Cross® Partnered HMO Bronze Extra","98185MI075",,"MIN003","MIS005","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750002-00","Blue Cross® Partnered HMO Bronze Extra","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/partnered-hmo-extra.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750002","Blue Cross® Partnered HMO Bronze Extra","98185MI075",,"MIN003","MIS005","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750002-01","Blue Cross® Partnered HMO Bronze Extra","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/partnered-hmo-extra.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750002","Blue Cross® Partnered HMO Bronze Extra","98185MI075",,"MIN003","MIS005","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750002-02","Blue Cross® Partnered HMO Bronze Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-extra-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750002","Blue Cross® Partnered HMO Bronze Extra","98185MI075",,"MIN003","MIS005","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750002-03","Blue Cross® Partnered HMO Bronze Extra","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/partnered-bronze-extra-na-more-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750003","Blue Cross® Metro Detroit HMO Bronze Extra","98185MI075",,"MIN004","MIS006","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750003-00","Blue Cross® Metro Detroit HMO Bronze Extra","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/metro-detroit-hmo-extra.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750003","Blue Cross® Metro Detroit HMO Bronze Extra","98185MI075",,"MIN004","MIS006","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750003-01","Blue Cross® Metro Detroit HMO Bronze Extra","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2017/bronze/metro-detroit-hmo-extra.html"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750003","Blue Cross® Metro Detroit HMO Bronze Extra","98185MI075",,"MIN004","MIS006","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750003-02","Blue Cross® Metro Detroit HMO Bronze Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-extra-na-less-than-300-sbc.pdf"
"2017","MI","98185","SERFF","2017-04-24 20:15:32","Individual","No","38-2359234","98185MI0750003","Blue Cross® Metro Detroit HMO Bronze Extra","98185MI075",,"MIN004","MIS006","MIF033","New","HMO","Bronze","Design 1","No","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Accidental Injury and Emergency Only","Yes","Accidental Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2017selectdruglisthmo","98185MI0750003-03","Blue Cross® Metro Detroit HMO Bronze Extra","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2017-individual/sbc/metro-detroit-hmo-bronze-extra-na-more-than-300-sbc.pdf"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180030","PSN Bronze 7150","23603MT018",,"MTN001","MTS001","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-Participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180030-00","PSN Bronze 7150","Standard Bronze Off Exchange Plan",,"0.619369626045227","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180030-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","Yes","93-0245545","23603MT0260001","Dental Choice 0-20-50","23603MT026",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No","Emergency care only","Yes","This plan covers services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0260001-00","Dental Choice 0-20-50","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/individual-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150012","SmartHealth Gold 1500","23603MT015",,"MTN002","MTS003","MTF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150012-00","SmartHealth Gold 1500","Standard Gold Off Exchange Plan",,"0.793008744716644","Yes","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150012-00.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0200002","Dental Choice Core","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200002-00","Dental Choice Core","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0200002","Dental Choice Core","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200002-01","Dental Choice Core","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550019","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS041","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550019-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","Yes","93-0245545","23603MT0190002","Kids Dental Choice 0-20-50","23603MT019",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0190002-00","Kids Dental Choice 0-20-50","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/individual-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0170013","PSN Bronze HSA 6550","23603MT017",,"MTN001","MTS001","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170013-00","PSN Bronze HSA 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2017/SBC/23603MT0170013-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0200001","Dental Choice 0-20-50 750","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200001-00","Dental Choice 0-20-50 750","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0200001","Dental Choice 0-20-50 750","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200001-01","Dental Choice 0-20-50 750","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0170013","PSN Bronze HSA 6550","23603MT017",,"MTN001","MTS001","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170013-01","PSN Bronze HSA 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2017/SBC/23603MT0170013-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","Yes","93-0245545","23603MT0190002","Kids Dental Choice 0-20-50","23603MT019",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0190002-01","Kids Dental Choice 0-20-50","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/individual-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0170014","SmartHealth Bronze HSA 6550","23603MT017",,"MTN002","MTS003","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170014-00","SmartHealth Bronze HSA 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2017/SBC/23603MT0170014-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150012","SmartHealth Gold 1500","23603MT015",,"MTN002","MTS003","MTF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150012-01","SmartHealth Gold 1500","Standard Gold On Exchange Plan",,"0.793008744716644","Yes","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150012-01.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","Yes","93-0245545","23603MT0260001","Dental Choice 0-20-50","23603MT026",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No","Emergency care only","Yes","This plan covers services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0260001-01","Dental Choice 0-20-50","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/individual-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180030","PSN Bronze 7150","23603MT018",,"MTN001","MTS001","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-Participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180030-01","PSN Bronze 7150","Standard Bronze On Exchange Plan",,"0.619369626045227","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180030-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180010","SmartHealth Bronze 7150","23603MT018",,"MTN002","MTS003","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating Providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180010-00","SmartHealth Bronze 7150","Standard Bronze Off Exchange Plan",,"0.619369626045227","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180010-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150012","SmartHealth Gold 1500","23603MT015",,"MTN002","MTS003","MTF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150012-02","SmartHealth Gold 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2017/SBC/23603MT0150012-02.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150012","SmartHealth Gold 1500","23603MT015",,"MTN002","MTS003","MTF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150012-03","SmartHealth Gold 1500","Limited Cost Sharing Plan Variation",,"0.793008744716644","Yes","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150012-03.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180010","SmartHealth Bronze 7150","23603MT018",,"MTN002","MTS003","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating Providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180010-01","SmartHealth Bronze 7150","Standard Bronze On Exchange Plan",,"0.619369626045227","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180010-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150013","SmartHealth Silver HSA 3000","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150013-00","SmartHealth Silver HSA 3000","Standard Silver Off Exchange Plan",,"0.683735430240631","Yes","Yes","No","100%",,"$3,000","$0","$1,070","$150","$3,000","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150013-00.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150013","SmartHealth Silver HSA 3000","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150013-01","SmartHealth Silver HSA 3000","Standard Silver On Exchange Plan",,"0.683735430240631","Yes","Yes","No","100%",,"$3,000","$0","$1,070","$150","$3,000","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150013-01.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150013","SmartHealth Silver HSA 3000","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150013-02","SmartHealth Silver HSA 3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2017/SBC/23603MT0150013-02.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150013","SmartHealth Silver HSA 3000","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150013-03","SmartHealth Silver HSA 3000","Limited Cost Sharing Plan Variation",,"0.683735430240631","Yes","Yes","No","100%",,"$3,000","$0","$1,070","$150","$3,000","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150013-03.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150013","SmartHealth Silver HSA 3000","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150013-04","SmartHealth Silver HSA 3000","73% AV Level Silver Plan",,"0.724367499351501","Yes","Yes","No","100%",,"$1,800","$0","$1,370","$150","$1,800","$0","$870","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150013-04.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150013","SmartHealth Silver HSA 3000","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150013-05","SmartHealth Silver HSA 3000","87% AV Level Silver Plan",,"0.867603421211243","Yes","Yes","No","100%",,"$750","$0","$750","$150","$750","$0","$750","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150013-05.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150013","SmartHealth Silver HSA 3000","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150013-06","SmartHealth Silver HSA 3000","94% AV Level Silver Plan",,"0.93794846534729","Yes","Yes","No","100%",,"$250","$0","$350","$150","$250","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150013-06.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150015","PSN Gold 1500","23603MT015",,"MTN001","MTS004","MTF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150015-00","PSN Gold 1500","Standard Gold Off Exchange Plan",,"0.793008744716644","Yes","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,500","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150015-00.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150015","PSN Gold 1500","23603MT015",,"MTN001","MTS004","MTF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150015-01","PSN Gold 1500","Standard Gold On Exchange Plan",,"0.793008744716644","Yes","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,500","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150015-01.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150015","PSN Gold 1500","23603MT015",,"MTN001","MTS004","MTF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150015-02","PSN Gold 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2017/SBC/23603MT0150015-02.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150015","PSN Gold 1500","23603MT015",,"MTN001","MTS004","MTF005","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150015-03","PSN Gold 1500","Limited Cost Sharing Plan Variation",,"0.793008744716644","Yes","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,500","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150015-03.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150014","PSN Silver HSA 3000","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150014-00","PSN Silver HSA 3000","Standard Silver Off Exchange Plan",,"0.683735430240631","Yes","Yes","No","100%",,"$3,000","$0","$1,070","$150","$3,000","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150014-00.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150014","PSN Silver HSA 3000","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150014-01","PSN Silver HSA 3000","Standard Silver On Exchange Plan",,"0.683735430240631","Yes","Yes","No","100%",,"$3,000","$0","$1,070","$150","$3,000","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150014-01.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150014","PSN Silver HSA 3000","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150014-02","PSN Silver HSA 3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2017/SBC/23603MT0150014-02.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150014","PSN Silver HSA 3000","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150014-03","PSN Silver HSA 3000","Limited Cost Sharing Plan Variation",,"0.683735430240631","Yes","Yes","No","100%",,"$3,000","$0","$1,070","$150","$3,000","$0","$570","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150014-03.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150014","PSN Silver HSA 3000","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150014-04","PSN Silver HSA 3000","73% AV Level Silver Plan",,"0.724367499351501","Yes","Yes","No","100%",,"$1,800","$0","$1,370","$150","$1,800","$0","$870","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150014-04.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150014","PSN Silver HSA 3000","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150014-05","PSN Silver HSA 3000","87% AV Level Silver Plan",,"0.867603421211243","Yes","Yes","No","100%",,"$750","$0","$750","$150","$750","$0","$750","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150014-05.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150014","PSN Silver HSA 3000","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150014-06","PSN Silver HSA 3000","94% AV Level Silver Plan",,"0.93794846534729","Yes","Yes","No","100%",,"$250","$0","$350","$150","$250","$0","$350","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/23603MT0150014-06.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150005","SmartHealth Bronze HSA 6550","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150005-00","SmartHealth Bronze HSA 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150005-00.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150005","SmartHealth Bronze HSA 6550","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150005-01","SmartHealth Bronze HSA 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150005-01.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150005","SmartHealth Bronze HSA 6550","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150005-02","SmartHealth Bronze HSA 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2017/SBC/23603MT0150005-02.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150005","SmartHealth Bronze HSA 6550","23603MT015",,"MTN002","MTS003","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150005-03","SmartHealth Bronze HSA 6550","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150005-03.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150009","PSN Bronze HSA 6550","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150009-00","PSN Bronze HSA 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150009-00.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150009","PSN Bronze HSA 6550","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150009-01","PSN Bronze HSA 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150009-01.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150009","PSN Bronze HSA 6550","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150009-02","PSN Bronze HSA 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2017/SBC/23603MT0150009-02.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","Individual","No","93-0245545","23603MT0150009","PSN Bronze HSA 6550","23603MT015",,"MTN001","MTS004","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150009-03","PSN Bronze HSA 6550","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2017/SBC/23603MT0150009-03.PDF","https://pacificsource.com/montana/individual-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180006","PSN Silver 2500 VH","23603MT018",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9883",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180006-00","PSN Silver 2500 VH","Standard Silver Off Exchange Plan",,"0.717083036899567","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180006-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0200010","Dental Choice 0-20-50 1500","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200010-00","Dental Choice 0-20-50 1500","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180006","PSN Silver 2500 VH","23603MT018",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9883",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180006-01","PSN Silver 2500 VH","Standard Silver On Exchange Plan",,"0.717083036899567","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180006-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550020","Blue Preferred Security PPO? 100","30751MT055",,"MTN001","MTS011","MTF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550020-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550009-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550030","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550030-03","Blue Preferred Bronze PPO? 103","Limited Cost Sharing Plan Variation",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0170014","SmartHealth Bronze HSA 6550","23603MT017",,"MTN002","MTS003","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170014-01","SmartHealth Bronze HSA 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2017/SBC/23603MT0170014-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0170005","PSN Silver HSA 3600","23603MT017",,"MTN001","MTS001","MTF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170005-00","PSN Silver HSA 3600","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2017/SBC/23603MT0170005-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0170005","PSN Silver HSA 3600","23603MT017",,"MTN001","MTS001","MTF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170005-01","PSN Silver HSA 3600","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2017/SBC/23603MT0170005-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0170008","SmartHealth Silver HSA 3600","23603MT017",,"MTN002","MTS003","MTF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170008-00","SmartHealth Silver HSA 3600","Standard Silver Off Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2017/SBC/23603MT0170008-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0170008","SmartHealth Silver HSA 3600","23603MT017",,"MTN002","MTS003","MTF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170008-01","SmartHealth Silver HSA 3600","Standard Silver On Exchange Plan",,"0.717919588088989","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2017/SBC/23603MT0170008-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180033","PSN Silver 2500","23603MT018",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180033-00","PSN Silver 2500","Standard Silver Off Exchange Plan",,"0.717083036899567","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180033-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0200009","Dental Choice 0-20-50 1000","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200009-00","Dental Choice 0-20-50 1000","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180033","PSN Silver 2500","23603MT018",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180033-01","PSN Silver 2500","Standard Silver On Exchange Plan",,"0.717083036899567","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180033-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180011","SmartHealth Silver 2500","23603MT018",,"MTN002","MTS003","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180011-00","SmartHealth Silver 2500","Standard Silver Off Exchange Plan",,"0.717083036899567","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180011-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180011","SmartHealth Silver 2500","23603MT018",,"MTN002","MTS003","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180011-01","SmartHealth Silver 2500","Standard Silver On Exchange Plan",,"0.717083036899567","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180011-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180036","PSN Silver 3000","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180036-00","PSN Silver 3000","Standard Silver Off Exchange Plan",,"0.709760546684265","Yes","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$280","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180036-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180036","PSN Silver 3000","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180036-01","PSN Silver 3000","Standard Silver On Exchange Plan",,"0.709760546684265","Yes","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$280","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180036-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180022","SmartHealth Gold 1000 VH","23603MT018",,"MTN002","MTS003","MTF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9903",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180022-01","SmartHealth Gold 1000 VH","Standard Gold On Exchange Plan",,"0.813666343688965","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180022-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0210007","Dental Choice Plus 0-20-50 25-1000","23603MT021",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0210007-00","Dental Choice Plus 0-20-50 25-1000","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0210008","Dental Choice Plus 0-20-50 50-1000","23603MT021",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0210008-00","Dental Choice Plus 0-20-50 50-1000","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0210009","Dental Choice Plus 0-20-50 25-1500","23603MT021",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0210009-00","Dental Choice Plus 0-20-50 25-1500","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0210010","Dental Choice Plus 0-20-50 50-1500","23603MT021",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0210010-00","Dental Choice Plus 0-20-50 50-1500","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0220002","Kids Dental Choice 0-20-50","23603MT022",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0220002-00","Kids Dental Choice 0-20-50","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","Yes","93-0245545","23603MT0220001","Kids Dental Choice 20-40-50","23603MT022",,"MTN003","MTS002",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Emergency care only","No","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0220001-00","Kids Dental Choice 20-40-50","Standard Low Off Exchange Plan","68.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2017.PDF"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560019","Blue Preferred Bronze PPO 019","30751MT056",,"MTN011","MTS001","MTF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560019-01","Blue Preferred Bronze PPO 019","Standard Bronze On Exchange Plan",,"0.616755425930023","Yes","Yes","Yes","60%","40%","$6,000","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%","$6,000","$6000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560019-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180038","SmartHealth Silver 3000","23603MT018",,"MTN002","MTS003","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180038-00","SmartHealth Silver 3000","Standard Silver Off Exchange Plan",,"0.709760546684265","Yes","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$280","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180038-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180038","SmartHealth Silver 3000","23603MT018",,"MTN002","MTS003","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180038-01","SmartHealth Silver 3000","Standard Silver On Exchange Plan",,"0.709760546684265","Yes","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$280","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180038-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180028","PSN Silver 4000","23603MT018",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180028-00","PSN Silver 4000","Standard Silver Off Exchange Plan",,"0.698196113109589","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180028-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180028","PSN Silver 4000","23603MT018",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180028-01","PSN Silver 4000","Standard Silver On Exchange Plan",,"0.698196113109589","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180028-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180026","SmartHealth Silver 4000","23603MT018",,"MTN002","MTS003","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180026-00","SmartHealth Silver 4000","Standard Silver Off Exchange Plan",,"0.698196113109589","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180026-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180026","SmartHealth Silver 4000","23603MT018",,"MTN002","MTS003","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180026-01","SmartHealth Silver 4000","Standard Silver On Exchange Plan",,"0.698196113109589","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180026-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180040","PSN Silver 5000","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180040-00","PSN Silver 5000","Standard Silver Off Exchange Plan",,"0.694606482982636","Yes","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$30","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180040-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180040","PSN Silver 5000","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180040-01","PSN Silver 5000","Standard Silver On Exchange Plan",,"0.694606482982636","Yes","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$30","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180040-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180042","SmartHealth Silver 5000","23603MT018",,"MTN002","MTS003","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180042-00","SmartHealth Silver 5000","Standard Silver Off Exchange Plan",,"0.694606482982636","Yes","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$30","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180042-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180042","SmartHealth Silver 5000","23603MT018",,"MTN002","MTS003","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180042-01","SmartHealth Silver 5000","Standard Silver On Exchange Plan",,"0.694606482982636","Yes","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$30","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180042-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180032","PSN Gold 1000","23603MT018",,"MTN001","MTS001","MTF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180032-00","PSN Gold 1000","Standard Gold Off Exchange Plan",,"0.813666343688965","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180032-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180032","PSN Gold 1000","23603MT018",,"MTN001","MTS001","MTF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180032-01","PSN Gold 1000","Standard Gold On Exchange Plan",,"0.813666343688965","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180032-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180021","SmartHealth Gold 1000","23603MT018",,"MTN002","MTS003","MTF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180021-00","SmartHealth Gold 1000","Standard Gold Off Exchange Plan",,"0.813666343688965","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180021-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180021","SmartHealth Gold 1000","23603MT018",,"MTN002","MTS003","MTF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergecy care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180021-01","SmartHealth Gold 1000","Standard Gold On Exchange Plan",,"0.813666343688965","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180021-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180015","SmartHealth Silver 2500 VH","23603MT018",,"MTN002","MTS003","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9883",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180015-00","SmartHealth Silver 2500 VH","Standard Silver Off Exchange Plan",,"0.717083036899567","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180015-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180015","SmartHealth Silver 2500 VH","23603MT018",,"MTN002","MTS003","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9883",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180015-01","SmartHealth Silver 2500 VH","Standard Silver On Exchange Plan",,"0.717083036899567","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180015-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180037","PSN Silver 3000 VH","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9881",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180037-00","PSN Silver 3000 VH","Standard Silver Off Exchange Plan",,"0.709760546684265","Yes","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$280","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180037-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180037","PSN Silver 3000 VH","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9881",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180037-01","PSN Silver 3000 VH","Standard Silver On Exchange Plan",,"0.709760546684265","Yes","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$280","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180037-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180039","SmartHealth Silver 3000 VH","23603MT018",,"MTN002","MTS003","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9881",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180039-00","SmartHealth Silver 3000 VH","Standard Silver Off Exchange Plan",,"0.709760546684265","Yes","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$280","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180039-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180039","SmartHealth Silver 3000 VH","23603MT018",,"MTN002","MTS003","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9881",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180039-01","SmartHealth Silver 3000 VH","Standard Silver On Exchange Plan",,"0.709760546684265","Yes","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$280","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180039-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180029","PSN Silver 4000 VH","23603MT018",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9878",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180029-00","PSN 4000 Silver VH","Standard Silver Off Exchange Plan",,"0.698196113109589","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180029-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180029","PSN Silver 4000 VH","23603MT018",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9878",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180029-01","PSN 4000 Silver VH","Standard Silver On Exchange Plan",,"0.698196113109589","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180029-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180027","SmartHealth Silver 4000 VH","23603MT018",,"MTN002","MTS003","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9878",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180027-00","SmartHealth Silver 4000 VH","Standard Silver Off Exchange Plan",,"0.698196113109589","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180027-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180027","SmartHealth Silver 4000 VH","23603MT018",,"MTN002","MTS003","MTF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9878",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180027-01","SmartHealth Silver 4000 VH","Standard Silver On Exchange Plan",,"0.698196113109589","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180027-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180041","PSN Silver 5000 VH","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9875",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180041-00","PSN Silver 5000 VH","Standard Silver Off Exchange Plan",,"0.694606482982636","Yes","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$30","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180041-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180041","PSN Silver 5000 VH","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9875",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180041-01","PSN Silver 5000 VH","Standard Silver On Exchange Plan",,"0.694606482982636","Yes","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$30","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180041-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180043","SmartHealth Silver 5000 VH","23603MT018",,"MTN002","MTS003","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9875",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180043-00","SmartHealth Silver 5000 VH","Standard Silver Off Exchange Plan",,"0.694606482982636","Yes","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$30","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180043-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180043","SmartHealth Silver 5000 VH","23603MT018",,"MTN002","MTS003","MTF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9875",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180043-01","SmartHealth Silver 5000 VH","Standard Silver On Exchange Plan",,"0.694606482982636","Yes","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$30","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180043-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180019","PSN Gold 1000 VH","23603MT018",,"MTN001","MTS001","MTF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9903",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180019-00","PSN Gold 1000 VH","Standard Gold Off Exchange Plan",,"0.813666343688965","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180019-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180019","PSN Gold 1000 VH","23603MT018",,"MTN001","MTS001","MTF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9903",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180019-01","PSN Gold 1000 VH","Standard Gold On Exchange Plan",,"0.813666343688965","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180019-01.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","23603","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","93-0245545","23603MT0180022","SmartHealth Gold 1000 VH","23603MT018",,"MTN002","MTS003","MTF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9903",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180022-00","SmartHealth Gold 1000 VH","Standard Gold Off Exchange Plan",,"0.813666343688965","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2017/SBC/23603MT0180022-00.PDF","https://pacificsource.com/montana/small-group-brochure-2017.PDF"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560005","Blue Preferred Gold PPO 005","30751MT056",,"MTN011","MTS001","MTF012","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560005-00","Blue Preferred Gold PPO 005","Standard Gold Off Exchange Plan",,"0.801346898078918","No","Yes","Yes","60%","40%","$2,000","$30","$1,000","$200","$2,000","$30","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$3,250","$3250 per person","$6500 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560005-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550009","Blue Preferred Security PPO? 100","30751MT055",,"MTN001","MTS021","MTF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550009-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550009-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","Yes","36-1236610","30751MT0580001","BlueCare Dental? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","Yes","36-1236610","30751MT0580001","BlueCare Dental? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550009","Blue Preferred Security PPO? 100","30751MT055",,"MTN001","MTS021","MTF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550009-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550009-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560005","Blue Preferred Gold PPO 005","30751MT056",,"MTN011","MTS001","MTF012","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560005-01","Blue Preferred Gold PPO 005","Standard Gold On Exchange Plan",,"0.801346898078918","No","Yes","Yes","60%","40%","$2,000","$30","$1,000","$200","$2,000","$30","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$3,250","$3250 per person","$6500 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560005-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560007","Blue Preferred Gold PPO 007","30751MT056",,"MTN011","MTS001","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560007-00","Blue Preferred Gold PPO 007","Standard Gold Off Exchange Plan",,"0.817301750183105","No","Yes","Yes","60%","40%","$1,000","$30","$1,000","$200","$1,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$1,000","$1000 per person","$2000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560007-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550020","Blue Preferred Security PPO? 100","30751MT055",,"MTN001","MTS011","MTF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550020-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550009-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560007","Blue Preferred Gold PPO 007","30751MT056",,"MTN011","MTS001","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560007-01","Blue Preferred Gold PPO 007","Standard Gold On Exchange Plan",,"0.817301750183105","No","Yes","Yes","60%","40%","$1,000","$30","$1,000","$200","$1,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$1,000","$1000 per person","$2000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560007-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550021","Blue Preferred Security PPO? 100","30751MT055",,"MTN001","MTS031","MTF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550021-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550009-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560014","Blue Preferred Silver PPO 014","30751MT056",,"MTN011","MTS001","MTF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560014-00","Blue Preferred Silver PPO 014","Standard Silver Off Exchange Plan",,"0.717343091964722","No","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560014-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560014","Blue Preferred Silver PPO 014","30751MT056",,"MTN011","MTS001","MTF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560014-01","Blue Preferred Silver PPO 014","Standard Silver On Exchange Plan",,"0.717343091964722","No","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560014-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550021","Blue Preferred Security PPO? 100","30751MT055",,"MTN001","MTS031","MTF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550021-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550009-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550022","Blue Preferred Security PPO? 100","30751MT055",,"MTN001","MTS041","MTF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550022-00","Blue Preferred Security PPO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550009-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560020","Blue Preferred Silver PPO 020","30751MT056",,"MTN011","MTS001","MTF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560020-00","Blue Preferred Silver PPO 020","Standard Silver Off Exchange Plan",,"0.717535018920898","No","Yes","Yes","60%","40%","$2,400","$0","$1,500","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","30.00%","$2,350","$2350 per person","$4700 per group","30.00%","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560020-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560020","Blue Preferred Silver PPO 020","30751MT056",,"MTN011","MTS001","MTF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560020-01","Blue Preferred Silver PPO 020","Standard Silver On Exchange Plan",,"0.717535018920898","No","Yes","Yes","60%","40%","$2,400","$0","$1,500","$200","$2,400","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","30.00%","$2,350","$2350 per person","$4700 per group","30.00%","$4,700","$4700 per person","$9400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560020-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550022","Blue Preferred Security PPO? 100","30751MT055",,"MTN001","MTS041","MTF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550022-01","Blue Preferred Security PPO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550009-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560018","Blue Preferred Bronze PPO 018","30751MT056",,"MTN011","MTS001","MTF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560018-00","Blue Preferred Bronze PPO 018","Standard Bronze Off Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%","$5,500","$5500 per person","$11000 per group","30.00%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560018-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550012","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550012-00","Blue Preferred Bronze PPO? 103","Standard Bronze Off Exchange Plan",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","Yes","36-1236610","30751MT0580003","BlueCare Dental 4 Kids? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","Yes","36-1236610","30751MT0580003","BlueCare Dental 4 Kids? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550012","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550012-01","Blue Preferred Bronze PPO? 103","Standard Bronze On Exchange Plan",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560018","Blue Preferred Bronze PPO 018","30751MT056",,"MTN011","MTS001","MTF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560018-01","Blue Preferred Bronze PPO 018","Standard Bronze On Exchange Plan",,"0.616959095001221","Yes","Yes","Yes","60%","40%","$5,500","$0","$500","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%","$5,500","$5500 per person","$11000 per group","30.00%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560018-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","SHOP (Small Group)","No","36-1236610","30751MT0560019","Blue Preferred Bronze PPO 019","30751MT056",,"MTN011","MTS001","MTF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0560019-00","Blue Preferred Bronze PPO 019","Standard Bronze Off Exchange Plan",,"0.616755425930023","Yes","Yes","Yes","60%","40%","$6,000","$0","$300","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%","$6,000","$6000 per person","$12000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$0.00","http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0560019-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550012","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550012-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550012","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550012-03","Blue Preferred Bronze PPO? 103","Limited Cost Sharing Plan Variation",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550029","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550029-00","Blue Preferred Bronze PPO? 103","Standard Bronze Off Exchange Plan",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550014","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS011","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550014-06","Blue Preferred Silver PPO? 105","94% AV Level Silver Plan",,"0.940134167671204","Yes","Yes","Yes","60%","40%","$100","$0","$600","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550037","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS041","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550037-04","Blue Preferred Silver PPO? 105","73% AV Level Silver Plan",,"0.731212615966797","Yes","Yes","Yes","60%","40%","$2,800","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%","$2,750","$2750 per person","$5500 per group","20.00%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550037","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS041","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550037-05","Blue Preferred Silver PPO? 105","87% AV Level Silver Plan",,"0.872437179088593","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550032","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550032-01","Blue Preferred Gold PPO? 104","Standard Gold On Exchange Plan","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550024","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550024-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550024","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550024-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550024","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550024-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550029","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550029-01","Blue Preferred Bronze PPO? 103","Standard Bronze On Exchange Plan",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550029","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550029-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550029","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550029-03","Blue Preferred Bronze PPO? 103","Limited Cost Sharing Plan Variation",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550030","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550030-00","Blue Preferred Bronze PPO? 103","Standard Bronze Off Exchange Plan",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550030","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550030-01","Blue Preferred Bronze PPO? 103","Standard Bronze On Exchange Plan",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550030","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550030-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550031","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550031-00","Blue Preferred Bronze PPO? 103","Standard Bronze Off Exchange Plan",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550031","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550031-01","Blue Preferred Bronze PPO? 103","Standard Bronze On Exchange Plan",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550031","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550031-02","Blue Preferred Bronze PPO? 103","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550031","Blue Preferred Bronze PPO? 103","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550031-03","Blue Preferred Bronze PPO? 103","Limited Cost Sharing Plan Variation",,"0.617309510707855","No","Yes","Yes","60%","40%","$6,400","$0","$300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%","$6,350","$6350 per person","$12700 per group","30.00%","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550012-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550006","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS021","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550006-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","Yes","36-1236610","30751MT0580002","BlueCare Dental? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","Yes","36-1236610","30751MT0580002","BlueCare Dental? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550006","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS021","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550006-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550006","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS021","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550006-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550006","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS021","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550006-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550017","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS011","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550017-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550017","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS011","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550017-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550017","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS011","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550017-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550017","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS011","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550017-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550018","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS031","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550018-00","Blue Preferred Bronze PPO? 006","Standard Bronze Off Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550018","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS031","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550018-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550018","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS031","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550018-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550018","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS031","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550018-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550019","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS041","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550019-01","Blue Preferred Bronze PPO? 006","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550019","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS041","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550019-02","Blue Preferred Bronze PPO? 006","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550019","Blue Preferred Bronze PPO? 006","30751MT055",,"MTN001","MTS041","MTF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550019-03","Blue Preferred Bronze PPO? 006","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550006-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550011","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS021","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550011-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550011","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS021","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550011-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550011","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS021","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550011-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550011","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS021","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550011-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550026","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS011","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550026-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550026","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS011","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550026-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550026","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS011","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550026-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550026","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS011","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550026-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550027","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS031","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550027-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550027","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS031","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550027-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550027","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS031","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550027-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550027","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS031","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550027-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550028","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS041","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550028-00","Blue Preferred Bronze PPO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550028","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS041","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550028-01","Blue Preferred Bronze PPO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550028","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS041","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550028-02","Blue Preferred Bronze PPO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550028","Blue Preferred Bronze PPO? 102","30751MT055",,"MTN001","MTS041","MTF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550028-03","Blue Preferred Bronze PPO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550011-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550014","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS011","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550014-00","Blue Preferred Silver PPO? 105","Standard Silver Off Exchange Plan",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","Yes","36-1236610","30751MT0580004","BlueCare Dental 4 Kids? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","Yes","36-1236610","30751MT0580004","BlueCare Dental 4 Kids? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550014","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS011","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550014-01","Blue Preferred Silver PPO? 105","Standard Silver On Exchange Plan",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550014","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS011","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550014-02","Blue Preferred Silver PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550014","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS011","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550014-03","Blue Preferred Silver PPO? 105","Limited Cost Sharing Plan Variation",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550014","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS011","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550014-04","Blue Preferred Silver PPO? 105","73% AV Level Silver Plan",,"0.731212615966797","Yes","Yes","Yes","60%","40%","$2,800","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%","$2,750","$2750 per person","$5500 per group","20.00%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550014","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS011","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550014-05","Blue Preferred Silver PPO? 105","87% AV Level Silver Plan",,"0.872437179088593","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650008","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650008-02","Blue Focus Gold POS? 101","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650004-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550035","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS021","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550035-00","Blue Preferred Silver PPO? 105","Standard Silver Off Exchange Plan",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550035","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS021","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550035-01","Blue Preferred Silver PPO? 105","Standard Silver On Exchange Plan",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550035","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS021","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550035-02","Blue Preferred Silver PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550035","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS021","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550035-03","Blue Preferred Silver PPO? 105","Limited Cost Sharing Plan Variation",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550035","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS021","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550035-04","Blue Preferred Silver PPO? 105","73% AV Level Silver Plan",,"0.731212615966797","Yes","Yes","Yes","60%","40%","$2,800","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%","$2,750","$2750 per person","$5500 per group","20.00%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550035","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS021","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550035-05","Blue Preferred Silver PPO? 105","87% AV Level Silver Plan",,"0.872437179088593","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550035","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS021","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550035-06","Blue Preferred Silver PPO? 105","94% AV Level Silver Plan",,"0.940134167671204","Yes","Yes","Yes","60%","40%","$100","$0","$600","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550036","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS031","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550036-00","Blue Preferred Silver PPO? 105","Standard Silver Off Exchange Plan",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550036","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS031","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550036-01","Blue Preferred Silver PPO? 105","Standard Silver On Exchange Plan",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550036","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS031","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550036-02","Blue Preferred Silver PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550036","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS031","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550036-03","Blue Preferred Silver PPO? 105","Limited Cost Sharing Plan Variation",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550036","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS031","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550036-04","Blue Preferred Silver PPO? 105","73% AV Level Silver Plan",,"0.731212615966797","Yes","Yes","Yes","60%","40%","$2,800","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%","$2,750","$2750 per person","$5500 per group","20.00%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550036","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS031","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550036-05","Blue Preferred Silver PPO? 105","87% AV Level Silver Plan",,"0.872437179088593","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550036","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS031","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550036-06","Blue Preferred Silver PPO? 105","94% AV Level Silver Plan",,"0.940134167671204","Yes","Yes","Yes","60%","40%","$100","$0","$600","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550037","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS041","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550037-00","Blue Preferred Silver PPO? 105","Standard Silver Off Exchange Plan",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550037","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS041","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550037-01","Blue Preferred Silver PPO? 105","Standard Silver On Exchange Plan",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550037","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS041","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550037-02","Blue Preferred Silver PPO? 105","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550037","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS041","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550037-03","Blue Preferred Silver PPO? 105","Limited Cost Sharing Plan Variation",,"0.698437452316284","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550037","Blue Preferred Silver PPO? 105","30751MT055",,"MTN001","MTS041","MTF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550037-06","Blue Preferred Silver PPO? 105","94% AV Level Silver Plan",,"0.940134167671204","Yes","Yes","Yes","60%","40%","$100","$0","$600","$200","$100","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550014-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550013","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550013-00","Blue Preferred Gold PPO? 104","Standard Gold Off Exchange Plan","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550013","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550013-01","Blue Preferred Gold PPO? 104","Standard Gold On Exchange Plan","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550013","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550013-02","Blue Preferred Gold PPO? 104","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550013","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550013-03","Blue Preferred Gold PPO? 104","Limited Cost Sharing Plan Variation","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550032","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550032-00","Blue Preferred Gold PPO? 104","Standard Gold Off Exchange Plan","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550032","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550032-02","Blue Preferred Gold PPO? 104","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550032","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550032-03","Blue Preferred Gold PPO? 104","Limited Cost Sharing Plan Variation","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550033","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550033-00","Blue Preferred Gold PPO? 104","Standard Gold Off Exchange Plan","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550033","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550033-01","Blue Preferred Gold PPO? 104","Standard Gold On Exchange Plan","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550033","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550033-02","Blue Preferred Gold PPO? 104","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550033","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550033-03","Blue Preferred Gold PPO? 104","Limited Cost Sharing Plan Variation","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550034","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550034-00","Blue Preferred Gold PPO? 104","Standard Gold Off Exchange Plan","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550034","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550034-01","Blue Preferred Gold PPO? 104","Standard Gold On Exchange Plan","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550034","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550034-02","Blue Preferred Gold PPO? 104","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550034","Blue Preferred Gold PPO? 104","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550034-03","Blue Preferred Gold PPO? 104","Limited Cost Sharing Plan Variation","79.65%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,700","$0","$100","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550013-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550010-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550010-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550010-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550010-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550010-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","72.77%","0","No","Yes","Yes","60%","40%","$2,700","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$22,800","$22800 per person","$45600 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550010-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.51%","0.875050723552704","No","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS021","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550010-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.49%","0.94485467672348","No","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550023","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550023-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550023","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550023-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550023","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550023-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550023","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550023-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550023","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550023-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","72.77%","0","No","Yes","Yes","60%","40%","$2,700","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$22,800","$22800 per person","$45600 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550023","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550023-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.51%","0.875050723552704","No","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550023","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS011","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550023-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.49%","0.94485467672348","No","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550024","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550024-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650006-02","Blue Focus Silver POS? 102","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","59968","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-0883760","59968MT0030001","EHB Low Passive","59968MT003",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59968MT0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","MT","62818","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5123390","62818MT0010002","Guardian Pediatric Advantage","62818MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","62818MT0010002-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010011","BESTDental Choice - L","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Choice-L_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010012","BESTDental Value","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Value_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010012","BESTDental Value","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Value_Plan.pdf"
"2017","MT","62818","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5123390","62818MT0020003","Guardian Pediatric Essentials","62818MT002",,"MTN001","MTS001",,"New","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","62818MT0020003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","MT","70415","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","70415MT0030002","EHB High Passive","70415MT003",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","70415MT0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","MT","70415","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","70415MT0030001","EHB Low Passive","70415MT003",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","70415MT0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010005-02","Medica Insure Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBCNEZ&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010005-03","Medica Insure Bronze Copay","Limited Cost Sharing Plan Variation",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBCNEL&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze H S A","20305NE001",,"NEN001","NES001","NEF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010011-00","Medica Insure Bronze H S A","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBHNE&uid=FFM",
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550024","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550024-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","72.77%","0","No","Yes","Yes","60%","40%","$2,700","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$22,800","$22800 per person","$45600 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550024","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550024-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.51%","0.875050723552704","No","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550024","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS031","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550024-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.49%","0.94485467672348","No","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550025","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550025-00","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver Off Exchange Plan","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550025","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550025-01","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Standard Silver On Exchange Plan","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550025","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550025-02","Blue Preferred Silver PPO? 101","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550025","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550025-03","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","Limited Cost Sharing Plan Variation","69.79%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$3,000","$3000 per person","$6000 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550025","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550025-04","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","73% AV Level Silver Plan","72.77%","0","No","Yes","Yes","60%","40%","$2,700","$0","$900","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$22,800","$22800 per person","$45600 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550025","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550025-05","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","87% AV Level Silver Plan","87.51%","0.875050723552704","No","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0550025","Blue Preferred Silver PPO? 101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0550025-06","Blue Preferred Silver PPO? 101 - Five $0 PCP Visits","94% AV Level Silver Plan","94.49%","0.94485467672348","No","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80","$0","$0","$0","$0",,"0","5","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0550010-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650004","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650004-00","Blue Focus Gold POS? 101","Standard Gold Off Exchange Plan","80.80%","0","No","Yes","Yes","60%","40%","$800","$20","$1,500","$200","$800","$100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","30.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650004-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650004","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650004-01","Blue Focus Gold POS? 101","Standard Gold On Exchange Plan","80.80%","0","No","Yes","Yes","60%","40%","$800","$20","$1,500","$200","$800","$100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","30.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650004-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650004","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650004-02","Blue Focus Gold POS? 101","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650004-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650004","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650004-03","Blue Focus Gold POS? 101","Limited Cost Sharing Plan Variation","80.80%","0","No","Yes","Yes","60%","40%","$800","$20","$1,500","$200","$800","$100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","30.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650004-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650008","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650008-00","Blue Focus Gold POS? 101","Standard Gold Off Exchange Plan","80.80%","0","No","Yes","Yes","60%","40%","$800","$20","$1,500","$200","$800","$100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","30.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650004-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650008","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650008-01","Blue Focus Gold POS? 101","Standard Gold On Exchange Plan","80.80%","0","No","Yes","Yes","60%","40%","$800","$20","$1,500","$200","$800","$100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","30.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650004-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650008","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650008-03","Blue Focus Gold POS? 101","Limited Cost Sharing Plan Variation","80.80%","0","No","Yes","Yes","60%","40%","$800","$20","$1,500","$200","$800","$100","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","30.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650004-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650002-00","Blue Focus Silver POS? 102","Standard Silver Off Exchange Plan","70.88%","0","No","Yes","Yes","60%","40%","$3,000","$0","$1,300","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650002-01","Blue Focus Silver POS? 102","Standard Silver On Exchange Plan","70.88%","0","No","Yes","Yes","60%","40%","$3,000","$0","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650002-02","Blue Focus Silver POS? 102","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650002-03","Blue Focus Silver POS? 102","Limited Cost Sharing Plan Variation","70.88%","0","No","Yes","Yes","60%","40%","$3,000","$0","$1,300","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650002-04","Blue Focus Silver POS? 102","73% AV Level Silver Plan","72.97%","0","No","Yes","Yes","60%","40%","$3,000","$0","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$22,800","$22800 per person","$45600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650002-05","Blue Focus Silver POS? 102","87% AV Level Silver Plan","87.24%","0","No","Yes","Yes","60%","40%","$1,000","$10","$1,000","$200","$1,000","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","30.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650002-06","Blue Focus Silver POS? 102","94% AV Level Silver Plan","94.41%","0","No","Yes","Yes","60%","40%","$500","$10","$200","$200","$500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650006-00","Blue Focus Silver POS? 102","Standard Silver Off Exchange Plan","70.88%","0","No","Yes","Yes","60%","40%","$3,000","$0","$1,300","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650006-01","Blue Focus Silver POS? 102","Standard Silver On Exchange Plan","70.88%","0","No","Yes","Yes","60%","40%","$3,000","$0","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650006-03","Blue Focus Silver POS? 102","Limited Cost Sharing Plan Variation","70.88%","0","No","Yes","Yes","60%","40%","$3,000","$0","$1,300","$200","$3,000","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650006-04","Blue Focus Silver POS? 102","73% AV Level Silver Plan","72.97%","0","No","Yes","Yes","60%","40%","$3,000","$0","$1,300","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$22,800","$22800 per person","$45600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650006-05","Blue Focus Silver POS? 102","87% AV Level Silver Plan","87.24%","0","No","Yes","Yes","60%","40%","$1,000","$10","$1,000","$200","$1,000","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%","$500","$500 per person","$1000 per group","30.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650006-06","Blue Focus Silver POS? 102","94% AV Level Silver Plan","94.41%","0","No","Yes","Yes","60%","40%","$500","$10","$200","$200","$500","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650002-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650003-00","Blue Focus Silver POS? 103","Standard Silver Off Exchange Plan","69.68%","0","No","Yes","Yes","60%","40%","$4,100","$0","$600","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20.00%","$3,850","$3850 per person","$7700 per group","20.00%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650003-01","Blue Focus Silver POS? 103","Standard Silver On Exchange Plan","69.68%","0","No","Yes","Yes","60%","40%","$4,100","$0","$600","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20.00%","$3,850","$3850 per person","$7700 per group","20.00%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650003-02","Blue Focus Silver POS? 103","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650003-03","Blue Focus Silver POS? 103","Limited Cost Sharing Plan Variation","69.68%","0","No","Yes","Yes","60%","40%","$4,100","$300","$600","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20.00%","$3,850","$3850 per person","$7700 per group","20.00%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650003-04","Blue Focus Silver POS? 103","73% AV Level Silver Plan","73.22%","0","No","Yes","Yes","60%","40%","$3,200","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$22,800","$22800 per person","$45600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%","$2,900","$2900 per person","$5800 per group","20.00%","$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650003-05","Blue Focus Silver POS? 103","87% AV Level Silver Plan","87.60%","0","No","Yes","Yes","60%","40%","$800","$10","$1,000","$200","$800","$60","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650003-06","Blue Focus Silver POS? 103","94% AV Level Silver Plan","94.38%","0","No","Yes","Yes","60%","40%","$500","$10","$100","$200","$500","$50","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650007-00","Blue Focus Silver POS? 103","Standard Silver Off Exchange Plan","69.68%","0","No","Yes","Yes","60%","40%","$4,100","$0","$600","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20.00%","$3,850","$3850 per person","$7700 per group","20.00%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650007-01","Blue Focus Silver POS? 103","Standard Silver On Exchange Plan","69.68%","0","No","Yes","Yes","60%","40%","$4,100","$0","$600","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20.00%","$3,850","$3850 per person","$7700 per group","20.00%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650007-02","Blue Focus Silver POS? 103","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650007-03","Blue Focus Silver POS? 103","Limited Cost Sharing Plan Variation","69.68%","0","No","Yes","Yes","60%","40%","$4,100","$300","$600","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20.00%","$3,850","$3850 per person","$7700 per group","20.00%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650007-04","Blue Focus Silver POS? 103","73% AV Level Silver Plan","73.22%","0","No","Yes","Yes","60%","40%","$3,200","$0","$800","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$22,800","$22800 per person","$45600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%","$2,900","$2900 per person","$5800 per group","20.00%","$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-04.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650007-05","Blue Focus Silver POS? 103","87% AV Level Silver Plan","87.60%","0","No","Yes","Yes","60%","40%","$800","$10","$1,000","$200","$800","$60","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-05.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650007-06","Blue Focus Silver POS? 103","94% AV Level Silver Plan","94.38%","0","No","Yes","Yes","60%","40%","$500","$10","$100","$200","$500","$50","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650003-06.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650001","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS012","MTF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650001-00","Blue Focus Bronze POS? 104 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.26%","0","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%","$6,000","$6000 per person","$12000 per group","20.00%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650001-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650001","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS012","MTF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650001-01","Blue Focus Bronze POS? 104 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.26%","0","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%","$6,000","$6000 per person","$12000 per group","20.00%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650001-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650001","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS012","MTF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650001-02","Blue Focus Bronze POS? 104","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650001-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650001","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS012","MTF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650001-03","Blue Focus Bronze POS? 104 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.26%","0","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%","$6,000","$6000 per person","$12000 per group","20.00%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650001-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650005","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS032","MTF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650005-00","Blue Focus Bronze POS? 104 - One $0 PCP Visit","Standard Bronze Off Exchange Plan","61.26%","0","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%","$6,000","$6000 per person","$12000 per group","20.00%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650001-00.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650005","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS032","MTF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650005-01","Blue Focus Bronze POS? 104 - One $0 PCP Visit","Standard Bronze On Exchange Plan","61.26%","0","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%","$6,000","$6000 per person","$12000 per group","20.00%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650001-01.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650005","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS032","MTF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650005-02","Blue Focus Bronze POS? 104","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650001-02.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","30751","SERFF","2017-01-25 20:15:24","Individual","No","36-1236610","30751MT0650005","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS032","MTF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_MT_5T_EX.pdf","30751MT0650005-03","Blue Focus Bronze POS? 104 - One $0 PCP Visit","Limited Cost Sharing Plan Variation","61.26%","0","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%","$6,000","$6000 per person","$12000 per group","20.00%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/static/mt/pdf/sbc/2017/30751MT0650001-03.pdf","http://www.bcbsmt.com/static/mt/pdf/brochure/2017/mt-plan-overview.pdf"
"2017","MT","59110","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","57-0523959","59110MT0020001","Group Dental Policy","59110MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","59110MT0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","MT","59968","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-0883760","59968MT0030002","EHB High Passive","59968MT003",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59968MT0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","MT","71788","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","94-2761537","71788MT0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0020001-17"
"2017","MT","71788","SERFF","2016-08-24 05:44:16","Individual","Yes","94-2761537","71788MT0010001","Delta Dental PPO Pediatric Basic Plan","71788MT001",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0010001-17"
"2017","MT","71788","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","94-2761537","71788MT0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0020002-17"
"2017","MT","71788","SERFF","2016-08-24 05:44:16","Individual","Yes","94-2761537","71788MT0010002","Delta Dental PPO Pediatric Preferred Plan","71788MT001",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0010002-17"
"2017","MT","71788","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","94-2761537","71788MT0020009","Delta Dental PPO Basic Plan for Families for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0020009-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0020009-17"
"2017","MT","71788","SERFF","2016-08-24 05:44:16","Individual","Yes","94-2761537","71788MT0010009","Delta Dental PPO Basic Plan for Families","71788MT001",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0010009-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0010009-17"
"2017","MT","71788","SERFF","2016-08-24 05:44:16","Individual","Yes","94-2761537","71788MT0010004","Delta Dental PPO Preferred Plan for Families","71788MT001",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0010004-17"
"2017","MT","71788","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","94-2761537","71788MT0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0020004-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0020004-17"
"2017","MT","92216","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","92216MT0030002","EHB High Passive","92216MT003",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","92216MT0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","MT","92216","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","92216MT0030001","EHB Low Passive","92216MT003",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","92216MT0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","93895MT0020003","BESTOne Advantage Gold","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTOne_Dental_Advantage-High_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010007","BESTDental Premium","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Premium_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010007","BESTDental Premium","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Premium_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","93895MT0020003","BESTOne Advantage Gold","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTOne_Dental_Advantage-High_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","93895MT0020004","BESTOne Plus Gold","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTOne_Dental_Plus-High_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010008","BESTDental Standard - H","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Standard-H_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010008","BESTDental Standard - H","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Standard-H_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","93895MT0020004","BESTOne Plus Gold","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTOne_Dental_Plus-High_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010010","BESTDental Choice - H","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Choice-H_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010010","BESTDental Choice - H","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Choice-H_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010009","BESTDental Standard - L","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Standard-L_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","93895MT0020005","BESTOne Plus Silver","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTOne_Dental_Plus-Low_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","93895MT0020005","BESTOne Plus Silver","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTOne_Dental_Plus-Low_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010009","BESTDental Standard - L","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Standard-L_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","93895MT0010011","BESTDental Choice - L","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTDental_Choice-L_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","93895MT0020006","BESTOne Basic Silver","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTOne_Dental_Basic-Low_Plan.pdf"
"2017","MT","93895","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","93895MT0020006","BESTOne Basic Silver","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2017/MT_BESTOne_Dental_Basic-Low_Plan.pdf"
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES002","NEF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010019-00","Medica Insure Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IGPCNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES002","NEF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010019-01","Medica Insure Gold Copay Plus","Standard Gold On Exchange Plan",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IGPCNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES002","NEF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010019-02","Medica Insure Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IGPCNEZ&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES002","NEF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010019-03","Medica Insure Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.79470294713974","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IGPCNEL&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010003-00","Medica Insure Silver Copay","Standard Silver Off Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010003-01","Medica Insure Silver Copay","Standard Silver On Exchange Plan",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010003-02","Medica Insure Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCNEZ&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010003-03","Medica Insure Silver Copay","Limited Cost Sharing Plan Variation",,"0.707138121128082","Yes","Yes","No","100%",,"$2,600","$10","$1,100","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCNEL&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010003-04","Medica Insure Silver Copay","73% AV Level Silver Plan",,"0.73963475227356","Yes","Yes","No","100%",,"$2,400","$10","$900","$1,000","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCNE73&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010003-05","Medica Insure Silver Copay","87% AV Level Silver Plan",,"0.875553548336029","Yes","Yes","No","100%",,"$400","$10","$1,000","$1,000","$400","$400","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCNE87&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010003-06","Medica Insure Silver Copay","94% AV Level Silver Plan",,"0.934451282024384","Yes","Yes","No","100%",,"$100","$10","$300","$1,000","$100","$400","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISCNE94&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010009-00","Medica Insure Silver H S A","Standard Silver Off Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010009-01","Medica Insure Silver H S A","Standard Silver On Exchange Plan",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010009-02","Medica Insure Silver H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHNEZ&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010009-03","Medica Insure Silver H S A","Limited Cost Sharing Plan Variation",,"0.706601321697235","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHNEL&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010009-04","Medica Insure Silver H S A","73% AV Level Silver Plan",,"0.738642454147339","Yes","Yes","No","100%",,"$1,100","$0","$1,300","$1,000","$1,100","$0","$1,300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$3300 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHNE73&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010009-05","Medica Insure Silver H S A","87% AV Level Silver Plan",,"0.87436580657959","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHNE87&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010009-06","Medica Insure Silver H S A","94% AV Level Silver Plan",,"0.941599547863007","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ISHNE94&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010005-00","Medica Insure Bronze Copay","Standard Bronze Off Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBCNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010005-01","Medica Insure Bronze Copay","Standard Bronze On Exchange Plan",,"0.618261575698853","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBCNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze H S A","20305NE001",,"NEN001","NES001","NEF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010011-01","Medica Insure Bronze H S A","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBHNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze H S A","20305NE001",,"NEN001","NES001","NEF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010011-02","Medica Insure Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBHNEZ&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze H S A","20305NE001",,"NEN001","NES001","NEF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010011-03","Medica Insure Bronze H S A","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","per person not applicable","$12800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2IBHNEL&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010013","Medica Insure Catastrophic","20305NE001",,"NEN001","NES001","NEF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010013-00","Medica Insure Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICNE&uid=FFM",
"2017","NE","20305","SERFF","2016-09-29 04:19:41","Individual","No","41-1490988","20305NE0010013","Medica Insure Catastrophic","20305NE001",,"NEN001","NES001","NEF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/ifbpharmacy","20305NE0010013-01","Medica Insure Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2ICNE&uid=FFM",
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030001","Aetna Leap Basic MIPPA","44794NE003",,"NEN002","NES002","NEF015","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030001-02","Aetna Leap Basic MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721439_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030001","Aetna Leap Basic MIPPA","44794NE003",,"NEN002","NES002","NEF015","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030001-03","Aetna Leap Basic MIPPA","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721439_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","36768","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","36768NE0040002","EHB High PPO","36768NE004",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NE","36768","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","36768NE0040001","EHB Low PPO","36768NE004",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020011","Aetna Leap Diabetes Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020011-01","Aetna Leap Diabetes Nebraska Health Network","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720495_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","36768","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","36768NE0030002","EHB High Passive","36768NE003",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NE","36768","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","47-0098400","36768NE0030001","EHB Low Passive","36768NE003",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020001","Aetna Leap Basic CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020001-00","Aetna Leap Basic CHI Health Omaha","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721102_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020001","Aetna Leap Basic CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020001-01","Aetna Leap Basic CHI Health Omaha","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721102_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020001","Aetna Leap Basic CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020001-02","Aetna Leap Basic CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721102_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020001","Aetna Leap Basic CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020001-03","Aetna Leap Basic CHI Health Omaha","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721102_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030001","Aetna Leap Basic MIPPA","44794NE003",,"NEN002","NES002","NEF015","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030001-00","Aetna Leap Basic MIPPA","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721439_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030001","Aetna Leap Basic MIPPA","44794NE003",,"NEN002","NES002","NEF015","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030001-01","Aetna Leap Basic MIPPA","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721439_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020008","Aetna Leap Basic Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF008","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020008-00","Aetna Leap Basic Nebraska Health Network","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720513_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020008","Aetna Leap Basic Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF008","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020008-01","Aetna Leap Basic Nebraska Health Network","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720513_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020008","Aetna Leap Basic Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF008","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020008-02","Aetna Leap Basic Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720513_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020008","Aetna Leap Basic Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF008","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020008-03","Aetna Leap Basic Nebraska Health Network","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720513_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030008","Aetna Leap Basic POS","44794NE003",,"NEN004","NES004","NEF022","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030008-00","Aetna Leap Basic POS","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721980_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030008","Aetna Leap Basic POS","44794NE003",,"NEN004","NES004","NEF022","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030008-01","Aetna Leap Basic POS","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721980_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030008","Aetna Leap Basic POS","44794NE003",,"NEN004","NES004","NEF022","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030008-02","Aetna Leap Basic POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721980_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030008","Aetna Leap Basic POS","44794NE003",,"NEN004","NES004","NEF022","New","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030008-03","Aetna Leap Basic POS","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721980_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020004","Aetna Leap Diabetes CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020004-00","Aetna Leap Diabetes CHI Health Omaha","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721091_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020004","Aetna Leap Diabetes CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020004-01","Aetna Leap Diabetes CHI Health Omaha","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721091_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020004","Aetna Leap Diabetes CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020004-02","Aetna Leap Diabetes CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721091_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020004","Aetna Leap Diabetes CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020004-03","Aetna Leap Diabetes CHI Health Omaha","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721091_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020004","Aetna Leap Diabetes CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020004-04","Aetna Leap Diabetes CHI Health Omaha","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721091_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020004","Aetna Leap Diabetes CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020004-05","Aetna Leap Diabetes CHI Health Omaha","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721091_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020004","Aetna Leap Diabetes CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020004-06","Aetna Leap Diabetes CHI Health Omaha","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721091_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030004","Aetna Leap Diabetes MIPPA","44794NE003",,"NEN002","NES002","NEF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030004-00","Aetna Leap Diabetes MIPPA","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721428_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030004","Aetna Leap Diabetes MIPPA","44794NE003",,"NEN002","NES002","NEF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030004-01","Aetna Leap Diabetes MIPPA","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721428_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030004","Aetna Leap Diabetes MIPPA","44794NE003",,"NEN002","NES002","NEF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030004-02","Aetna Leap Diabetes MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721428_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030004","Aetna Leap Diabetes MIPPA","44794NE003",,"NEN002","NES002","NEF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030004-03","Aetna Leap Diabetes MIPPA","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721428_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030004","Aetna Leap Diabetes MIPPA","44794NE003",,"NEN002","NES002","NEF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030004-04","Aetna Leap Diabetes MIPPA","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721428_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030004","Aetna Leap Diabetes MIPPA","44794NE003",,"NEN002","NES002","NEF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030004-05","Aetna Leap Diabetes MIPPA","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721428_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030004","Aetna Leap Diabetes MIPPA","44794NE003",,"NEN002","NES002","NEF018","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030004-06","Aetna Leap Diabetes MIPPA","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721428_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020011","Aetna Leap Diabetes Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020011-00","Aetna Leap Diabetes Nebraska Health Network","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720495_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020011","Aetna Leap Diabetes Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020011-02","Aetna Leap Diabetes Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720495_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020011","Aetna Leap Diabetes Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020011-03","Aetna Leap Diabetes Nebraska Health Network","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720495_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020011","Aetna Leap Diabetes Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020011-04","Aetna Leap Diabetes Nebraska Health Network","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720495_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020011","Aetna Leap Diabetes Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020011-05","Aetna Leap Diabetes Nebraska Health Network","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720495_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020011","Aetna Leap Diabetes Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020011-06","Aetna Leap Diabetes Nebraska Health Network","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720495_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030011","Aetna Leap Diabetes POS","44794NE003",,"NEN004","NES004","NEF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030011-00","Aetna Leap Diabetes POS","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721969_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030011","Aetna Leap Diabetes POS","44794NE003",,"NEN004","NES004","NEF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030011-01","Aetna Leap Diabetes POS","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721969_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030011","Aetna Leap Diabetes POS","44794NE003",,"NEN004","NES004","NEF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030011-02","Aetna Leap Diabetes POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721969_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030011","Aetna Leap Diabetes POS","44794NE003",,"NEN004","NES004","NEF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030011-03","Aetna Leap Diabetes POS","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721969_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030011","Aetna Leap Diabetes POS","44794NE003",,"NEN004","NES004","NEF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030011-04","Aetna Leap Diabetes POS","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721969_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030011","Aetna Leap Diabetes POS","44794NE003",,"NEN004","NES004","NEF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030011-05","Aetna Leap Diabetes POS","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721969_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030011","Aetna Leap Diabetes POS","44794NE003",,"NEN004","NES004","NEF025","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030011-06","Aetna Leap Diabetes POS","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721969_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020005","Aetna Leap Everyday CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020005-00","Aetna Leap Everyday CHI Health Omaha","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721070_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020005","Aetna Leap Everyday CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020005-01","Aetna Leap Everyday CHI Health Omaha","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721070_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020005","Aetna Leap Everyday CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020005-02","Aetna Leap Everyday CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721070_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020005","Aetna Leap Everyday CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020005-03","Aetna Leap Everyday CHI Health Omaha","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721070_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020005","Aetna Leap Everyday CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020005-04","Aetna Leap Everyday CHI Health Omaha","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721070_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020005","Aetna Leap Everyday CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020005-05","Aetna Leap Everyday CHI Health Omaha","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721070_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020005","Aetna Leap Everyday CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020005-06","Aetna Leap Everyday CHI Health Omaha","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721070_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030005","Aetna Leap Everyday MIPPA","44794NE003",,"NEN002","NES002","NEF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030005-00","Aetna Leap Everyday MIPPA","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721407_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030005","Aetna Leap Everyday MIPPA","44794NE003",,"NEN002","NES002","NEF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030005-01","Aetna Leap Everyday MIPPA","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721407_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030005","Aetna Leap Everyday MIPPA","44794NE003",,"NEN002","NES002","NEF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030005-02","Aetna Leap Everyday MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721407_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030005","Aetna Leap Everyday MIPPA","44794NE003",,"NEN002","NES002","NEF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030005-03","Aetna Leap Everyday MIPPA","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721407_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030005","Aetna Leap Everyday MIPPA","44794NE003",,"NEN002","NES002","NEF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030005-04","Aetna Leap Everyday MIPPA","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721407_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030005","Aetna Leap Everyday MIPPA","44794NE003",,"NEN002","NES002","NEF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030005-05","Aetna Leap Everyday MIPPA","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721407_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030005","Aetna Leap Everyday MIPPA","44794NE003",,"NEN002","NES002","NEF019","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030005-06","Aetna Leap Everyday MIPPA","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721407_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020012","Aetna Leap Everyday Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020012-00","Aetna Leap Everyday Nebraska Health Network","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720576_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020012","Aetna Leap Everyday Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020012-01","Aetna Leap Everyday Nebraska Health Network","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720576_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020012","Aetna Leap Everyday Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020012-02","Aetna Leap Everyday Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720576_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020012","Aetna Leap Everyday Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020012-03","Aetna Leap Everyday Nebraska Health Network","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720576_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020012","Aetna Leap Everyday Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020012-04","Aetna Leap Everyday Nebraska Health Network","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720576_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020012","Aetna Leap Everyday Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020012-05","Aetna Leap Everyday Nebraska Health Network","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720576_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020012","Aetna Leap Everyday Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020012-06","Aetna Leap Everyday Nebraska Health Network","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720576_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020006","Aetna Leap Everyday Plus CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020006-00","Aetna Leap Everyday Plus CHI Health Omaha","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721077_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020006","Aetna Leap Everyday Plus CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020006-01","Aetna Leap Everyday Plus CHI Health Omaha","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721077_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020006","Aetna Leap Everyday Plus CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020006-02","Aetna Leap Everyday Plus CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721077_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020006","Aetna Leap Everyday Plus CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020006-03","Aetna Leap Everyday Plus CHI Health Omaha","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721077_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020006","Aetna Leap Everyday Plus CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020006-04","Aetna Leap Everyday Plus CHI Health Omaha","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721077_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020006","Aetna Leap Everyday Plus CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020006-05","Aetna Leap Everyday Plus CHI Health Omaha","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721077_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020006","Aetna Leap Everyday Plus CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020006-06","Aetna Leap Everyday Plus CHI Health Omaha","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721077_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030006","Aetna Leap Everyday Plus MIPPA","44794NE003",,"NEN002","NES002","NEF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030006-00","Aetna Leap Everyday Plus MIPPA","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721414_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030006","Aetna Leap Everyday Plus MIPPA","44794NE003",,"NEN002","NES002","NEF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030006-01","Aetna Leap Everyday Plus MIPPA","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721414_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030006","Aetna Leap Everyday Plus MIPPA","44794NE003",,"NEN002","NES002","NEF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030006-02","Aetna Leap Everyday Plus MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721414_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030006","Aetna Leap Everyday Plus MIPPA","44794NE003",,"NEN002","NES002","NEF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030006-03","Aetna Leap Everyday Plus MIPPA","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721414_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030006","Aetna Leap Everyday Plus MIPPA","44794NE003",,"NEN002","NES002","NEF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030006-04","Aetna Leap Everyday Plus MIPPA","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721414_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030006","Aetna Leap Everyday Plus MIPPA","44794NE003",,"NEN002","NES002","NEF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030006-05","Aetna Leap Everyday Plus MIPPA","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721414_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030006","Aetna Leap Everyday Plus MIPPA","44794NE003",,"NEN002","NES002","NEF020","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030006-06","Aetna Leap Everyday Plus MIPPA","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721414_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020013","Aetna Leap Everyday Plus Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020013-00","Aetna Leap Everyday Plus Nebraska Health Network","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720590_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020013","Aetna Leap Everyday Plus Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020013-01","Aetna Leap Everyday Plus Nebraska Health Network","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720590_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020013","Aetna Leap Everyday Plus Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020013-02","Aetna Leap Everyday Plus Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720590_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020013","Aetna Leap Everyday Plus Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020013-03","Aetna Leap Everyday Plus Nebraska Health Network","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720590_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020013","Aetna Leap Everyday Plus Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020013-04","Aetna Leap Everyday Plus Nebraska Health Network","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720590_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020013","Aetna Leap Everyday Plus Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020013-05","Aetna Leap Everyday Plus Nebraska Health Network","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720590_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020013","Aetna Leap Everyday Plus Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020013-06","Aetna Leap Everyday Plus Nebraska Health Network","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720590_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030013","Aetna Leap Everyday Plus POS","44794NE003",,"NEN004","NES004","NEF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030013-00","Aetna Leap Everyday Plus POS","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721955_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030013","Aetna Leap Everyday Plus POS","44794NE003",,"NEN004","NES004","NEF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030013-01","Aetna Leap Everyday Plus POS","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721955_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030013","Aetna Leap Everyday Plus POS","44794NE003",,"NEN004","NES004","NEF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030013-02","Aetna Leap Everyday Plus POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721955_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030013","Aetna Leap Everyday Plus POS","44794NE003",,"NEN004","NES004","NEF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030013-03","Aetna Leap Everyday Plus POS","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721955_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030013","Aetna Leap Everyday Plus POS","44794NE003",,"NEN004","NES004","NEF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030013-04","Aetna Leap Everyday Plus POS","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721955_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030013","Aetna Leap Everyday Plus POS","44794NE003",,"NEN004","NES004","NEF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030013-05","Aetna Leap Everyday Plus POS","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721955_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030013","Aetna Leap Everyday Plus POS","44794NE003",,"NEN004","NES004","NEF027","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030013-06","Aetna Leap Everyday Plus POS","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721955_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030012","Aetna Leap Everyday POS","44794NE003",,"NEN004","NES004","NEF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030012-00","Aetna Leap Everyday POS","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721948_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030012","Aetna Leap Everyday POS","44794NE003",,"NEN004","NES004","NEF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030012-01","Aetna Leap Everyday POS","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721948_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030012","Aetna Leap Everyday POS","44794NE003",,"NEN004","NES004","NEF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030012-02","Aetna Leap Everyday POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721948_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030012","Aetna Leap Everyday POS","44794NE003",,"NEN004","NES004","NEF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030012-03","Aetna Leap Everyday POS","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721948_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030012","Aetna Leap Everyday POS","44794NE003",,"NEN004","NES004","NEF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030012-04","Aetna Leap Everyday POS","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721948_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030012","Aetna Leap Everyday POS","44794NE003",,"NEN004","NES004","NEF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030012-05","Aetna Leap Everyday POS","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721948_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030012","Aetna Leap Everyday POS","44794NE003",,"NEN004","NES004","NEF026","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030012-06","Aetna Leap Everyday POS","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721948_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020007","Aetna Leap Healthy Minds CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020007-00","Aetna Leap Healthy Minds CHI Health Omaha","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721084_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020007","Aetna Leap Healthy Minds CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020007-01","Aetna Leap Healthy Minds CHI Health Omaha","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721084_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020007","Aetna Leap Healthy Minds CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020007-02","Aetna Leap Healthy Minds CHI Health Omaha","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721084_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020007","Aetna Leap Healthy Minds CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020007-03","Aetna Leap Healthy Minds CHI Health Omaha","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721084_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020007","Aetna Leap Healthy Minds CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020007-04","Aetna Leap Healthy Minds CHI Health Omaha","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721084_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020007","Aetna Leap Healthy Minds CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020007-05","Aetna Leap Healthy Minds CHI Health Omaha","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721084_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020007","Aetna Leap Healthy Minds CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020007-06","Aetna Leap Healthy Minds CHI Health Omaha","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721084_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030007","Aetna Leap Healthy Minds MIPPA","44794NE003",,"NEN002","NES002","NEF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030007-00","Aetna Leap Healthy Minds MIPPA","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721421_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030007","Aetna Leap Healthy Minds MIPPA","44794NE003",,"NEN002","NES002","NEF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030007-01","Aetna Leap Healthy Minds MIPPA","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721421_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030007","Aetna Leap Healthy Minds MIPPA","44794NE003",,"NEN002","NES002","NEF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030007-02","Aetna Leap Healthy Minds MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721421_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030007","Aetna Leap Healthy Minds MIPPA","44794NE003",,"NEN002","NES002","NEF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030007-03","Aetna Leap Healthy Minds MIPPA","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721421_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030007","Aetna Leap Healthy Minds MIPPA","44794NE003",,"NEN002","NES002","NEF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030007-04","Aetna Leap Healthy Minds MIPPA","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721421_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030007","Aetna Leap Healthy Minds MIPPA","44794NE003",,"NEN002","NES002","NEF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030007-05","Aetna Leap Healthy Minds MIPPA","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721421_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030007","Aetna Leap Healthy Minds MIPPA","44794NE003",,"NEN002","NES002","NEF021","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030007-06","Aetna Leap Healthy Minds MIPPA","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721421_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020014","Aetna Leap Healthy Minds Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020014-00","Aetna Leap Healthy Minds Nebraska Health Network","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720602_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020014","Aetna Leap Healthy Minds Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020014-01","Aetna Leap Healthy Minds Nebraska Health Network","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720602_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020014","Aetna Leap Healthy Minds Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020014-02","Aetna Leap Healthy Minds Nebraska Health Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720602_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020014","Aetna Leap Healthy Minds Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020014-03","Aetna Leap Healthy Minds Nebraska Health Network","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720602_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020014","Aetna Leap Healthy Minds Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020014-04","Aetna Leap Healthy Minds Nebraska Health Network","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720602_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020014","Aetna Leap Healthy Minds Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020014-05","Aetna Leap Healthy Minds Nebraska Health Network","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720602_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020014","Aetna Leap Healthy Minds Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020014-06","Aetna Leap Healthy Minds Nebraska Health Network","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720602_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030014","Aetna Leap Healthy Minds POS","44794NE003",,"NEN004","NES004","NEF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030014-00","Aetna Leap Healthy Minds POS","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721962_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030014","Aetna Leap Healthy Minds POS","44794NE003",,"NEN004","NES004","NEF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030014-01","Aetna Leap Healthy Minds POS","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721962_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030014","Aetna Leap Healthy Minds POS","44794NE003",,"NEN004","NES004","NEF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030014-02","Aetna Leap Healthy Minds POS","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721962_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030014","Aetna Leap Healthy Minds POS","44794NE003",,"NEN004","NES004","NEF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030014-03","Aetna Leap Healthy Minds POS","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721962_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030014","Aetna Leap Healthy Minds POS","44794NE003",,"NEN004","NES004","NEF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030014-04","Aetna Leap Healthy Minds POS","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721962_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030014","Aetna Leap Healthy Minds POS","44794NE003",,"NEN004","NES004","NEF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030014-05","Aetna Leap Healthy Minds POS","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721962_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030014","Aetna Leap Healthy Minds POS","44794NE003",,"NEN004","NES004","NEF028","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030014-06","Aetna Leap Healthy Minds POS","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721962_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030003","Aetna Leap Diabetes Gold MIPPA","44794NE003",,"NEN002","NES002","NEF017","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030003-00","Aetna Leap Diabetes Gold MIPPA","Standard Gold Off Exchange Plan","78.00%","0.778203129768372","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,950","$3950 per person","$7900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,950","$3950 per person","$7900 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721435_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030003","Aetna Leap Diabetes Gold MIPPA","44794NE003",,"NEN002","NES002","NEF017","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030003-01","Aetna Leap Diabetes Gold MIPPA","Standard Gold On Exchange Plan","78.00%","0.778203129768372","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,950","$3950 per person","$7900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,950","$3950 per person","$7900 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721435_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030003","Aetna Leap Diabetes Gold MIPPA","44794NE003",,"NEN002","NES002","NEF017","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030003-02","Aetna Leap Diabetes Gold MIPPA","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721435_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030003","Aetna Leap Diabetes Gold MIPPA","44794NE003",,"NEN002","NES002","NEF017","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030003-03","Aetna Leap Diabetes Gold MIPPA","Limited Cost Sharing Plan Variation","78.00%","0.778203129768372","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,950","$3950 per person","$7900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,950","$3950 per person","$7900 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721435_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020002","Aetna Leap Catastrophic CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF002","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020002-00","Aetna Leap Catastrophic CHI Health Omaha","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721106_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020002","Aetna Leap Catastrophic CHI Health Omaha","44794NE002",,"NEN001","NES001","NEF002","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020002-01","Aetna Leap Catastrophic CHI Health Omaha","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721106_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030002","Aetna Leap Catastrophic MIPPA","44794NE003",,"NEN002","NES002","NEF016","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030002-00","Aetna Leap Catastrophic MIPPA","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721443_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030002","Aetna Leap Catastrophic MIPPA","44794NE003",,"NEN002","NES002","NEF016","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030002-01","Aetna Leap Catastrophic MIPPA","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721443_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020009","Aetna Leap Catastrophic Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF009","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020009-00","Aetna Leap Catastrophic Nebraska Health Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720521_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0020009","Aetna Leap Catastrophic Nebraska Health Network","44794NE002",,"NEN003","NES003","NEF009","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0020009-01","Aetna Leap Catastrophic Nebraska Health Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_720521_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030009","Aetna Leap Catastrophic POS","44794NE003",,"NEN004","NES004","NEF023","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030009-00","Aetna Leap Catastrophic POS","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721984_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","44794","SERFF","2016-09-29 04:19:41","Individual","No","23-2169745","44794NE0030009","Aetna Leap Catastrophic POS","44794NE003",,"NEN004","NES004","NEF023","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5761210805","44794NE0030009-01","Aetna Leap Catastrophic POS","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/NE/SBC_2017_NE_721984_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_NE.html"
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0010001","Delta Dental Pediatric Low","45550NE001",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as in Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0010001-00","Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0170001","Delta Dental Pediatric Low","45550NE017",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as in Service Area","Yes",,"","45550NE0170001-00","Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0010001","Delta Dental Pediatric Low","45550NE001",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as in Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0010001-01","Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0020001","Delta Dental Bronze + Delta Dental Pediatric Low","45550NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.6","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as in Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0020001-00","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0180001","Delta Dental Bronze + Delta Dental Pediatric Low","45550NE018",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.6","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as in Service Area","Yes",,"","45550NE0180001-00","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0020001","Delta Dental Bronze + Delta Dental Pediatric Low","45550NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.6","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as in Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0020001-01","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0040001","Delta Dental Silver + Delta Dental Pediatric Low","45550NE004",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.49","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0040001-00","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0200001","Delta Dental Silver + Delta Dental Pediatric Low","45550NE020",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.49","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0200001-00","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0040001","Delta Dental Silver + Delta Dental Pediatric Low","45550NE004",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.49","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0040001-01","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0060001","Delta Dental Gold + Delta Dental Pediatric Low","45550NE006",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0060001-00","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0220001","Delta Dental Gold + Delta Dental Pediatric Low","45550NE022",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0220001-00","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0060001","Delta Dental Gold + Delta Dental Pediatric Low","45550NE006",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0060001-01","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0080001","Delta Dental Platinum + Delta Dental Pediatric Low","45550NE008",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.34","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0080001-00","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0240001","Delta Dental Platinum + Delta Dental Pediatric Low","45550NE024",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.34","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0240001-00","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0080001","Delta Dental Platinum + Delta Dental Pediatric Low","45550NE008",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.34","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0080001-01","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0090001","Delta Dental Pediatric High","45550NE009",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0090001-00","Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0250001","Delta Dental Pediatric High","45550NE025",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0250001-00","Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0090001","Delta Dental Pediatric High","45550NE009",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0090001-01","Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0100001","Delta Dental Bronze + Delta Dental Pediatric High","45550NE010",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.65","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0100001-00","Delta Dental Bronze + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0260001","Delta Dental Bronze + Delta Dental Pediatric High","45550NE026",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.65","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0260001-00","Delta Dental Bronze + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0100001","Delta Dental Bronze + Delta Dental Pediatric High","45550NE010",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.65","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0100001-01","Delta Dental Bronze + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0120001","Delta Dental Silver + Delta Dental Pediatric High","45550NE012",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0120001-00","Delta Dental Silver + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0280001","Delta Dental Silver + Delta Dental Pediatric High","45550NE028",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0280001-00","Delta Dental Silver + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0120001","Delta Dental Silver + Delta Dental Pediatric High","45550NE012",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0120001-01","Delta Dental Silver + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0140001","Delta Dental Gold + Delta Dental Pediatric High","45550NE014",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0140001-00","Delta Dental Gold + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0300001","Delta Dental Gold + Delta Dental Pediatric High","45550NE030",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0300001-00","Delta Dental Gold + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0140001","Delta Dental Gold + Delta Dental Pediatric High","45550NE014",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0140001-01","Delta Dental Gold + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0160001","Delta Dental Platinum + Delta Dental Pediatric High","45550NE016",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0160001-00","Delta Dental Premium + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300064","Best Buy Silver HMO LP 4000","59025NH030",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0300064-00","Best Buy Silver HMO LP 4000","Standard Silver Off Exchange Plan","70.90%","0","No","Yes","Yes","70%","30%","$3,620","$10","$0","$150","$0","$1,840","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/25_sbc_PD0000005069_MD0000004162.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005069.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0010001","MyDoc HMO Platinum","61163NH001",,"NHN001","NHS001","NHF004","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0010001-01","MyDoc HMO Platinum","Standard Platinum On Exchange Plan","88.70%","0.887428402900696","Yes","Yes","No","100%",,"$0","$100","$730","$0","$0","$970","$30","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Platinum%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","45-3596033","61163NH0360001","MyDoc HMO Gold Basic 1000","61163NH036",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0360001-01","MyDoc HMO Gold Basic 1000","Standard Gold On Exchange Plan","81.07%","0.810707151889801","Yes","Yes","No","100%",,"$1,000","$70","$1,250","$0","$540","$590","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Gold%20Basic%201000%20SG%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20SG.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330022","ElevateHealth Bronze HSA 6300","59025NH033",,"NHN002","NHS002","NHF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330022-01","ElevateHealth Bronze HSA 6300","Standard Bronze On Exchange Plan",,"0.614376127719879","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/15_sbc_PD0000005111_MD0000004179.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005111.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330022","ElevateHealth Bronze HSA 6300","59025NH033",,"NHN002","NHS002","NHF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330022-02","ElevateHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/49_sbc_PD0000005157_MD0000004195.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005157.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330022","ElevateHealth Bronze HSA 6300","59025NH033",,"NHN002","NHS002","NHF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330022-03","ElevateHealth Bronze HSA 6300","Limited Cost Sharing Plan Variation",,"0.614376127719879","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/20_sbc_PD0000005116_MD0000004179.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005116.pdf"
"2017","NE","45550","SERFF","2016-09-28 04:33:02","SHOP (Small Group)","Yes","47-0685003","45550NE0320001","Delta Dental Platinum + Delta Dental Pediatric High","45550NE032",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0320001-00","Delta Dental Platinum + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","45550","SERFF","2016-09-28 04:33:02","Individual","Yes","47-0685003","45550NE0160001","Delta Dental Platinum + Delta Dental Pediatric High","45550NE016",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0160001-01","Delta Dental Premium + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2017HCR-NE.pdf",
"2017","NE","48282","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-3757528","48282NE0030001","TruAssure Dental Small Group Basic Plan","48282NE003",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","48282NE0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NE","48282","SERFF","2016-08-24 05:44:16","Individual","Yes","36-3757528","48282NE0010001","TruAssure Basic Adult or Child Dental Plan","48282NE001",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE"
"2017","NE","48282","SERFF","2016-08-24 05:44:16","Individual","Yes","36-3757528","48282NE0010001","TruAssure Basic Adult or Child Dental Plan","48282NE001",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE"
"2017","NE","48282","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-3757528","48282NE0040001","TruAssure Dental Small Group Preferred Plan","48282NE004",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","48282NE0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NE","48282","SERFF","2016-08-24 05:44:16","Individual","Yes","36-3757528","48282NE0020001","TruAssure Preferred Adult or Child Dental Plan","48282NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE"
"2017","NE","48282","SERFF","2016-08-24 05:44:16","Individual","Yes","36-3757528","48282NE0020001","TruAssure Preferred Adult or Child Dental Plan","48282NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","50022NE0020003","BESTOne Advantage Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010007","BESTDental Premium","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Premium_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010007","BESTDental Premium","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Premium_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","50022NE0020003","BESTOne Advantage Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","50022NE0020004","BESTOne Plus Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010008","BESTDental Standard - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Standard-H_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010008","BESTDental Standard - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Standard-H_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","50022NE0020004","BESTOne Plus Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010010","BESTDental Choice - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Choice-H_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010010","BESTDental Choice - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Choice-H_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010009","BESTDental Standard - L","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Standard-L_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","50022NE0020005","BESTOne Plus Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","50022NE0020005","BESTOne Plus Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010009","BESTDental Standard - L","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Standard-L_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010011","BESTDental Choice - L","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Choice-L_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","50022NE0020006","BESTOne Basic Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","50022NE0020006","BESTOne Basic Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010011","BESTDental Choice - L","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/2017/NE_BESTDental_Choice-L_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010012","BESTDental Value","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NE/2017/NE_BESTDental_Value_Plan.pdf"
"2017","NE","50022","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","95-6042390","50022NE0010012","BESTDental Value","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NE/2017/NE_BESTDental_Value_Plan.pdf"
"2017","NE","78502","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","Yes","57-0523959","78502NE0020001","Group Dental Policy","78502NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","78502NE0020001-00","Group Dental Policy","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NE","88667","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","13-5581829","88667NE0060001","EHB Basic Dental Plan (Low)","88667NE006",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","88667NE0060001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NE","95796","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","95796NE0040002","EHB High PPO","95796NE004",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","95796NE0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NE","95796","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","95796NE0040001","EHB Low PPO","95796NE004",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","95796NE0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NE","95796","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","95796NE0030002","EHB High Passive","95796NE003",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","95796NE0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NE","95796","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","93-0242990","95796NE0030001","EHB Low Passive","95796NE003",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","95796NE0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","NH","57601","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0510530","57601NH0420004","Anthem Dental Family Enhanced","57601NH042",,"NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.882","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215611.pdf",
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330014","ElevateHealth Silver 3500","59025NH033",,"NHN002","NHS002","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330014-00","ElevateHealth Silver 3500","Standard Silver Off Exchange Plan",,"0.696725249290466","No","Yes","No","100%",,"$3,500","$510","$0","$150","$0","$2,850","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/12_sbc_PD0000005099_MD0000004175.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005099.pdf"
"2017","NH","44500","SERFF","2016-08-23 04:37:23","SHOP (Small Group)","Yes","13-5581829","44500NH0080001","EHB Basic Dental Plan (Low)","44500NH008",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","44500NH0080001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","NH","57601","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","02-0510530","57601NH0390003","Anthem Dental Family","57601NH039",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0390003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215610.pdf",
"2017","NH","57601","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0510530","57601NH0420005","Anthem Dental Family Value","57601NH042",,"NHN001","NHS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215612.pdf",
"2017","NH","57601","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0510530","57601NH0420005","Anthem Dental Family Value","57601NH042",,"NHN001","NHS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215612.pdf",
"2017","NH","57601","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","02-0510530","57601NH0390003","Anthem Dental Family","57601NH039",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0390003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215610.pdf",
"2017","NH","57601","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","02-0510530","57601NH0390004","Anthem Dental Family Enhanced","57601NH039",,"NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.882","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0390004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215611.pdf",
"2017","NH","57601","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0510530","57601NH0420003","Anthem Dental Family","57601NH042",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215610.pdf",
"2017","NH","57601","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0510530","57601NH0420003","Anthem Dental Family","57601NH042",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215610.pdf",
"2017","NH","57601","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","02-0510530","57601NH0390004","Anthem Dental Family Enhanced","57601NH039",,"NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.882","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0390004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215611.pdf",
"2017","NH","57601","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0510530","57601NH0420004","Anthem Dental Family Enhanced","57601NH042",,"NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.882","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215611.pdf",
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330014","ElevateHealth Silver 3500","59025NH033",,"NHN002","NHS002","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330014-01","ElevateHealth Silver 3500","Standard Silver On Exchange Plan",,"0.696725249290466","No","Yes","No","100%",,"$3,500","$510","$0","$150","$0","$2,850","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/10_sbc_PD0000005097_MD0000004175.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005097.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0320030","ElevateHealth Silver HMO 4000","59025NH032",,"NHN002","NHS002","NHF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0320030-00","ElevateHealth Silver HMO 4000","Standard Silver Off Exchange Plan","70.90%","0","No","Yes","No","100%",,"$4,000","$10","$0","$150","$140","$1,840","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/4_sbc_PD0000005048_MD0000004154.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005048.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330020","ElevateHealth Silver HSA 3000","59025NH033",,"NHN002","NHS002","NHF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330020-02","ElevateHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/48_sbc_PD0000005156_MD0000004195.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005156.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330020","ElevateHealth Silver HSA 3000","59025NH033",,"NHN002","NHS002","NHF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330020-03","ElevateHealth Silver HSA 3000","Limited Cost Sharing Plan Variation",,"0.692003190517426","Yes","Yes","No","100%",,"$3,000","$20","$200","$150","$3,000","$1,190","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/2_sbc_PD0000005115_MD0000004178.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005115.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330020","ElevateHealth Silver HSA 3000","59025NH033",,"NHN002","NHS002","NHF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330020-04","ElevateHealth Silver HSA 2500","73% AV Level Silver Plan",,"0.730012357234955","Yes","Yes","No","100%",,"$2,500","$20","$180","$150","$2,500","$1,440","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/36_sbc_PD0000005132_MD0000004186.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005132.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300064","Best Buy Silver HMO LP 4000","59025NH030",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0300064-01","Best Buy Silver HMO LP 4000","Standard Silver On Exchange Plan","70.90%","0","No","Yes","Yes","70%","30%","$3,620","$10","$0","$150","$0","$1,840","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/26_sbc_PD0000005070_MD0000004162.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005070.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330020","ElevateHealth Silver HSA 3000","59025NH033",,"NHN002","NHS002","NHF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330020-05","ElevateHealth Silver HSA 750","87% AV Level Silver Plan",,"0.878092706203461","Yes","Yes","No","100%",,"$750","$10","$360","$150","$750","$690","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/37_sbc_PD0000005133_MD0000004187.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005133.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0320030","ElevateHealth Silver HMO 4000","59025NH032",,"NHN002","NHS002","NHF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0320030-01","ElevateHealth Silver HMO 4000","Standard Silver On Exchange Plan","70.90%","0","No","Yes","No","100%",,"$4,000","$10","$0","$150","$140","$1,840","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/5_sbc_PD0000005049_MD0000004154.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005049.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330014","ElevateHealth Silver 3500","59025NH033",,"NHN002","NHS002","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330014-02","ElevateHealth","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/45_sbc_PD0000005143_MD0000004197.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005143.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330014","ElevateHealth Silver 3500","59025NH033",,"NHN002","NHS002","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330014-03","ElevateHealth Silver 3500","Limited Cost Sharing Plan Variation",,"0.696725249290466","No","Yes","No","100%",,"$3,500","$510","$0","$150","$0","$2,850","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/1_sbc_PD0000005112_MD0000004175.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005112.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330014","ElevateHealth Silver 3500","59025NH033",,"NHN002","NHS002","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330014-04","ElevateHealth Silver 3000","73% AV Level Silver Plan",,"0.739426136016846","No","Yes","No","100%",,"$3,000","$960","$0","$150","$0","$2,800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/35_sbc_PD0000005131_MD0000004185.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005131.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330014","ElevateHealth Silver 3500","59025NH033",,"NHN002","NHS002","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330014-05","ElevateHealth Silver 1250","87% AV Level Silver Plan",,"0.873053312301636","No","Yes","No","100%",,"$1,250","$370","$0","$150","$0","$1,650","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/33_sbc_PD0000005129_MD0000004183.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005129.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330014","ElevateHealth Silver 3500","59025NH033",,"NHN002","NHS002","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330014-06","ElevateHealth Silver 350","94% AV Level Silver Plan",,"0.949815034866333","No","Yes","No","100%",,"$0","$80","$0","$150","$0","$370","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/34_sbc_PD0000005130_MD0000004184.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005130.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330018","ElevateHealth Bronze 5750","59025NH033",,"NHN002","NHS002","NHF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330018-00","ElevateHealth Bronze 5750","Standard Bronze Off Exchange Plan","61.91%","0.636304616928101","Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$4,870","$160","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/8_sbc_PD0000005104_MD0000004177.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005104.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0320032","ElevateHealth Silver HMO 3000 with Rx Deductible","59025NH032",,"NHN002","NHS002","NHF005","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0320032-00","ElevateHealth Silver HMO 3000 with Rx Deductible","Standard Silver Off Exchange Plan","71.00%","0","No","Yes","No","100%",,"$3,020","$0","$260","$150","$640","$1,700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/7_sbc_PD0000005051_MD0000004155.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005051.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0320032","ElevateHealth Silver HMO 3000 with Rx Deductible","59025NH032",,"NHN002","NHS002","NHF005","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0320032-01","ElevateHealth Silver HMO 3000 with Rx Deductible","Standard Silver On Exchange Plan","71.00%","0","No","Yes","No","100%",,"$3,020","$0","$260","$150","$640","$1,700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/8_sbc_PD0000005052_MD0000004155.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005052.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330018","ElevateHealth Bronze 5750","59025NH033",,"NHN002","NHS002","NHF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330018-01","ElevateHealth Bronze 5750","Standard Bronze On Exchange Plan","61.91%","0.636304616928101","Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$4,870","$160","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/9_sbc_PD0000005105_MD0000004177.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005105.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330018","ElevateHealth Bronze 5750","59025NH033",,"NHN002","NHS002","NHF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330018-02","ElevateHealth","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/47_sbc_PD0000005155_MD0000004195.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005155.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330018","ElevateHealth Bronze 5750","59025NH033",,"NHN002","NHS002","NHF007","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330018-03","ElevateHealth Bronze 5750","Limited Cost Sharing Plan Variation","61.91%","0.636304616928101","Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$4,870","$160","$0","$80","$0","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/18_sbc_PD0000005114_MD0000004177.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005114.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330016","ElevateHealth Gold HSA 1500","59025NH033",,"NHN002","NHS002","NHF008","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330016-00","ElevateHealth Gold HSA 1500","Standard Gold Off Exchange Plan",,"0.789424359798431","Yes","Yes","No","100%",,"$1,500","$20","$280","$150","$1,500","$1,700","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/4_sbc_PD0000005100_MD0000004176.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005100.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0320036","ElevateHealth Silver HSA HMO 3000","59025NH032",,"NHN002","NHS002","NHF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","59025NH0320036-00","ElevateHealth Silver HSA HMO 3000","Standard Silver Off Exchange Plan",,"0.719796061515808","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/12_sbc_PD0000005056_MD0000004157.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005056.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0320036","ElevateHealth Silver HSA HMO 3000","59025NH032",,"NHN002","NHS002","NHF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","59025NH0320036-01","ElevateHealth Silver HSA HMO 3000","Standard Silver On Exchange Plan",,"0.719796061515808","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/13_sbc_PD0000005057_MD0000004157.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005056.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330016","ElevateHealth Gold HSA 1500","59025NH033",,"NHN002","NHS002","NHF008","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330016-01","ElevateHealth Gold HSA 1500","Standard Gold On Exchange Plan",,"0.789424359798431","Yes","Yes","No","100%",,"$1,500","$20","$280","$150","$1,500","$1,700","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/6_sbc_PD0000005102_MD0000004176.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005102.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330016","ElevateHealth Gold HSA 1500","59025NH033",,"NHN002","NHS002","NHF008","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330016-02","ElevateHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/43_sbc_PD0000005141_MD0000004195.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005141.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330016","ElevateHealth Gold HSA 1500","59025NH033",,"NHN002","NHS002","NHF008","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330016-03","ElevateHealth Gold HSA 1500","Limited Cost Sharing Plan Variation",,"0.789424359798431","Yes","Yes","No","100%",,"$1,500","$20","$280","$150","$1,500","$1,700","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/17_sbc_PD0000005113_MD0000004176.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005113.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330020","ElevateHealth Silver HSA 3000","59025NH033",,"NHN002","NHS002","NHF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330020-00","ElevateHealth Silver HSA 3000","Standard Silver Off Exchange Plan",,"0.692003190517426","Yes","Yes","No","100%",,"$3,000","$20","$200","$150","$3,000","$1,190","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/19_sbc_PD0000005107_MD0000004178.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005107.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330020","ElevateHealth Silver HSA 3000","59025NH033",,"NHN002","NHS002","NHF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330020-01","ElevateHealth Silver HSA 3000","Standard Silver On Exchange Plan",,"0.692003190517426","Yes","Yes","No","100%",,"$3,000","$20","$200","$150","$3,000","$1,190","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/25_sbc_PD0000005108_MD0000004178.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005108.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300058","Best Buy Gold HMO LP 2000","59025NH030",,"NHN001","NHS001","NHF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0300058-00","Best Buy Gold HMO LP 2000","Standard Gold Off Exchange Plan","79.80%","0","No","Yes","Yes","70%","30%","$2,000","$10","$160","$150","$0","$1,640","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/39%20-%201989_PD0000004592.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004592.PDF"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300058","Best Buy Gold HMO LP 2000","59025NH030",,"NHN001","NHS001","NHF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0300058-01","Best Buy Gold HMO LP 2000","Standard Gold On Exchange Plan","79.80%","0","No","Yes","Yes","70%","30%","$2,000","$10","$160","$150","$0","$1,640","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005062.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005062.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330020","ElevateHealth Silver HSA 3000","59025NH033",,"NHN002","NHS002","NHF010","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330020-06","ElevateHealth Silver HSA 200","94% AV Level Silver Plan",,"0.938259422779083","Yes","Yes","No","100%",,"$200","$10","$410","$150","$200","$470","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/38_sbc_PD0000005134_MD0000004188.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005134.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0330022","ElevateHealth Bronze HSA 6300","59025NH033",,"NHN002","NHS002","NHF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0330022-00","ElevateHealth Bronze HSA 6300","Standard Bronze Off Exchange Plan",,"0.614376127719879","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/14_sbc_PD0000005110_MD0000004179.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005110.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300062","Best Buy Silver HMO LP 3000 with Rx Deductible","59025NH030",,"NHN001","NHS001","NHF005","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0300062-00","Best Buy Silver HMO LP 3000 with Rx Deductible","Standard Silver Off Exchange Plan","70.40%","0","No","Yes","Yes","70%","30%","$3,020","$0","$120","$150","$500","$1,700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","40.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/22_sbc_PD0000005066_MD0000004161.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005066.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300062","Best Buy Silver HMO LP 3000 with Rx Deductible","59025NH030",,"NHN001","NHS001","NHF005","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value5T","59025NH0300062-01","Best Buy Silver HMO LP 3000 with Rx Deductible","Standard Silver On Exchange Plan","70.40%","0","No","Yes","Yes","70%","30%","$3,020","$0","$120","$150","$500","$1,700","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","40.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/23_sbc_PD0000005067_MD0000004161.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005067.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","45-3596033","61163NH0360001","MyDoc HMO Gold Basic 1000","61163NH036",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0360001-00","MyDoc HMO Gold Basic 1000","Standard Gold Off Exchange Plan","81.07%","0.810707151889801","Yes","Yes","No","100%",,"$1,000","$70","$1,250","$0","$540","$590","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Gold%20Basic%201000%20SG%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20SG.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0010001","MyDoc HMO Platinum","61163NH001",,"NHN001","NHS001","NHF004","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0010001-00","MyDoc HMO Platinum","Standard Platinum Off Exchange Plan","88.70%","0.887428402900696","Yes","Yes","No","100%",,"$0","$100","$730","$0","$0","$970","$30","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Platinum%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340008","New Hampshire Network Gold 1000","59025NH034",,"NHN003","NHS003","NHF006","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340008-00","New Hampshire Network Gold 1000","Standard Gold Off Exchange Plan","80.50%","0.805000841617584","Yes","Yes","No","100%",,"$1,000","$20","$330","$150","$140","$2,480","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/22_sbc_PD0000005118_MD0000004180.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005118.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0290001","MyDoc HMO Silver Care","61163NH029",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0290001-02","MyDoc HMO Silver Care Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Care%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0290001","MyDoc HMO Silver Care","61163NH029",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0290001-03","MyDoc HMO Silver Care Limited","Limited Cost Sharing Plan Variation","71.40%","0.713524162769318","Yes","Yes","No","100%",,"$3,000","$0","$440","$0","$3,000","$0","$40","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Care%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0290001","MyDoc HMO Silver Care","61163NH029",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0290001-04","MyDoc HMO Silver Care (73%)","73% AV Level Silver Plan","73.60%","0.736309051513672","Yes","Yes","No","100%",,"$2,500","$0","$480","$0","$2,500","$0","$40","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2600 per person","$5000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Care%2073%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0290001","MyDoc HMO Silver Care","61163NH029",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0290001-05","MyDoc HMO Silver Care (87%)","87% AV Level Silver Plan","87.80%","0.878141224384308","Yes","Yes","No","100%",,"$675","$0","$660","$0","$675","$0","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Care%2087%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0290001","MyDoc HMO Silver Care","61163NH029",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0290001-06","MyDoc HMO Silver Care (94%)","94% AV Level Silver Plan","94.40%","0.944286346435547","Yes","Yes","No","100%",,"$250","$0","$350","$0","$250","$0","$110","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Care%2094%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0470001","MyDoc HMO Bronze HSA 5800","61163NH047",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0470001-00","MyDoc HMO Bronze HSA 5800","Standard Bronze Off Exchange Plan","61.50%","0.614890813827515","Yes","Yes","No","100%",,"$5,800","$0","$330","$0","$5,360","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20HSA%205800%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0470001","MyDoc HMO Bronze HSA 5800","61163NH047",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0470001-01","MyDoc HMO Bronze HSA 5800","Standard Bronze On Exchange Plan","61.50%","0.614890813827515","Yes","Yes","No","100%",,"$5,800","$0","$330","$0","$5,360","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20HSA%205800%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300070","Best Buy Silver HSA HMO 3000","59025NH030",,"NHN001","NHS001","NHF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","59025NH0300070-00","Best Buy Silver HSA HMO 3000","Standard Silver Off Exchange Plan",,"0.719796061515808","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/32_sbc_PD0000005076_MD0000004165.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005076.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300070","Best Buy Silver HSA HMO 3000","59025NH030",,"NHN001","NHS001","NHF001","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","59025NH0300070-01","Best Buy Silver HSA HMO 3000","Standard Silver On Exchange Plan",,"0.719796061515808","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$380","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/33_sbc_PD0000005077_MD0000004165.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005077.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340008","New Hampshire Network Gold 1000","59025NH034",,"NHN003","NHS003","NHF006","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340008-01","New Hampshire Network Gold 1000","Standard Gold On Exchange Plan","80.50%","0.805000841617584","Yes","Yes","No","100%",,"$1,000","$20","$330","$150","$140","$2,480","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/23_sbc_PD0000005119_MD0000004180.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005119.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340008","New Hampshire Network Gold 1000","59025NH034",,"NHN003","NHS003","NHF006","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340008-02","New Hampshire Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/42_sbc_PD0000005140_MD0000004194.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005140.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340008","New Hampshire Network Gold 1000","59025NH034",,"NHN003","NHS003","NHF006","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340008-03","New Hampshire Network Gold 1000","Limited Cost Sharing Plan Variation","80.50%","0.805000841617584","Yes","Yes","No","100%",,"$1,000","$20","$330","$150","$140","$2,480","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/24_sbc_PD0000005120_MD0000004180.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005120.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300072","Best Buy Bronze HSA HMO 6250","59025NH030",,"NHN001","NHS001","NHF002","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","59025NH0300072-00","Best Buy Bronze HSA HMO 6250","Standard Bronze Off Exchange Plan",,"0.615478098392487","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/36_sbc_PD0000005080_MD0000004166.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005080.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","SHOP (Small Group)","No","04-2663394","59025NH0300072","Best Buy Bronze HSA HMO 6250","59025NH030",,"NHN001","NHS001","NHF002","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998651993950554",,,"2017-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2017Value4T","59025NH0300072-01","Best Buy Bronze HSA HMO 6250","Standard Bronze On Exchange Plan",,"0.615478098392487","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20SMALL%20GROUP/NH%20SMALL%20GROUP/36_sbc_PD0000005080_MD0000004166.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005080.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340010","New Hampshire Network Silver 2500","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialistsexcept for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340010-00","New Hampshire Network Silver 2500","Standard Silver Off Exchange Plan",,"0.705589652061462","No","Yes","No","100%",,"$2,500","$1,420","$0","$150","$0","$2,900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/27_sbc_PD0000005122_MD0000004181.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005122.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340010","New Hampshire Network Silver 2500","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialistsexcept for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340010-01","New Hampshire Network Silver 2500","Standard Silver On Exchange Plan",,"0.705589652061462","No","Yes","No","100%",,"$2,500","$1,420","$0","$150","$0","$2,900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/28_sbc_PD0000005123_MD0000004181.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005123.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340010","New Hampshire Network Silver 2500","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialistsexcept for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340010-02","New Hampshire Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/44_sbc_PD0000005142_MD0000004196.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005142.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340010","New Hampshire Network Silver 2500","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialistsexcept for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340010-03","New Hampshire Network Silver 2500","Limited Cost Sharing Plan Variation",,"0.705589652061462","No","Yes","No","100%",,"$2,500","$1,420","$0","$150","$0","$2,900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/3_sbc_PD0000005124_MD0000004181.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005124.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340010","New Hampshire Network Silver 2500","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialistsexcept for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340010-04","New Hampshire Network Silver 2250","73% AV Level Silver Plan",,"0.738073766231537","No","Yes","No","100%",,"$2,250","$1,140","$0","$150","$0","$2,850","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/43_1975_PD0000004573_SBC_NHNETWORKSILVERHMOPREMIUM.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004573.PDF"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340010","New Hampshire Network Silver 2500","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialistsexcept for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340010-05","New Hampshire Network Silver 750","87% AV Level Silver Plan",,"0.872115254402161","No","Yes","No","100%",,"$750","$530","$0","$150","$0","$1,720","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/40_sbc_PD0000005136_MD0000004190.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005136.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340010","New Hampshire Network Silver 2500","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialistsexcept for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340010-06","New Hampshire Network Silver 350","94% AV Level Silver Plan",,"0.949815034866333","No","Yes","No","100%",,"$0","$80","$0","$150","$0","$370","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/41_sbc_PD0000005137_MD0000004191.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005137.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340012","New Hampshire Network Bronze HSA 5100","59025NH034",,"NHN003","NHS003","NHF013","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340012-00","New Hampshire Network Bronze HSA 5100","Standard Bronze Off Exchange Plan",,"0.619165539741516","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,100","$0","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/30_sbc_PD0000005126_MD0000004182.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005126.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340012","New Hampshire Network Bronze HSA 5100","59025NH034",,"NHN003","NHS003","NHF013","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340012-01","New Hampshire Network Bronze HSA 5100","Standard Bronze On Exchange Plan",,"0.619165539741516","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,100","$0","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/31_sbc_PD0000005127_MD0000004182.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005127.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340012","New Hampshire Network Bronze HSA 5100","59025NH034",,"NHN003","NHS003","NHF013","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340012-02","New Hampshire Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/46_sbc_PD0000005154_MD0000004194.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005154.pdf"
"2017","NH","59025","SERFF","2017-04-20 20:15:32","Individual","No","04-2663394","59025NH0340012","New Hampshire Network Bronze HSA 5100","59025NH034",,"NHN003","NHS003","NHF013","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998530898003924",,,"2017-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2017Value4T","59025NH0340012-03","New Hampshire Network Bronze HSA 5100","Limited Cost Sharing Plan Variation",,"0.619165539741516","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,100","$0","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/NH%20INDIVIDUAL/32_sbc_PD0000005128_MD0000004182.pdf","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2017%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000005128.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","45-3596033","61163NH1640001","MyDoc HMO Silver HSA 3000","61163NH164",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH1640001-00","MyDoc HMO Silver HSA 3000","Standard Silver Off Exchange Plan","71.35%","0.713524162769318","Yes","Yes","No","100%",,"$3,000","$0","$440","$0","$3,000","$0","$40","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20HSA%203000%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20SG.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0010001","MyDoc HMO Platinum","61163NH001",,"NHN001","NHS001","NHF004","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0010001-02","MyDoc HMO Platinum Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Platinum%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0010001","MyDoc HMO Platinum","61163NH001",,"NHN001","NHS001","NHF004","Existing","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0010001-03","MyDoc HMO Platinum Limited","Limited Cost Sharing Plan Variation","88.70%","0.887428402900696","Yes","Yes","No","100%",,"$0","$100","$730","$0","$0","$970","$30","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Platinum%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","45-3596033","61163NH1640001","MyDoc HMO Silver HSA 3000","61163NH164",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH1640001-01","MyDoc HMO Silver HSA 3000","Standard Silver On Exchange Plan","71.35%","0.713524162769318","Yes","Yes","No","100%",,"$3,000","$0","$440","$0","$3,000","$0","$40","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20HSA%203000%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20SG.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","45-3596033","61163NH1660001","MyDoc HMO Bronze HSA 6000","61163NH166",,"NHN001","NHS001","NHF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH1660001-00","MyDoc HMO Bronze HSA 6000","Standard Bronze Off Exchange Plan","61.78%","0.617761015892029","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,360","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20HSA%206000%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20SG.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","45-3596033","61163NH1660001","MyDoc HMO Bronze HSA 6000","61163NH166",,"NHN001","NHS001","NHF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH1660001-01","MyDoc HMO Bronze HSA 6000","Standard Bronze On Exchange Plan","61.78%","0.617761015892029","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,360","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20HSA%206000%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20SG.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0030001","MyDoc HMO Gold Basic 1000","61163NH003",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0030001-00","MyDoc HMO Gold Basic 1000","Standard Gold Off Exchange Plan","81.10%","0.810707151889801","Yes","Yes","No","100%",,"$1,000","$70","$1,250","$0","$540","$590","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Gold%20Basic%201000%20NG%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0030001","MyDoc HMO Gold Basic 1000","61163NH003",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0030001-01","MyDoc HMO Gold Basic 1000","Standard Gold On Exchange Plan","81.10%","0.810707151889801","Yes","Yes","No","100%",,"$1,000","$70","$1,250","$0","$540","$590","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Gold%20Basic%201000%20NG%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0030001","MyDoc HMO Gold Basic 1000","61163NH003",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0030001-02","MyDoc HMO Gold Basic Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Gold%20Basic%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0030001","MyDoc HMO Gold Basic 1000","61163NH003",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0030001-03","MyDoc HMO Gold Basic Limited","Limited Cost Sharing Plan Variation","81.10%","0.810707151889801","Yes","Yes","No","100%",,"$1,000","$70","$1,250","$0","$540","$590","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Gold%20Basic%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0290001","MyDoc HMO Silver Care","61163NH029",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0290001-00","MyDoc HMO Silver Care","Standard Silver Off Exchange Plan","71.40%","0.713524162769318","Yes","Yes","No","100%",,"$3,000","$0","$440","$0","$3,000","$0","$40","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Care%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0290001","MyDoc HMO Silver Care","61163NH029",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0290001-01","MyDoc HMO Silver Care","Standard Silver On Exchange Plan","71.40%","0.713524162769318","Yes","Yes","No","100%",,"$3,000","$0","$440","$0","$3,000","$0","$40","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Care%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0470001","MyDoc HMO Bronze HSA 5800","61163NH047",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0470001-02","MyDoc HMO Bronze HSA 5800 Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Hsa%205800%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0470001","MyDoc HMO Bronze HSA 5800","61163NH047",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0470001-03","MyDoc HMO Bronze HSA 5800 Limited","Limited Cost Sharing Plan Variation","61.50%","0.614890813827515","Yes","Yes","No","100%",,"$5,800","$0","$330","$0","$5,360","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Hsa%205800%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0350001","MyDoc HMO Bronze 6300","61163NH035",,"NHN001","NHS001","NHF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0350001-00","MyDoc HMO Bronze 6300","Standard Bronze Off Exchange Plan","61.10%","0.610791683197021","Yes","Yes","No","100%",,"$6,300","$50","$0","$0","$5,360","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%206300%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0350001","MyDoc HMO Bronze 6300","61163NH035",,"NHN001","NHS001","NHF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0350001-01","MyDoc HMO Bronze 6300","Standard Bronze On Exchange Plan","61.10%","0.610791683197021","Yes","Yes","No","100%",,"$6,300","$50","$0","$0","$5,360","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%206300%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0350001","MyDoc HMO Bronze 6300","61163NH035",,"NHN001","NHS001","NHF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0350001-02","MyDoc HMO Bronze 6300 Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%206300%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0350001","MyDoc HMO Bronze 6300","61163NH035",,"NHN001","NHS001","NHF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0350001-03","MyDoc HMO Bronze 6300 Limited","Limited Cost Sharing Plan Variation","61.10%","0.610791683197021","Yes","Yes","No","100%",,"$6,300","$50","$0","$0","$5,360","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%206300%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0270001","MyDoc HMO Silver Basic","61163NH027",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0270001-00","MyDoc HMO Silver Basic","Standard Silver Off Exchange Plan","70.90%","0.709256768226624","Yes","Yes","No","100%",,"$2,000","$130","$1,520","$0","$1,190","$640","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Basic%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0270001","MyDoc HMO Silver Basic","61163NH027",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0270001-01","MyDoc HMO Silver Basic","Standard Silver On Exchange Plan","70.90%","0.709256768226624","Yes","Yes","No","100%",,"$2,000","$130","$1,520","$0","$1,190","$640","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Basic%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0270001","MyDoc HMO Silver Basic","61163NH027",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0270001-02","MyDoc HMO Silver Basic Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Basic%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0270001","MyDoc HMO Silver Basic","61163NH027",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0270001-03","MyDoc HMO Silver Basic Limited","Limited Cost Sharing Plan Variation","70.90%","0.709256768226624","Yes","Yes","No","100%",,"$2,000","$130","$1,520","$0","$1,190","$640","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Basic%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0270001","MyDoc HMO Silver Basic","61163NH027",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0270001-04","MyDoc HMO Silver Basic (73%)","73% AV Level Silver Plan","73.30%","0.733052909374237","Yes","Yes","No","100%",,"$1,800","$120","$1,640","$0","$1,190","$640","$860","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Basic%2073%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0270001","MyDoc HMO Silver Basic","61163NH027",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0270001-05","MyDoc HMO Silver Basic (87%)","87% AV Level Silver Plan","87.00%","0.870099425315857","Yes","Yes","No","100%",,"$800","$40","$660","$0","$800","$220","$480","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Basic%2087%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0270001","MyDoc HMO Silver Basic","61163NH027",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0270001-06","MyDoc HMO Silver Basic (94%)","94% AV Level Silver Plan","93.90%","0.93905633687973","Yes","Yes","No","100%",,"$175","$20","$460","$0","$175","$130","$350","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Basic%2094%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0450001","MyDoc HMO Silver Assistance A","61163NH045",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0450001-00","MyDoc HMO Silver Assistance A","Standard Silver Off Exchange Plan","70.50%","0","Yes","Yes","No","100%",,"$3,500","$1,170","$0","$0","$230","$2,630","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Assistance%20A%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0450001","MyDoc HMO Silver Assistance A","61163NH045",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0450001-01","MyDoc HMO Silver Assistance A","Standard Silver On Exchange Plan","70.50%","0","Yes","Yes","No","100%",,"$3,500","$1,170","$0","$0","$230","$2,630","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Assistance%20A%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0450001","MyDoc HMO Silver Assistance A","61163NH045",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0450001-02","MyDoc HMO Silver Assistance A Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Assistance%20A%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0450001","MyDoc HMO Silver Assistance A","61163NH045",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0450001-03","MyDoc HMO Silver Assistance A Limited","Limited Cost Sharing Plan Variation","70.50%","0","Yes","Yes","No","100%",,"$3,500","$1,170","$0","$0","$230","$2,630","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Assistance%20A%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0450001","MyDoc HMO Silver Assistance A","61163NH045",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0450001-04","MyDoc HMO Silver Assistance A (73%)","73% AV Level Silver Plan","73.10%","0","Yes","Yes","No","100%",,"$3,000","$670","$0","$0","$230","$2,630","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Assistance%20A%2073%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0450001","MyDoc HMO Silver Assistance A","61163NH045",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0450001-05","MyDoc HMO Silver Assistance A (87%)","87% AV Level Silver Plan","87.80%","0.865439176559448","Yes","Yes","No","100%",,"$1,200","$320","$0","$0","$80","$1,210","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Assistance%20A%2087%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0450001","MyDoc HMO Silver Assistance A","61163NH045",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0450001-06","MyDoc HMO Silver Assistance A (94%)","94% AV Level Silver Plan","94.98%","0.951908826828003","Yes","Yes","No","100%",,"$350","$220","$0","$0","$80","$430","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Silver%20Assistance%20A%2094%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0250001","MyDoc HMO Bronze Value","61163NH025",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0250001-00","MyDoc HMO Bronze Value","Standard Bronze Off Exchange Plan","61.90%","0","Yes","Yes","No","100%",,"$4,750","$1,170","$0","$0","$4,060","$910","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Value%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0250001","MyDoc HMO Bronze Value","61163NH025",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0250001-01","MyDoc HMO Bronze Value","Standard Bronze On Exchange Plan","61.90%","0","Yes","Yes","No","100%",,"$4,750","$1,170","$0","$0","$4,060","$910","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Value%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0250001","MyDoc HMO Bronze Value","61163NH025",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0250001-02","MyDoc HMO Bronze Value Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Value%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0250001","MyDoc HMO Bronze Value","61163NH025",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0250001-03","MyDoc HMO Bronze Value Limited","Limited Cost Sharing Plan Variation","61.90%","0","Yes","Yes","No","100%",,"$4,750","$1,170","$0","$0","$4,060","$910","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Value%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0310001","MyDoc HMO Bronze Basic 4500","61163NH031",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0310001-00","MyDoc HMO Bronze Basic 4500","Standard Bronze Off Exchange Plan","62.00%","0.620113730430603","Yes","Yes","No","100%",,"$4,500","$170","$830","$0","$4,060","$910","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Basic%204500%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0310001","MyDoc HMO Bronze Basic 4500","61163NH031",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0310001-01","MyDoc HMO Bronze Basic 4500","Standard Bronze On Exchange Plan","62.00%","0.620113730430603","Yes","Yes","No","100%",,"$4,500","$170","$830","$0","$4,060","$910","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Basic%204500%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0310001","MyDoc HMO Bronze Basic 4500","61163NH031",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0310001-02","MyDoc HMO Bronze Basic 4500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Basic%204500%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0310001","MyDoc HMO Bronze Basic 4500","61163NH031",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0310001-03","MyDoc HMO Bronze Basic 4500 Limited","Limited Cost Sharing Plan Variation","62.00%","0.620113730430603","Yes","Yes","No","100%",,"$4,500","$170","$830","$0","$4,060","$910","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Bronze%20Basic%204500%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0370001","MyDoc HMO Simple Care","61163NH037",,"NHN001","NHS001","NHF009","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9986",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0370001-00","MyDoc HMO Simple Care","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$100","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Simple%20Care%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0370001","MyDoc HMO Simple Care","61163NH037",,"NHN001","NHS001","NHF009","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9986",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0370001-01","MyDoc HMO Simple Care","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$100","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Simple%20Care%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0390001","MyDoc HMO Platinum Extra Value","61163NH039",,"NHN001","NHS001","NHF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0390001-00","MyDoc HMO Platinum Extra Value","Standard Platinum Off Exchange Plan","91.00%","0","Yes","Yes","No","100%",,"$0","$1,930","$0","$0","$0","$1,150","$20","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Platinum%20Extra%20Value%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0390001","MyDoc HMO Platinum Extra Value","61163NH039",,"NHN001","NHS001","NHF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0390001-01","MyDoc HMO Platinum Extra Value","Standard Platinum On Exchange Plan","91.00%","0","Yes","Yes","No","100%",,"$0","$1,930","$0","$0","$0","$1,150","$20","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Platinum%20Extra%20Value%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0390001","MyDoc HMO Platinum Extra Value","61163NH039",,"NHN001","NHS001","NHF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0390001-02","MyDoc HMO Platinum Value Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Platinum%20Value%20Zero%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","61163","SERFF","2017-01-23 20:15:25","Individual","No","45-3596033","61163NH0390001","MyDoc HMO Platinum Extra Value","61163NH039",,"NHN001","NHS001","NHF012","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2017-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","https://crx.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=MPSHNE","61163NH0390001-03","MyDoc HMO Platinum Extra Value Limited","Limited Cost Sharing Plan Variation","91.00%","0","Yes","Yes","No","100%",,"$0","$1,930","$0","$0","$0","$1,150","$20","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/MinutemanHealth/media/2017%20SBCs/New%20Hampshire/NH%20SBC%20HMO%20Platinum%20Extra%20Value%20Limited%20Final.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20IND.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090001-00","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090001-00.pdf","https://api.centene.com/Brochures/2017/75841NH0090001-00.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090001-01","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090001-01.pdf","https://api.centene.com/Brochures/2017/75841NH0090001-01.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090001-02","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090001-02.pdf","https://api.centene.com/Brochures/2017/75841NH0090001-02.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090001-03","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090001-03.pdf","https://api.centene.com/Brochures/2017/75841NH0090001-03.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2017)","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-00","Ambetter Balanced Care 8 (2017)","Standard Silver Off Exchange Plan",,"0.710159838199615","No","Yes","No","100%",,"$3,500","$400","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090002-00.pdf","https://api.centene.com/Brochures/2017/75841NH0090002-00.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2017)","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-01","Ambetter Balanced Care 8 (2017)","Standard Silver On Exchange Plan",,"0.710159838199615","No","Yes","No","100%",,"$3,500","$400","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090002-01.pdf","https://api.centene.com/Brochures/2017/75841NH0090002-01.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2017)","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-02","Ambetter Balanced Care 8 (2017)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090002-02.pdf","https://api.centene.com/Brochures/2017/75841NH0090002-02.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2017)","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-03","Ambetter Balanced Care 8 (2017)","Limited Cost Sharing Plan Variation",,"0.710159838199615","No","Yes","No","100%",,"$3,500","$400","$0","$200","$2,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090002-03.pdf","https://api.centene.com/Brochures/2017/75841NH0090002-03.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2017)","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-04","Ambetter Balanced Care 8 (2017)","73% AV Level Silver Plan",,"0.739638805389404","No","Yes","No","100%",,"$3,000","$300","$0","$200","$2,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090002-04.pdf","https://api.centene.com/Brochures/2017/75841NH0090002-04.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2017)","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-05","Ambetter Balanced Care 8 (2017)","87% AV Level Silver Plan",,"0.877415657043457","No","Yes","No","100%",,"$1,000","$200","$0","$200","$1,000","$500","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090002-05.pdf","https://api.centene.com/Brochures/2017/75841NH0090002-05.pdf"
"2017","NH","75841","SERFF","2016-08-18 04:06:30","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2017)","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-06","Ambetter Balanced Care 8 (2017)","94% AV Level Silver Plan",,"0.949816405773163","No","Yes","No","100%",,"$350","$200","$0","$200","$350","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/75841NH0090002-06.pdf","https://api.centene.com/Brochures/2017/75841NH0090002-06.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","02-0273013","87701NH0110001","Delta Dental PPO Family High Plan","87701NH011","7992708454","NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes",,"","87701NH0110001-01","Delta Dental PPO Family High Plan","Standard High On Exchange Plan","85.63%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20175.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0273013","87701NH0070001","Delta Dental Family High","87701NH007","7992708454","NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0070001-00","Delta Dental Family High","Standard High Off Exchange Plan","85.63%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2017a.pdf"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150016","Anthem Bronze Pathway X Enhanced HMO 0 for HSA","96751NH015",,"NHN001","NHS001","NHF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150016-02","Anthem Bronze Pathway X Enhanced HMO 5700 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ1","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160008","Anthem Bronze Pathway X HMO 6550 0 6550 w HSA","96751NH016",,"NHN002","NHS001","NHF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160008-00","Anthem Bronze Pathway X HMO 6550 0 6550 w HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd205P",
"2017","NH","87701","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0273013","87701NH0070001","Delta Dental Family High","87701NH007","7992708454","NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0070001-01","Delta Dental Family High","Standard High On Exchange Plan","85.63%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20171.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","02-0273013","87701NH0120001","Delta Dental PPO Family Low Plan","87701NH012","7992708454","NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes",,"","87701NH0120001-01","Delta Dental PPO Family Low Plan","Standard Low On Exchange Plan","71.96%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20176.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","02-0273013","87701NH0110002","Delta Dental PPO Family High Plan","87701NH011","7992708454","NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9507","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes",,"","87701NH0110002-00","Delta Dental PPO Family High Plan","Standard High Off Exchange Plan","85.63%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2017c.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0273013","87701NH0080001","Delta Dental Family Low","87701NH008","7992708454","NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0080001-00","Delta Dental Family Low","Standard Low Off Exchange Plan","71.96%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2017b.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0273013","87701NH0080001","Delta Dental Family Low","87701NH008","7992708454","NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0080001-01","Delta Dental Family Low","Standard Low On Exchange Plan","71.96%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20172.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","02-0273013","87701NH0120002","Delta Dental PPO Family Low Plan","87701NH012","7992708454","NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes",,"","87701NH0120002-00","Delta Dental PPO Family Low Plan","Standard Low Off Exchange Plan","71.96%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2017d.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0273013","87701NH0090001","Delta Dental Pediatric High Plan","87701NH009","7992708454","NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0090001-01","Delta Dental Pediatric High Plan","Standard High On Exchange Plan","85.63%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20173.pdf"
"2017","NH","87701","SERFF","2016-08-15 08:50:08","Individual","Yes","02-0273013","87701NH0100001","Delta Dental Pediatric Low Plan","87701NH010","7992708454","NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"0.9972","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0100001-01","Delta Dental Pediatric Low Plan","Standard Low On Exchange Plan","71.96%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20174.pdf"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150023","Anthem Gold Pathway X Enhanced HMO 1000 10","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150023-00","Anthem Gold Pathway X Enhanced HMO 1000 10","Standard Gold Off Exchange Plan","81.22%","0.821562826633453","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYZ","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150023","Anthem Gold Pathway X Enhanced HMO 1000 10","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150023-01","Anthem Gold Pathway X Enhanced HMO 1000 10","Standard Gold On Exchange Plan","81.22%","0.821562826633453","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPY","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150023","Anthem Gold Pathway X Enhanced HMO 1000 10","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150023-02","Anthem Gold Pathway X Enhanced HMO 1000 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ7","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150023","Anthem Gold Pathway X Enhanced HMO 1000 10","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150023-03","Anthem Gold Pathway X Enhanced HMO 1000 10","Limited Cost Sharing Plan Variation","81.22%","0.821562826633453","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPY","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150026","Anthem Bronze Pathway X Enhanced HMO 6350 40","96751NH015",,"NHN001","NHS001","NHF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150026-00","Anthem Bronze Pathway X Enhanced HMO 6350 40","Standard Bronze Off Exchange Plan",,"0.595619440078735","Yes","Yes","No","100%",,"$6,400","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECL","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150026","Anthem Bronze Pathway X Enhanced HMO 6350 40","96751NH015",,"NHN001","NHS001","NHF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150026-01","Anthem Bronze Pathway X Enhanced HMO 6350 40","Standard Bronze On Exchange Plan",,"0.595619440078735","Yes","Yes","No","100%",,"$6,400","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECM","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150026","Anthem Bronze Pathway X Enhanced HMO 6350 40","96751NH015",,"NHN001","NHS001","NHF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150026-02","Anthem Bronze Pathway X Enhanced HMO 6350 40 AI","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ECN","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160012","Anthem Bronze Pathway X HMO 5250 30 6550 w HSA","96751NH016",,"NHN002","NHS001","NHF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160012-00","Anthem Bronze Pathway X HMO 5250 30 6550 w HSA","Standard Bronze Off Exchange Plan",,"0.617813110351563","Yes","Yes","No","100%",,"$5,250","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd205H",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","96751NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9972",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-00","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","Standard Bronze Off Exchange Plan","61.97%","0.620893239974976","Yes","Yes","No","100%",,"$5,200","$0","$500","$0","$5,200","$0","$10","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JYT","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","96751NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9972",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-01","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","Standard Bronze On Exchange Plan","61.97%","0.620893239974976","Yes","Yes","No","100%",,"$5,200","$0","$500","$0","$5,200","$0","$10","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPG","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160012","Anthem Bronze Pathway X HMO 5250 30 6550 w HSA","96751NH016",,"NHN002","NHS001","NHF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160012-01","Anthem Bronze Pathway X HMO 5250 30 6550 w HSA","Standard Bronze On Exchange Plan",,"0.617813110351563","Yes","Yes","No","100%",,"$5,250","$0","$600","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd205H",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160010","Anthem Silver Pathway X HMO 3000 0 6550 w HSA","96751NH016",,"NHN002","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160010-00","Anthem Silver Pathway X HMO 3000 0 6550 w HSA","Standard Silver Off Exchange Plan",,"0.719632685184479","Yes","Yes","No","100%",,"$3,000","$0","$10","$0","$3,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd205J",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","96751NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9972",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-02","Anthem Bronze Pathway X Enhanced HMO 4500 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ0","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","96751NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9972",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-03","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","Limited Cost Sharing Plan Variation","61.97%","0.620893239974976","Yes","Yes","No","100%",,"$5,200","$0","$500","$0","$5,200","$0","$10","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPG","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160010","Anthem Silver Pathway X HMO 3000 0 6550 w HSA","96751NH016",,"NHN002","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160010-01","Anthem Silver Pathway X HMO 3000 0 6550 w HSA","Standard Silver On Exchange Plan",,"0.719632685184479","Yes","Yes","No","100%",,"$3,000","$0","$10","$0","$3,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd205J",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150016","Anthem Bronze Pathway X Enhanced HMO 0 for HSA","96751NH015",,"NHN001","NHS001","NHF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150016-00","Anthem Bronze Pathway X Enhanced HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.97%","0.620370924472809","Yes","Yes","No","100%",,"$6,100","$0","$20","$0","$5,200","$0","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JYU","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160011","Anthem Gold Pathway X HMO 1500 10 3000 w HSA","96751NH016",,"NHN002","NHS001","NHF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160011-00","Anthem Gold Pathway X HMO 1500 10 3000 w HSA","Standard Gold Off Exchange Plan",,"0.805655658245087","Yes","Yes","No","100%",,"$1,500","$0","$600","$0","$1,500","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd205L",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160011","Anthem Gold Pathway X HMO 1500 10 3000 w HSA","96751NH016",,"NHN002","NHS001","NHF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160011-01","Anthem Gold Pathway X HMO 1500 10 3000 w HSA","Standard Gold On Exchange Plan",,"0.805655658245087","Yes","Yes","No","100%",,"$1,500","$0","$600","$0","$1,500","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd205L",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150016","Anthem Bronze Pathway X Enhanced HMO 0 for HSA","96751NH015",,"NHN001","NHS001","NHF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150016-01","Anthem Bronze Pathway X Enhanced HMO 0 for HSA","Standard Bronze On Exchange Plan","61.97%","0.620370924472809","Yes","Yes","No","100%",,"$6,100","$0","$20","$0","$5,200","$0","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPH","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160008","Anthem Bronze Pathway X HMO 6550 0 6550 w HSA","96751NH016",,"NHN002","NHS001","NHF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160008-01","Anthem Bronze Pathway X HMO 6550 0 6550 w HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd205P",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150016","Anthem Bronze Pathway X Enhanced HMO 0 for HSA","96751NH015",,"NHN001","NHS001","NHF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150016-03","Anthem Bronze Pathway X Enhanced HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.97%","0.620370924472809","Yes","Yes","No","100%",,"$6,100","$0","$20","$0","$5,200","$0","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPH","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-00","Anthem Silver Pathway X Enhanced HMO 10 for HSA","Standard Silver Off Exchange Plan","69.27%","0.694478094577789","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$200","$200","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JYX","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-01","Anthem Silver Pathway X Enhanced HMO 10 for HSA","Standard Silver On Exchange Plan","69.27%","0.694478094577789","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$200","$200","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPL","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-02","Anthem Silver Pathway X Enhanced HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ4","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-03","Anthem Silver Pathway X Enhanced HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.27%","0.694478094577789","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$200","$200","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPL","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-04","Anthem Silver Pathway X Enhanced HMO 10 for HSA S04","73% AV Level Silver Plan","72.90%","0.730806589126587","Yes","Yes","No","100%",,"$2,700","$0","$500","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPM","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-05","Anthem Silver Pathway X Enhanced HMO 10 S05","87% AV Level Silver Plan","86.40%","0.863974511623383","Yes","Yes","No","100%",,"$1,400","$0","$0","$0","$1,400","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPN","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-06","Anthem Silver Pathway X Enhanced HMO 10 S06","94% AV Level Silver Plan","94.28%","0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPP","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150026","Anthem Bronze Pathway X Enhanced HMO 6350 40","96751NH015",,"NHN001","NHS001","NHF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150026-03","Anthem Bronze Pathway X Enhanced HMO 6350 40","Limited Cost Sharing Plan Variation",,"0.595619440078735","Yes","Yes","No","100%",,"$6,400","$0","$400","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECM","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-00","Anthem Silver Pathway X Enhanced HMO 5300 25","Standard Silver Off Exchange Plan",,"0.680114686489105","Yes","Yes","No","100%",,"$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECP","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-01","Anthem Silver Pathway X Enhanced HMO 5300 25","Standard Silver On Exchange Plan",,"0.680114686489105","Yes","Yes","No","100%",,"$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECQ","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-02","Anthem Silver Pathway X Enhanced HMO 5300 25 AI","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ECR","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-03","Anthem Silver Pathway X Enhanced HMO 5300 25","Limited Cost Sharing Plan Variation",,"0.680114686489105","Yes","Yes","No","100%",,"$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECQ","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-04","Anthem Silver Pathway X Enhanced HMO 5300 25 S04","73% AV Level Silver Plan",,"0.721941292285919","Yes","Yes","No","100%",,"$3,000","$60","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECS","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-05","Anthem Silver Pathway X Enhanced HMO 5300 25 S05","87% AV Level Silver Plan",,"0.861232578754425","Yes","Yes","No","100%",,"$900","$40","$1,000","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECT","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-06","Anthem Silver Pathway X Enhanced HMO 5300 25 S06","94% AV Level Silver Plan",,"0.930502235889435","Yes","Yes","No","100%",,"$200","$40","$500","$0","$200","$500","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECU","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150017","Anthem Bronze Pathway X Enhanced HMO 5400 30","96751NH015",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150017-00","Anthem Bronze Pathway X Enhanced HMO 5400 30","Standard Bronze Off Exchange Plan","60.42%","0.620014429092407","Yes","Yes","No","100%",,"$5,400","$0","$600","$0","$4,500","$200","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYV","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160005","Anthem Gold Pathway X HMO 1500 20 3000","96751NH016",,"NHN002","NHS001","NHF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier5","96751NH0160005-00","Anthem Gold Pathway X HMO 1500 20 3000","Standard Gold Off Exchange Plan","79.03%","0.798401474952698","No","Yes","No","100%",,"$1,500","$200","$1,100","$0","$400","$2,200","$500","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd204T",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160005","Anthem Gold Pathway X HMO 1500 20 3000","96751NH016",,"NHN002","NHS001","NHF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier5","96751NH0160005-01","Anthem Gold Pathway X HMO 1500 20 3000","Standard Gold On Exchange Plan","79.03%","0.798401474952698","No","Yes","No","100%",,"$1,500","$200","$1,100","$0","$400","$2,200","$500","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd204T",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150017","Anthem Bronze Pathway X Enhanced HMO 5400 30","96751NH015",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150017-01","Anthem Bronze Pathway X Enhanced HMO 5400 30","Standard Bronze On Exchange Plan","60.42%","0.620014429092407","Yes","Yes","No","100%",,"$5,400","$0","$600","$0","$4,500","$200","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPJ","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150017","Anthem Bronze Pathway X Enhanced HMO 5400 30","96751NH015",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150017-02","Anthem Bronze Pathway X Enhanced HMO 5400 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ2","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150024","Anthem Catastrophic Pathway X Enhanced HMO 7150 0","96751NH015",,"NHN001","NHS001","NHF012","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9964",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150024-01","Anthem Catastrophic Pathway X Enhanced HMO 7150 0","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPZ","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-00","Anthem Silver Pathway X Enhanced HMO 4200 0","Standard Silver Off Exchange Plan","70.62%","0.699650466442108","Yes","Yes","No","100%",,"$4,200","$600","$0","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2901","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-01","Anthem Silver Pathway X Enhanced HMO 4200 0","Standard Silver On Exchange Plan","70.62%","0.699650466442108","Yes","Yes","No","100%",,"$4,200","$600","$0","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2904","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160006","Anthem Silver Pathway X HMO 3500 10 6000","96751NH016",,"NHN002","NHS001","NHF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9956",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier5","96751NH0160006-00","Anthem Silver Pathway X HMO 3500 10 6000","Standard Silver Off Exchange Plan","69.89%","0.689777970314026","No","Yes","No","100%",,"$3,500","$200","$400","$0","$400","$2,300","$500","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd204W",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","02-0494919","96751NH0160006","Anthem Silver Pathway X HMO 3500 10 6000","96751NH016",,"NHN002","NHS001","NHF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9956",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NHSelectdrugtier5","96751NH0160006-01","Anthem Silver Pathway X HMO 3500 10 6000","Standard Silver On Exchange Plan","69.89%","0.689777970314026","No","Yes","No","100%",,"$3,500","$200","$400","$0","$400","$2,300","$500","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd204W",
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150017","Anthem Bronze Pathway X Enhanced HMO 5400 30","96751NH015",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150017-03","Anthem Bronze Pathway X Enhanced HMO 5400 30","Limited Cost Sharing Plan Variation","60.42%","0.620014429092407","Yes","Yes","No","100%",,"$5,400","$0","$600","$0","$4,500","$200","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPJ","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9972",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-00","Anthem Bronze Pathway X Enhanced HMO 5750 10","Standard Bronze Off Exchange Plan","61.04%","0.625395476818085","Yes","Yes","No","100%",,"$5,800","$0","$200","$0","$4,500","$200","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYW","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9972",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-01","Anthem Bronze Pathway X Enhanced HMO 5750 10","Standard Bronze On Exchange Plan","61.04%","0.625395476818085","Yes","Yes","No","100%",,"$5,800","$0","$200","$0","$4,500","$200","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPK","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9972",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-02","Anthem Bronze Pathway X Enhanced HMO 5750 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ3","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9972",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-03","Anthem Bronze Pathway X Enhanced HMO 5750 10","Limited Cost Sharing Plan Variation","61.04%","0.625395476818085","Yes","Yes","No","100%",,"$5,800","$0","$200","$0","$4,500","$200","$0","$200","$0","$0","$0","$0","$500","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPK","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-00","Anthem Silver Pathway X Enhanced HMO 4000 0","Standard Silver Off Exchange Plan","68.99%","0.710538744926453","Yes","Yes","No","100%",,"$4,000","$600","$10","$0","$500","$2,100","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYY","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-01","Anthem Silver Pathway X Enhanced HMO 4000 0","Standard Silver On Exchange Plan","68.99%","0.710538744926453","Yes","Yes","No","100%",,"$4,000","$600","$10","$0","$500","$2,100","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPU","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-02","Anthem Silver Pathway X Enhanced HMO 4000 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ6","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-03","Anthem Silver Pathway X Enhanced HMO 4000 0","Limited Cost Sharing Plan Variation","68.99%","0.710538744926453","Yes","Yes","No","100%",,"$4,000","$600","$10","$0","$500","$2,100","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPU","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-04","Anthem Silver Pathway X Enhanced HMO 4000 0 S04","73% AV Level Silver Plan","73.56%","0.753416180610657","Yes","Yes","No","100%",,"$3,000","$600","$10","$0","$500","$1,700","$0","$200","$0","$0","$0","$0","$250","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPV","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-05","Anthem Silver Pathway X Enhanced HMO 4000 0 S05","87% AV Level Silver Plan","87.77%","0.885910093784332","Yes","Yes","No","100%",,"$800","$600","$10","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPW","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9976",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-06","Anthem Silver Pathway X Enhanced HMO 4000 0 S06","94% AV Level Silver Plan","94.06%","0.94750452041626","Yes","Yes","No","100%",,"$300","$300","$0","$0","$300","$500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPX","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150024","Anthem Catastrophic Pathway X Enhanced HMO 7150 0","96751NH015",,"NHN001","NHS001","NHF012","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9964",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150024-00","Anthem Catastrophic Pathway X Enhanced HMO 7150 0","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JZ0","http://editiondigital.net/view/IU65/2017/OFF_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-02","Anthem Silver Pathway X Enhanced HMO 4200 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2902","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-03","Anthem Silver Pathway X Enhanced HMO 4200 0","Limited Cost Sharing Plan Variation","70.62%","0.699650466442108","Yes","Yes","No","100%",,"$4,200","$600","$0","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2904","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-04","Anthem Silver Pathway X Enhanced HMO 4200 0 S04","73% AV Level Silver Plan","73.69%","0.731856167316437","Yes","Yes","No","100%",,"$3,500","$600","$0","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2905","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-05","Anthem Silver Pathway X Enhanced HMO 4200 0 S05","87% AV Level Silver Plan","87.09%","0.870725631713867","Yes","Yes","No","100%",,"$1,000","$600","$0","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2906","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NH","96751","SERFF","2017-04-21 20:15:32","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-06","Anthem Silver Pathway X Enhanced HMO 4200 0 S06","94% AV Level Silver Plan","94.81%","0.951893150806427","Yes","Yes","No","100%",,"$350","$300","$0","$0","$300","$600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2903","http://editiondigital.net/view/IU65/2017/ON_HIX_NH_KIT_2017"
"2017","NM","17911","SERFF","2016-08-24 05:44:16","Individual","Yes","47-0397286","17911NM0060001","Delta Dental Individual PPO, EHB Certified (Exchange)","17911NM006",,"NMN002","NMS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0060001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_EHB_High_2017","http://www.deltadentalnm.com/NM_EHB_High_2017"
"2017","NM","17911","SERFF","2016-08-24 05:44:16","Individual","Yes","47-0397286","17911NM0060002","Delta Dental Individual PPO, EHB Certified (Exchange)","17911NM006",,"NMN002","NMS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0060002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_EHB_Low_2017","http://www.deltadentalnm.com/NM_EHB_Low_2017"
"2017","NM","17911","SERFF","2016-08-24 05:44:16","Individual","Yes","47-0397286","17911NM0090001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","17911NM009",,"NMN002","NMS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0090001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_Ped_High_2017","http://www.deltadentalnm.com/NM_Ped_High_2017"
"2017","NM","17911","SERFF","2016-08-24 05:44:16","Individual","Yes","47-0397286","17911NM0090002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","17911NM009",,"NMN002","NMS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0090002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_Ped_Low_2017","http://www.deltadentalnm.com/NM_Ped_Low_2017"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold","19722NM001","7053314291","NMN001","NMS001","NMF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010001-00","Molina Marketplace Gold","Standard Gold Off Exchange Plan",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold","19722NM001","7053314291","NMN001","NMS001","NMF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010001-01","Molina Marketplace Gold","Standard Gold On Exchange Plan",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold","19722NM001","7053314291","NMN001","NMS001","NMF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010001-02","Molina Marketplace Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold","19722NM001","7053314291","NMN001","NMS001","NMF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010001-03","Molina Marketplace Gold LCS","Limited Cost Sharing Plan Variation",,"0.785358071327209","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-lcs-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010002-00","Molina Marketplace Silver 250","Standard Silver Off Exchange Plan",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010002-01","Molina Marketplace Silver 250","Standard Silver On Exchange Plan",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010002-02","Molina Marketplace Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010002-03","Molina Marketplace Silver LCS","Limited Cost Sharing Plan Variation",,"0.719652771949768","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-lcs-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010002-04","Molina Marketplace Silver 200","73% AV Level Silver Plan",,"0.739942610263824","No","Yes","No","100%",,"$2,270","$290","$1,340","$150","$2,270","$400","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,275","$2275 per person","$4550 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,275","$2275 per person","$4550 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010002-05","Molina Marketplace Silver 150","87% AV Level Silver Plan",,"0.879904866218567","No","Yes","No","100%",,"$500","$180","$890","$150","$500","$320","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010002-06","Molina Marketplace Silver 100","94% AV Level Silver Plan",,"0.949759483337402","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze","19722NM001","7053314291","NMN001","NMS001","NMF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010003-00","Molina Marketplace Bronze","Standard Bronze Off Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze","19722NM001","7053314291","NMN001","NMS001","NMF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010003-01","Molina Marketplace Bronze","Standard Bronze On Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze","19722NM001","7053314291","NMN001","NMS001","NMF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010003-02","Molina Marketplace Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","19722","SERFF","2016-11-21 20:15:49","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze","19722NM001","7053314291","NMN001","NMS001","NMF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","URGENT AND EMERGENT ARE COVERED","Yes","URGENT AND EMERGENT ARE COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2017.pdf","19722NM0010003-03","Molina Marketplace Bronze LCS","Limited Cost Sharing Plan Variation",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-lcs-2017.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","NM","26075","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","26075NM0020003","BESTOne Advantage Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2017/NM_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","NM","26075","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","26075NM0020003","BESTOne Advantage Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2017/NM_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","NM","26075","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","26075NM0020004","BESTOne Plus Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2017/NM_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","NM","26075","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","26075NM0020004","BESTOne Plus Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2017/NM_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","NM","26075","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","26075NM0020005","BESTOne Plus Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2017/NM_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","NM","26075","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","26075NM0020005","BESTOne Plus Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2017/NM_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","NM","26075","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","26075NM0020006","BESTOne Basic Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2017/NM_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","NM","26075","SERFF","2016-08-24 05:44:16","Individual","Yes","95-6042390","26075NM0020006","BESTOne Basic Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2017/NM_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0030001","New Mexico Bronze","72034NM003",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0030001-00","New Mexico Bronze","Standard Bronze Off Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0030001","New Mexico Bronze","72034NM003",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0030001-01","New Mexico Bronze","Standard Bronze On Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0060001","New Mexico Catastrophic","72034NM006",,"NMN001","NMS002","NMF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0060001-00","New Mexico Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0060001","New Mexico Catastrophic","72034NM006",,"NMN001","NMS002","NMF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0060001-01","New Mexico Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0050001","New Mexico Catastrophic S","72034NM005",,"NMN001","NMS001","NMF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0050001-00","New Mexico Catastrophic S","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0050001","New Mexico Catastrophic S","72034NM005",,"NMN001","NMS001","NMF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0050001-01","New Mexico Catastrophic S","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,400","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0030001","New Mexico Bronze","72034NM003",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0030001-02","New Mexico Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0030001","New Mexico Bronze","72034NM003",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0030001-03","New Mexico Bronze","Limited Cost Sharing Plan Variation",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0040001","New Mexico Bronze S","72034NM004",,"NMN001","NMS001","NMF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0040001-00","New Mexico Bronze S","Standard Bronze Off Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0040001","New Mexico Bronze S","72034NM004",,"NMN001","NMS001","NMF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0040001-01","New Mexico Bronze S","Standard Bronze On Exchange Plan",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0040001","New Mexico Bronze S","72034NM004",,"NMN001","NMS001","NMF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0040001-02","New Mexico Bronze S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0040001","New Mexico Bronze S","72034NM004",,"NMN001","NMS001","NMF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0040001-03","New Mexico Bronze S","Limited Cost Sharing Plan Variation",,"0.619728326797485","No","Yes","No","100%",,"$5,400","$1,450","$0","$0","$1,300","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","65.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0130001-00","New Mexico Silver HD","Standard Silver Off Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0130001-01","New Mexico Silver HD","Standard Silver On Exchange Plan",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0130001-02","New Mexico Silver HD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0130001-03","New Mexico Silver HD","Limited Cost Sharing Plan Variation",,"0.695661246776581","No","Yes","No","100%",,"$5,200","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0130001-04","New Mexico Silver HD","73% AV Level Silver Plan",,"0.722358047962189","No","Yes","No","100%",,"$4,400","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0130001-05","New Mexico Silver HD","87% AV Level Silver Plan",,"0.860265672206879","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0130001-06","New Mexico Silver HD","94% AV Level Silver Plan",,"0.94161456823349","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0170001-00","New Mexico Silver LD","Standard Silver Off Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0170001-01","New Mexico Silver LD","Standard Silver On Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0170001-02","New Mexico Silver LD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0170001-03","New Mexico Silver LD","Limited Cost Sharing Plan Variation",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0170001-04","New Mexico Silver LD","73% AV Level Silver Plan",,"0.739931523799896","No","Yes","No","100%",,"$3,300","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0170001-05","New Mexico Silver LD","87% AV Level Silver Plan",,"0.864413619041443","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0170001-06","New Mexico Silver LD","94% AV Level Silver Plan",,"0.944842338562012","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0180001-00","New Mexico Silver SLD","Standard Silver Off Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0180001-01","New Mexico Silver SLD","Standard Silver On Exchange Plan",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0180001-02","New Mexico Silver SLD","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0180001-03","New Mexico Silver SLD","Limited Cost Sharing Plan Variation",,"0.719011247158051","No","Yes","No","100%",,"$4,000","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0180001-04","New Mexico Silver SLD","73% AV Level Silver Plan",,"0.739931523799896","No","Yes","No","100%",,"$3,300","$1,100","$0","$0","$1,600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0180001-05","New Mexico Silver SLD","87% AV Level Silver Plan",,"0.864413619041443","No","Yes","No","100%",,"$400","$1,100","$0","$0","$600","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0180001-06","New Mexico Silver SLD","94% AV Level Silver Plan",,"0.944842338562012","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0080001","New Mexico Gold","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0080001-00","New Mexico Gold","Standard Gold Off Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0080001","New Mexico Gold","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0080001-01","New Mexico Gold","Standard Gold On Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0080001","New Mexico Gold","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0080001-02","New Mexico Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0080001","New Mexico Gold","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0080001-03","New Mexico Gold","Limited Cost Sharing Plan Variation",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0090001","New Mexico Gold S","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0090001-00","New Mexico Gold S","Standard Gold Off Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0090001","New Mexico Gold S","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0090001-01","New Mexico Gold S","Standard Gold On Exchange Plan",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0090001","New Mexico Gold S","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0090001-02","New Mexico Gold S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","72034","SERFF","2016-11-22 20:15:54","Individual","No","45-2106295","72034NM0090001","New Mexico Gold S","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://www.chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2017healthexchangeformulary","72034NM0090001-03","New Mexico Gold S","Limited Cost Sharing Plan Variation",,"0.819815874099731","No","Yes","No","100%",,"$2,200","$200","$0","$0","$1,500","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2017","http://www.christushealthplan.org/health-insurance-exchange-plan-information"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","Yes","36-1236610","75605NM0430001","BlueCare Dental? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390034","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS012","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390034-00","Blue Community Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390034","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS012","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390034-01","Blue Community Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","Yes","36-1236610","75605NM0430001","BlueCare Dental? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390068","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS032","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390068-02","Blue Community Bronze HMO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390070","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS052","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390070-02","Blue Community Bronze HMO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390070","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS052","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390070-03","Blue Community Bronze HMO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390031","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS012","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390031-00","Blue Community Bronze HMO? 101","Standard Bronze Off Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","Yes","36-1236610","75605NM0430002","BlueCare Dental? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","Yes","36-1236610","75605NM0430002","BlueCare Dental? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390032","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390032-04","Blue Community Silver HMO? 103","73% AV Level Silver Plan","72.96%","0","Yes","Yes","Yes","60%","40%","$2,800","$20","$900","$200","$2,800","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10900 per group","$5,250","$5250 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390032","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390032-05","Blue Community Silver HMO? 103","87% AV Level Silver Plan","86.95%","0","Yes","Yes","Yes","60%","40%","$400","$20","$1,000","$200","$400","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","20.00%","$350","$350 per person","$1050 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390032","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390032-06","Blue Community Silver HMO? 103","94% AV Level Silver Plan","94.01%","0","Yes","Yes","Yes","60%","40%","$0","$10","$300","$200","$0","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390051","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS022","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390051-00","Blue Community Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390051","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS022","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390051-01","Blue Community Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390052","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS032","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390052-00","Blue Community Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390052","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS032","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390052-01","Blue Community Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390053","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS042","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390053-00","Blue Community Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390053","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS042","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390053-01","Blue Community Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390054","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS052","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390054-00","Blue Community Security HMO? 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390054","Blue Community Security HMO? 100","75605NM039",,"NMN002","NMS052","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390054-01","Blue Community Security HMO? 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390034-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390038","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS012","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390038-00","Blue Community Bronze HMO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","Yes","36-1236610","75605NM0430003","BlueCare Dental 4 Kids? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","Yes","36-1236610","75605NM0430003","BlueCare Dental 4 Kids? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390038","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS012","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390038-01","Blue Community Bronze HMO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390038","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS012","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390038-02","Blue Community Bronze HMO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390038","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS012","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390038-03","Blue Community Bronze HMO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390067","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS022","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390067-00","Blue Community Bronze HMO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390067","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS022","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390067-01","Blue Community Bronze HMO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390067","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS022","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390067-02","Blue Community Bronze HMO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390067","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS022","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390067-03","Blue Community Bronze HMO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390068","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS032","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390068-00","Blue Community Bronze HMO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390068","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS032","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390068-01","Blue Community Bronze HMO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390068","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS032","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390068-03","Blue Community Bronze HMO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390069","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS042","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390069-00","Blue Community Bronze HMO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390069","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS042","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390069-01","Blue Community Bronze HMO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390069","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS042","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390069-02","Blue Community Bronze HMO? 102","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390069","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS042","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390069-03","Blue Community Bronze HMO? 102","Limited Cost Sharing Plan Variation",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390070","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS052","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390070-00","Blue Community Bronze HMO? 102","Standard Bronze Off Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390070","Blue Community Bronze HMO? 102","75605NM039",,"NMN002","NMS052","NMF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390070-01","Blue Community Bronze HMO? 102","Standard Bronze On Exchange Plan",,"0.617566466331482","Yes","Yes","Yes","60%","40%","$5,000","$0","$900","$200","$5,000","$0","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13100 per group","40.00%","$5,000","$5000 per person","$13100 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390038-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390031","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS012","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390031-01","Blue Community Bronze HMO? 101","Standard Bronze On Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390031","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS012","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390031-02","Blue Community Bronze HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390031","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS012","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390031-03","Blue Community Bronze HMO? 101","Limited Cost Sharing Plan Variation","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390039","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS022","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390039-00","Blue Community Bronze HMO? 101","Standard Bronze Off Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390039","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS022","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390039-01","Blue Community Bronze HMO? 101","Standard Bronze On Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390039","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS022","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390039-02","Blue Community Bronze HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390039","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS022","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390039-03","Blue Community Bronze HMO? 101","Limited Cost Sharing Plan Variation","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390040","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS032","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390040-00","Blue Community Bronze HMO? 101","Standard Bronze Off Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390040","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS032","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390040-01","Blue Community Bronze HMO? 101","Standard Bronze On Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390040","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS032","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390040-02","Blue Community Bronze HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390040","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS032","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390040-03","Blue Community Bronze HMO? 101","Limited Cost Sharing Plan Variation","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390041","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS042","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390041-00","Blue Community Bronze HMO? 101","Standard Bronze Off Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390041","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS042","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390041-01","Blue Community Bronze HMO? 101","Standard Bronze On Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390041","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS042","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390041-02","Blue Community Bronze HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390041","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS042","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390041-03","Blue Community Bronze HMO? 101","Limited Cost Sharing Plan Variation","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390042","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS052","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390042-00","Blue Community Bronze HMO? 101","Standard Bronze Off Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390042","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS052","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390042-01","Blue Community Bronze HMO? 101","Standard Bronze On Exchange Plan","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390042","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS052","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390042-02","Blue Community Bronze HMO? 101","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390042","Blue Community Bronze HMO? 101","75605NM039",,"NMN002","NMS052","NMF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390042-03","Blue Community Bronze HMO? 101","Limited Cost Sharing Plan Variation","58.92%","0","Yes","Yes","Yes","60%","40%","$7,000","$200","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14300 per group","40.00%","$7,000","$7000 per person","$14300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390031-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390032","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390032-00","Blue Community Silver HMO? 103","Standard Silver Off Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390032","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390032-01","Blue Community Silver HMO? 103","Standard Silver On Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390045","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390045-01","Blue Community Silver HMO? 103","Standard Silver On Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390049","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390049-03","Blue Community Gold HMO? 104","Limited Cost Sharing Plan Variation","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390050","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390050-00","Blue Community Gold HMO? 104","Standard Gold Off Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390050","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390050-01","Blue Community Gold HMO? 104","Standard Gold On Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390032","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390032-02","Blue Community Silver HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390032","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390032-03","Blue Community Silver HMO? 103","Limited Cost Sharing Plan Variation","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390043","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390043-00","Blue Community Silver HMO? 103","Standard Silver Off Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390043","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390043-01","Blue Community Silver HMO? 103","Standard Silver On Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390043","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390043-02","Blue Community Silver HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390043","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390043-03","Blue Community Silver HMO? 103","Limited Cost Sharing Plan Variation","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390043","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390043-04","Blue Community Silver HMO? 103","73% AV Level Silver Plan","72.96%","0","Yes","Yes","Yes","60%","40%","$2,800","$20","$900","$200","$2,800","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10900 per group","$5,250","$5250 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390043","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390043-05","Blue Community Silver HMO? 103","87% AV Level Silver Plan","86.95%","0","Yes","Yes","Yes","60%","40%","$400","$20","$1,000","$200","$400","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","20.00%","$350","$350 per person","$1050 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390043","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390043-06","Blue Community Silver HMO? 103","94% AV Level Silver Plan","94.01%","0","Yes","Yes","Yes","60%","40%","$0","$10","$300","$200","$0","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390044","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390044-00","Blue Community Silver HMO? 103","Standard Silver Off Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390044","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390044-01","Blue Community Silver HMO? 103","Standard Silver On Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390044","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390044-02","Blue Community Silver HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390044","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390044-03","Blue Community Silver HMO? 103","Limited Cost Sharing Plan Variation","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390044","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390044-04","Blue Community Silver HMO? 103","73% AV Level Silver Plan","72.96%","0","Yes","Yes","Yes","60%","40%","$2,800","$20","$900","$200","$2,800","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10900 per group","$5,250","$5250 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390044","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390044-05","Blue Community Silver HMO? 103","87% AV Level Silver Plan","86.95%","0","Yes","Yes","Yes","60%","40%","$400","$20","$1,000","$200","$400","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","20.00%","$350","$350 per person","$1050 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390044","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390044-06","Blue Community Silver HMO? 103","94% AV Level Silver Plan","94.01%","0","Yes","Yes","Yes","60%","40%","$0","$10","$300","$200","$0","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390045","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390045-00","Blue Community Silver HMO? 103","Standard Silver Off Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390045","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390045-02","Blue Community Silver HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390045","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390045-03","Blue Community Silver HMO? 103","Limited Cost Sharing Plan Variation","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390045","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390045-04","Blue Community Silver HMO? 103","73% AV Level Silver Plan","72.96%","0","Yes","Yes","Yes","60%","40%","$2,800","$20","$900","$200","$2,800","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10900 per group","$5,250","$5250 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390045","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390045-05","Blue Community Silver HMO? 103","87% AV Level Silver Plan","86.95%","0","Yes","Yes","Yes","60%","40%","$400","$20","$1,000","$200","$400","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","20.00%","$350","$350 per person","$1050 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390045","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390045-06","Blue Community Silver HMO? 103","94% AV Level Silver Plan","94.01%","0","Yes","Yes","Yes","60%","40%","$0","$10","$300","$200","$0","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390046","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390046-00","Blue Community Silver HMO? 103","Standard Silver Off Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390046","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390046-01","Blue Community Silver HMO? 103","Standard Silver On Exchange Plan","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390046","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390046-02","Blue Community Silver HMO? 103","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390046","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390046-03","Blue Community Silver HMO? 103","Limited Cost Sharing Plan Variation","68.61%","0","Yes","Yes","Yes","60%","40%","$4,000","$500","$700","$200","$2,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$14300 per group","$6,100","$6100 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20.00%","$4,000","$4000 per person","$12000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390046","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390046-04","Blue Community Silver HMO? 103","73% AV Level Silver Plan","72.96%","0","Yes","Yes","Yes","60%","40%","$2,800","$20","$900","$200","$2,800","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10900 per group","$5,250","$5250 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20.00%","$2,750","$2750 per person","$8250 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390046","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390046-05","Blue Community Silver HMO? 103","87% AV Level Silver Plan","86.95%","0","Yes","Yes","Yes","60%","40%","$400","$20","$1,000","$200","$400","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","20.00%","$350","$350 per person","$1050 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390046","Blue Community Silver HMO? 103","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390046-06","Blue Community Silver HMO? 103","94% AV Level Silver Plan","94.01%","0","Yes","Yes","Yes","60%","40%","$0","$10","$300","$200","$0","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390032-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390033","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390033-00","Blue Community Gold HMO? 104","Standard Gold Off Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390033","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390033-01","Blue Community Gold HMO? 104","Standard Gold On Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390033","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390033-02","Blue Community Gold HMO? 104","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390033","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390033-03","Blue Community Gold HMO? 104","Limited Cost Sharing Plan Variation","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390047","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390047-00","Blue Community Gold HMO? 104","Standard Gold Off Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390047","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390047-01","Blue Community Gold HMO? 104","Standard Gold On Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390059","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390059-05","Blue Community Silver HMO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390059","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390059-06","Blue Community Silver HMO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390047","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390047-02","Blue Community Gold HMO? 104","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390047","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390047-03","Blue Community Gold HMO? 104","Limited Cost Sharing Plan Variation","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390048","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390048-00","Blue Community Gold HMO? 104","Standard Gold Off Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390048","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390048-01","Blue Community Gold HMO? 104","Standard Gold On Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390048","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390048-02","Blue Community Gold HMO? 104","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390048","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390048-03","Blue Community Gold HMO? 104","Limited Cost Sharing Plan Variation","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390049","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390049-00","Blue Community Gold HMO? 104","Standard Gold Off Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390049","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390049-01","Blue Community Gold HMO? 104","Standard Gold On Exchange Plan","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390049","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390049-02","Blue Community Gold HMO? 104","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390050","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390050-02","Blue Community Gold HMO? 104","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390050","Blue Community Gold HMO? 104","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390050-03","Blue Community Gold HMO? 104","Limited Cost Sharing Plan Variation","78.75%","0","Yes","Yes","Yes","60%","40%","$2,000","$300","$900","$200","$2,000","$20","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$9450 per group","$3,150","$3150 per person","$9450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30.00%","$2,000","$2000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390033-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390036","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390036-00","Blue Community Silver HMO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","Yes","36-1236610","75605NM0430004","BlueCare Dental 4 Kids? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","Yes","36-1236610","75605NM0430004","BlueCare Dental 4 Kids? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390061","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390061-00","Blue Community Silver HMO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390061","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390061-01","Blue Community Silver HMO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390061","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390061-02","Blue Community Silver HMO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010011","Care Connect HDHP Bronze","93091NM001",,"NMN001","NMS006","NMF009","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9956",,,"2017-01-01","2107-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010011-00","Care Connect HDHP Bronze","Standard Bronze Off Exchange Plan","61.20%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://mynmhc.org/care-connect-bronzehdhp-hmo-ind-2017.pdf",
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390036","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390036-01","Blue Community Silver HMO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390036","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390036-02","Blue Community Silver HMO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390036","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390036-03","Blue Community Silver HMO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390036","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390036-04","Blue Community Silver HMO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390036","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390036-05","Blue Community Silver HMO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390036","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390036-06","Blue Community Silver HMO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390059","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390059-00","Blue Community Silver HMO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390059","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390059-01","Blue Community Silver HMO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390059","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390059-02","Blue Community Silver HMO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390059","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390059-03","Blue Community Silver HMO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390059","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390059-04","Blue Community Silver HMO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390060","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390060-00","Blue Community Silver HMO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390060","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390060-01","Blue Community Silver HMO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390060","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390060-02","Blue Community Silver HMO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390060","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390060-03","Blue Community Silver HMO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390060","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390060-04","Blue Community Silver HMO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390060","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390060-05","Blue Community Silver HMO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390060","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390060-06","Blue Community Silver HMO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390061","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390061-03","Blue Community Silver HMO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390061","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390061-04","Blue Community Silver HMO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390061","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390061-05","Blue Community Silver HMO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390061","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390061-06","Blue Community Silver HMO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390062","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390062-00","Blue Community Silver HMO? 104","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-00.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390062","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390062-01","Blue Community Silver HMO? 104","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-01.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390062","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390062-02","Blue Community Silver HMO? 104","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-02.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390062","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390062-03","Blue Community Silver HMO? 104","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$3,500","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-03.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390062","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390062-04","Blue Community Silver HMO? 104","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-04.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390062","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390062-05","Blue Community Silver HMO? 104","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-05.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","75605","SERFF","2017-01-26 20:15:25","Individual","No","36-1236610","75605NM0390062","Blue Community Silver HMO? 104","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2017-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2017/2017_NM_5T_EX.pdf","75605NM0390062-06","Blue Community Silver HMO? 104","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$300","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/static/nm/pdf/sbc/2017/75605NM0390036-06.pdf","http://www.bcbsnm.com/static/nm/pdf/brochure/2017/nm-plan-overview.pdf"
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus","93091NM001",,"NMN001","NMS006","NMF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9964",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010002-00","Care Connect Silver Plus","Standard Silver Off Exchange Plan","70.70%","0.699109494686127","Yes","Yes","No","100%",,"$3,000","$2,520","$0","$150","$3,000","$640","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silverplus-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus","93091NM001",,"NMN001","NMS006","NMF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9964",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010002-01","Care Connect Silver Plus","Standard Silver On Exchange Plan","70.70%","0.699109494686127","Yes","Yes","No","100%",,"$3,000","$2,520","$0","$150","$3,000","$640","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silverplus-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus","93091NM001",,"NMN001","NMS006","NMF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9964",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010002-02","Care Connect Silver Plus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silverplus-0-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus","93091NM001",,"NMN001","NMS006","NMF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9964",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010002-03","Care Connect Silver Plus","Limited Cost Sharing Plan Variation","70.70%","0.699109494686127","Yes","Yes","No","100%",,"$3,000","$2,520","$0","$150","$3,000","$640","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silverplus-lim-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus","93091NM001",,"NMN001","NMS006","NMF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9964",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010002-04","Care Connect Silver Plus","73% AV Level Silver Plan","73.98%","0.732923567295074","Yes","Yes","No","100%",,"$1,750","$2,570","$0","$150","$1,750","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silverplus-73-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus","93091NM001",,"NMN001","NMS006","NMF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9964",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010002-05","Care Connect Silver Plus","87% AV Level Silver Plan","87.81%","0.874203979969025","Yes","Yes","No","100%",,"$500","$400","$0","$150","$500","$870","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silverplus-87-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus","93091NM001",,"NMN001","NMS006","NMF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9964",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010002-06","Care Connect Silver Plus","94% AV Level Silver Plan","93.73%","0.937263309955597","Yes","Yes","No","100%",,"$0","$370","$0","$150","$0","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silverplus-94-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-00","Care Connect Silver","Standard Silver Off Exchange Plan","69.50%","0.68761682510376","Yes","Yes","No","100%",,"$4,000","$20","$1,020","$150","$4,000","$380","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-01","Care Connect Silver","Standard Silver On Exchange Plan","69.50%","0.68761682510376","Yes","Yes","No","100%",,"$4,000","$20","$1,020","$150","$4,000","$380","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-02","Care Connect Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-0-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-03","Care Connect Silver","Limited Cost Sharing Plan Variation","69.50%","0.68761682510376","Yes","Yes","No","100%",,"$4,000","$20","$1,020","$150","$4,000","$380","$80","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-lim-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-04","Care Connect Silver","73% AV Level Silver Plan","73.90%","0.730535984039307","Yes","Yes","No","100%",,"$2,500","$20","$1,220","$150","$2,500","$870","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-73-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-05","Care Connect Silver","87% AV Level Silver Plan","87.70%","0.87373548746109","Yes","Yes","No","100%",,"$500","$50","$950","$150","$500","$860","$140","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-87-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-06","Care Connect Silver","94% AV Level Silver Plan","94.22%","0.938996315002441","Yes","Yes","No","100%",,"$100","$20","$380","$150","$100","$340","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-94-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0170001","Healthy Connect Gold","93091NM017",,"NMN001","NMS006","NMF011","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0170001-00","Healthy Connect Gold","Standard Gold Off Exchange Plan","79.10%","0.787840843200684","Yes","Yes","No","100%",,"$1,000","$60","$890","$150","$1,000","$600","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-gold-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0170001","Healthy Connect Gold","93091NM017",,"NMN001","NMS006","NMF011","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0170001-01","Healthy Connect Gold","Standard Gold On Exchange Plan","79.10%","0.787840843200684","Yes","Yes","No","100%",,"$1,000","$60","$890","$150","$1,000","$600","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-gold-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0170001","Healthy Connect Gold","93091NM017",,"NMN001","NMS006","NMF011","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0170001-02","Healthy Connect Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-gold-0-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0170001","Healthy Connect Gold","93091NM017",,"NMN001","NMS006","NMF011","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.997",,,"2017-01-01","2017-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0170001-03","Healthy Connect Gold","Limited Cost Sharing Plan Variation","79.10%","0.787840843200684","Yes","Yes","No","100%",,"$1,000","$60","$890","$150","$1,000","$600","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-gold-lim-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010011","Care Connect HDHP Bronze","93091NM001",,"NMN001","NMS006","NMF009","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9956",,,"2017-01-01","2107-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010011-01","Care Connect HDHP Bronze","Standard Bronze On Exchange Plan","61.20%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://mynmhc.org/care-connect-bronzehdhp-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010011","Care Connect HDHP Bronze","93091NM001",,"NMN001","NMS006","NMF009","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9956",,,"2017-01-01","2107-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010011-02","Care Connect HDHP Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronzehdhp-0-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010011","Care Connect HDHP Bronze","93091NM001",,"NMN001","NMS006","NMF009","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9956",,,"2017-01-01","2107-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010011-03","Care Connect HDHP Bronze","Limited Cost Sharing Plan Variation","61.20%","0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://mynmhc.org/care-connect-bronzehdhp-lim-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze","93091NM001",,"NMN001","NMS006","NMF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9955",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010006-00","Care Connect Bronze","Standard Bronze Off Exchange Plan","61.30%","0.658138871192932","Yes","Yes","No","100%",,"$4,000","$0","$6,317","$60","$3,592","$0","$3,592","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronze-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze","93091NM001",,"NMN001","NMS006","NMF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9955",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010006-01","Care Connect Bronze","Standard Bronze On Exchange Plan","61.30%","0.658138871192932","Yes","Yes","No","100%",,"$4,000","$0","$6,317","$60","$3,592","$0","$3,592","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronze-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze","93091NM001",,"NMN001","NMS006","NMF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9955",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010006-02","Care Connect Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronze-0-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze","93091NM001",,"NMN001","NMS006","NMF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9955",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010006-03","Care Connect Bronze","Limited Cost Sharing Plan Variation","61.30%","0.658138871192932","Yes","Yes","No","100%",,"$4,000","$0","$6,317","$60","$3,592","$0","$3,592","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronze-lim-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0170003","Healthy Connect Bronze","93091NM017",,"NMN001","NMS006","NMF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9953",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0170003-00","Healthy Connect Bronze","Standard Bronze Off Exchange Plan","61.80%","0.647823870182037","Yes","Yes","No","100%",,"$6,218","$100","$6,318","$60","$3,196","$400","$3,197","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-bronze-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0170003","Healthy Connect Bronze","93091NM017",,"NMN001","NMS006","NMF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9953",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0170003-01","Healthy Connect Bronze","Standard Bronze On Exchange Plan","61.80%","0.647823870182037","Yes","Yes","No","100%",,"$6,218","$100","$6,318","$60","$3,196","$400","$3,197","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-bronze-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0170003","Healthy Connect Bronze","93091NM017",,"NMN001","NMS006","NMF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9953",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0170003-02","Healthy Connect Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-bronze-0-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0170003","Healthy Connect Bronze","93091NM017",,"NMN001","NMS006","NMF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9953",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0170003-03","Healthy Connect Bronze","Limited Cost Sharing Plan Variation","61.80%","0.647823870182037","Yes","Yes","No","100%",,"$6,218","$100","$6,318","$60","$3,196","$400","$3,197","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-bronze-lim-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010007","Care Connect Catastrophic","93091NM001",,"NMN001","NMS006","NMF009","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9953",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010007-00","Care Connect Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$7,150","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-catastrophic-hmo-ind-2017.pdf",
"2017","NM","93091","SERFF","2016-11-22 20:15:54","Individual","No","45-1294709","93091NM0010007","Care Connect Catastrophic","93091NM001",,"NMN001","NMS006","NMF009","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9953",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010007-01","Care Connect Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$7,150","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-catastrophic-hmo-ind-2017.pdf",
"2017","NV","12553","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","94-2761537","12553NV0020009","Delta Dental PPO Basic Plan for Families for Small Businesses","12553NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0020009-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0020009-17","https://deltadentalins.com/hcx/nv/12553nv0020009-17"
"2017","NV","12553","SERFF","2016-08-15 08:50:08","Individual","Yes","94-2761537","12553NV0010009","Delta Dental PPO Basic Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010009-00","Delta Dental PPO Basic Plan for Families","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010009-17","https://deltadentalins.com/hcx/nv/12553nv0010009-17"
"2017","NV","12553","SERFF","2016-08-15 08:50:08","Individual","Yes","94-2761537","12553NV0010009","Delta Dental PPO Basic Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010009-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010009-17","https://deltadentalins.com/hcx/nv/12553nv0010009-17"
"2017","NV","12553","SERFF","2016-08-15 08:50:08","Individual","Yes","94-2761537","12553NV0010010","Delta Dental PPO Preferred Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010010-00","Delta Dental PPO Preferred Plan for Families","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010010-17","https://deltadentalins.com/hcx/nv/12553nv0010010-17"
"2017","NV","12553","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","94-2761537","12553NV0020010","Delta Dental PPO Preferred Plan for Families for Small Businesses","12553NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0020010-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0020010-17","https://deltadentalins.com/hcx/nv/12553nv0020010-17"
"2017","NV","12553","SERFF","2016-08-15 08:50:08","Individual","Yes","94-2761537","12553NV0010010","Delta Dental PPO Preferred Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010010-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010010-17","https://deltadentalins.com/hcx/nv/12553nv0010010-17"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450045","Gold 2 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF004","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450045-00","Gold 2 HealthCare Partners","Standard Gold Off Exchange Plan",,"0.818149447441101","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450045","Gold 2 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF004","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450045-01","Gold 2 HealthCare Partners","Standard Gold On Exchange Plan",,"0.818149447441101","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450045","Gold 2 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF004","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450045-02","Gold 2 HealthCare Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450045","Gold 2 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF004","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450045-03","Gold 2 HealthCare Partners","Limited Cost Sharing Plan Variation",,"0.818149447441101","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450044","Gold 2 Premier","16698NV045",,"NVN001","NVS001","NVF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450044-00","Gold 2 Premier","Standard Gold Off Exchange Plan",,"0.818149447441101","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450044","Gold 2 Premier","16698NV045",,"NVN001","NVS001","NVF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450044-01","Gold 2 Premier","Standard Gold On Exchange Plan",,"0.818149447441101","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450044","Gold 2 Premier","16698NV045",,"NVN001","NVS001","NVF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450044-02","Gold 2 Premier","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450044","Gold 2 Premier","16698NV045",,"NVN001","NVS001","NVF004","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450044-03","Gold 2 Premier","Limited Cost Sharing Plan Variation",,"0.818149447441101","Yes","Yes","No","100%",,"$0","$780","$0","$150","$0","$1,770","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450020","Silver 50 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450020-00","Silver 50 HealthCare Partners","Standard Silver Off Exchange Plan",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450020","Silver 50 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450020-01","Silver 50 HealthCare Partners","Standard Silver On Exchange Plan",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450020","Silver 50 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450020-02","Silver 50 HealthCare Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450020","Silver 50 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450020-03","Silver 50 HealthCare Partners","Limited Cost Sharing Plan Variation",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450020","Silver 50 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450020-04","Silver 50 HealthCare Partners","73% AV Level Silver Plan",,"0.729396104812622","Yes","Yes","No","100%",,"$4,000","$270","$140","$150","$0","$1,570","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450020","Silver 50 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450020-05","Silver 50 HealthCare Partners","87% AV Level Silver Plan",,"0.870619297027588","Yes","Yes","No","100%",,"$1,000","$250","$0","$150","$0","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450020","Silver 50 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450020-06","Silver 50 HealthCare Partners","94% AV Level Silver Plan",,"0.934321820735931","Yes","Yes","No","100%",,"$350","$230","$0","$150","$0","$670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450013","Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450013-00","Silver 50 Premier","Standard Silver Off Exchange Plan",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450013","Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450013-01","Silver 50 Premier","Standard Silver On Exchange Plan",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450013","Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450013-02","Silver 50 Premier","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450013","Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450013-03","Silver 50 Premier","Limited Cost Sharing Plan Variation",,"0.696625232696533","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450013","Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450013-04","Silver 50 Premier","73% AV Level Silver Plan",,"0.729396104812622","Yes","Yes","No","100%",,"$4,000","$270","$140","$150","$0","$1,570","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450013","Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450013-05","Silver 50 Premier","87% AV Level Silver Plan",,"0.870619297027588","Yes","Yes","No","100%",,"$1,000","$250","$0","$150","$0","$980","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450013","Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450013-06","Silver 50 Premier","94% AV Level Silver Plan",,"0.934321820735931","Yes","Yes","No","100%",,"$350","$230","$0","$150","$0","$670","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450028","Bronze 7 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF002","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450028-00","Bronze 7 HealthCare Partners","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450028","Bronze 7 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF002","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450028-01","Bronze 7 HealthCare Partners","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450028","Bronze 7 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF002","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450028-02","Bronze 7 HealthCare Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450028","Bronze 7 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF002","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450028-03","Bronze 7 HealthCare Partners","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450027","Bronze 7 Premier","16698NV045",,"NVN001","NVS001","NVF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450027-00","Bronze 7 Premier","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450027","Bronze 7 Premier","16698NV045",,"NVN001","NVS001","NVF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450027-01","Bronze 7 Premier","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450027","Bronze 7 Premier","16698NV045",,"NVN001","NVS001","NVF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450027-02","Bronze 7 Premier","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450027","Bronze 7 Premier","16698NV045",,"NVN001","NVS001","NVF002","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450027-03","Bronze 7 Premier","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$6,580","$0","$0","$150","$4,120","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050001","Anthem Bronze Pathway PPO 5150 for HSA","33670NV105",,"NVN001","NVS007","NVF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050001-03","Anthem Bronze Pathway X PPO 5150 for HSA","Limited Cost Sharing Plan Variation","61.94%","0.622751712799072","Yes","Yes","Yes","52%","48%","$5,150","$0","$400","$0","$5,150","$0","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$16,625","$16625 per person","$33250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","20.00%","$5,150","$5150 per person","$10300 per group","20.00%","$12,875","$12875 per person","$25750 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X7Z","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway PPO 2250","33670NV105",,"NVN001","NVS007","NVF005","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-00","Anthem Silver Pathway PPO 2250","Standard Silver Off Exchange Plan","71.58%","0.725352823734283","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20.00%","$2,250","$2250 per person","$4500 per group","20.00%","$5,625","$5625 per person","$11250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZZE","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway PPO 2250","33670NV105",,"NVN001","NVS007","NVF005","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-01","Anthem Silver Pathway X PPO 2250","Standard Silver On Exchange Plan","71.58%","0.725352823734283","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20.00%","$2,250","$2250 per person","$4500 per group","20.00%","$5,625","$5625 per person","$11250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8L","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090050","AultCare Platinum 200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090050-00","AultCare Platinum 200","Standard Platinum Off Exchange Plan",,"0.897195279598236","No","Yes","No","100%",,"$200","$20","$710","$30","$200","$710","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9502017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9502017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200001","AultCare Pediatric Dental High Plan OON PPO 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200001-00","AultCare Pediatric Dental High Plan OON PPO 85","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2012017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090050","AultCare Platinum 200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090050-01","AultCare Platinum 200","Standard Platinum On Exchange Plan",,"0.897195279598236","No","Yes","No","100%",,"$200","$20","$710","$30","$200","$710","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9502017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9502017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060049-01","AultCare Gold 350","Standard Gold On Exchange Plan",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492017.pdf"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450030","Bronze 10 Premier","16698NV045",,"NVN001","NVS001","NVF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450030-00","Bronze 10 Premier","Standard Bronze Off Exchange Plan",,"0.608506917953491","No","Yes","No","100%",,"$2,080","$4,020","$0","$150","$1,270","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450030","Bronze 10 Premier","16698NV045",,"NVN001","NVS001","NVF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450030-01","Bronze 10 Premier","Standard Bronze On Exchange Plan",,"0.608506917953491","No","Yes","No","100%",,"$2,080","$4,020","$0","$150","$1,270","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450030","Bronze 10 Premier","16698NV045",,"NVN001","NVS001","NVF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450030-02","Bronze 10 Premier","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450030","Bronze 10 Premier","16698NV045",,"NVN001","NVS001","NVF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450030-03","Bronze 10 Premier","Limited Cost Sharing Plan Variation",,"0.608506917953491","No","Yes","No","100%",,"$2,080","$4,020","$0","$150","$1,270","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450008","HSA 1 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450008-00","HSA 1 Premier","Standard Bronze Off Exchange Plan",,"0.619737446308136","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450008","HSA 1 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450008-01","HSA 1 Premier","Standard Bronze On Exchange Plan",,"0.619737446308136","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450008","HSA 1 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450008-02","HSA 1 Premier","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450008","HSA 1 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450008-03","HSA 1 Premier","Limited Cost Sharing Plan Variation",,"0.619737446308136","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450042","Silver 70 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450042-00","Silver 70 HealthCare Partners","Standard Silver Off Exchange Plan",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450042","Silver 70 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450042-01","Silver 70 HealthCare Partners","Standard Silver On Exchange Plan",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450042","Silver 70 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450042-02","Silver 70 HealthCare Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450042","Silver 70 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450042-03","Silver 70 HealthCare Partners","Limited Cost Sharing Plan Variation",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450042","Silver 70 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450042-04","Silver 70 HealthCare Partners","73% AV Level Silver Plan",,"0.739166557788849","Yes","Yes","No","100%",,"$2,250","$2,440","$30","$150","$0","$1,620","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450042","Silver 70 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450042-05","Silver 70 HealthCare Partners","87% AV Level Silver Plan",,"0.874638140201569","Yes","Yes","No","100%",,"$500","$1,720","$20","$150","$0","$1,270","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450042","Silver 70 HealthCare Partners","16698NV045",,"NVN002","NVS002","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450042-06","Silver 70 HealthCare Partners","94% AV Level Silver Plan",,"0.938101172447205","Yes","Yes","No","100%",,"$0","$710","$20","$150","$0","$970","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450041","Silver 70 Premier","16698NV045",,"NVN001","NVS001","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450041-00","Silver 70 Premier","Standard Silver Off Exchange Plan",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450041","Silver 70 Premier","16698NV045",,"NVN001","NVS001","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450041-01","Silver 70 Premier","Standard Silver On Exchange Plan",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450041","Silver 70 Premier","16698NV045",,"NVN001","NVS001","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450041-02","Silver 70 Premier","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450041","Silver 70 Premier","16698NV045",,"NVN001","NVS001","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450041-03","Silver 70 Premier","Limited Cost Sharing Plan Variation",,"0.68353533744812","Yes","Yes","No","100%",,"$4,000","$690","$30","$150","$0","$1,670","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450041","Silver 70 Premier","16698NV045",,"NVN001","NVS001","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450041-04","Silver 70 Premier","73% AV Level Silver Plan",,"0.739166557788849","Yes","Yes","No","100%",,"$2,250","$2,440","$30","$150","$0","$1,620","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450041","Silver 70 Premier","16698NV045",,"NVN001","NVS001","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450041-05","Silver 70 Premier","87% AV Level Silver Plan",,"0.87582004070282","Yes","Yes","No","100%",,"$500","$1,720","$20","$150","$0","$1,270","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","16698","SERFF","2017-01-19 20:15:29","Individual","No","88-0293082","16698NV0450041","Silver 70 Premier","16698NV045",,"NVN001","NVS001","NVF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/wp-content/uploads/UPH-Nevada-formulary_FINAL.pdf","16698NV0450041-06","Silver 70 Premier","94% AV Level Silver Plan",,"0.938101172447205","Yes","Yes","No","100%",,"$0","$710","$20","$150","$0","$970","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/","http://prominencehealthplan.com/find-a-plan/for-individuals-and-families/individuals-and-families-in-nevada/plan-information-for-individuals-and-families-in-nevada/2016-medical-plans-individuals-families/"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","Yes","84-0747736","33670NV0980005","Anthem Dental Family Value","33670NV098",,"NVN001","NVS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215624.pdf",
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050001","Anthem Bronze Pathway PPO 5150 for HSA","33670NV105",,"NVN001","NVS007","NVF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050001-00","Anthem Bronze Pathway PPO 5150 for HSA","Standard Bronze Off Exchange Plan","61.94%","0.622751712799072","Yes","Yes","Yes","52%","48%","$5,150","$0","$400","$0","$5,150","$0","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$16,625","$16625 per person","$33250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","20.00%","$5,150","$5150 per person","$10300 per group","20.00%","$12,875","$12875 per person","$25750 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1ZZ8","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050001","Anthem Bronze Pathway PPO 5150 for HSA","33670NV105",,"NVN001","NVS007","NVF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050001-01","Anthem Bronze Pathway X PPO 5150 for HSA","Standard Bronze On Exchange Plan","61.94%","0.622751712799072","Yes","Yes","Yes","52%","48%","$5,150","$0","$400","$0","$5,150","$0","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$16,625","$16625 per person","$33250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","20.00%","$5,150","$5150 per person","$10300 per group","20.00%","$12,875","$12875 per person","$25750 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X7Z","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","Yes","84-0747736","33670NV0980005","Anthem Dental Family Value","33670NV098",,"NVN001","NVS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215624.pdf",
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050001","Anthem Bronze Pathway PPO 5150 for HSA","33670NV105",,"NVN001","NVS007","NVF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050001-02","Anthem Bronze Pathway X PPO 5150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X80","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway PPO 2250","33670NV105",,"NVN001","NVS007","NVF005","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-02","Anthem Silver Pathway X PPO 2250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X8Q","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway PPO 2250","33670NV105",,"NVN001","NVS007","NVF005","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-03","Anthem Silver Pathway X PPO 2250","Limited Cost Sharing Plan Variation","71.58%","0.725352823734283","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20.00%","$2,250","$2250 per person","$4500 per group","20.00%","$5,625","$5625 per person","$11250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8L","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway PPO 2250","33670NV105",,"NVN001","NVS007","NVF005","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-04","Anthem Silver Pathway X PPO 2150 S04","73% AV Level Silver Plan","73.82%","0.744940221309662","Yes","Yes","Yes","52%","48%","$2,150","$700","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","20.00%","$2,150","$2150 per person","$4300 per group","20.00%","$5,375","$5375 per person","$10750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8M","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway PPO 2250","33670NV105",,"NVN001","NVS007","NVF005","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-05","Anthem Silver Pathway X PPO 750 S05","87% AV Level Silver Plan","87.29%","0.871669828891754","Yes","Yes","Yes","52%","48%","$750","$500","$500","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$4,375","$4375 per person","$8750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8N","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway PPO 2250","33670NV105",,"NVN001","NVS007","NVF005","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-06","Anthem Silver Pathway X PPO 250 S06","94% AV Level Silver Plan","93.00%","0.937110126018524","Yes","Yes","Yes","52%","48%","$250","$200","$300","$0","$250","$400","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8P","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway PPO 4000","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-00","Anthem Silver Pathway PPO 4000","Standard Silver Off Exchange Plan","68.37%","0.692686319351196","Yes","Yes","Yes","52%","48%","$4,000","$600","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%","$4,000","$4000 per person","$8000 per group","15.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8R","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway PPO 4000","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-01","Anthem Silver Pathway X PPO 4000","Standard Silver On Exchange Plan","68.37%","0.692686319351196","Yes","Yes","Yes","52%","48%","$4,000","$600","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%","$4,000","$4000 per person","$8000 per group","15.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8S","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway PPO 4000","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-02","Anthem Silver Pathway X PPO 4000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X8E","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway PPO 4000","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-03","Anthem Silver Pathway X PPO 4000","Limited Cost Sharing Plan Variation","68.37%","0.692686319351196","Yes","Yes","Yes","52%","48%","$4,000","$600","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%","$4,000","$4000 per person","$8000 per group","15.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8S","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway PPO 4000","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-04","Anthem Silver Pathway X PPO 3100 S04","73% AV Level Silver Plan","73.38%","0.738545179367065","Yes","Yes","Yes","52%","48%","$3,100","$600","$900","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","15.00%","$3,100","$3100 per person","$6200 per group","15.00%","$7,750","$7750 per person","$15500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8T","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway PPO 4000","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-05","Anthem Silver Pathway X PPO 1000 S05","87% AV Level Silver Plan","87.29%","0.871845364570618","Yes","Yes","Yes","52%","48%","$1,000","$400","$300","$0","$500","$1,200","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8U","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway PPO 4000","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-06","Anthem Silver Pathway X PPO 250 S06","94% AV Level Silver Plan","94.12%","0.93956196308136","Yes","Yes","Yes","52%","48%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8V","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050011","Anthem Gold Pathway PPO 700","33670NV105",,"NVN001","NVS007","NVF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050011-00","Anthem Gold Pathway PPO 700","Standard Gold Off Exchange Plan","79.55%","0.808085083961487","Yes","Yes","Yes","52%","48%","$700","$800","$1,600","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","15.00%","$700","$700 per person","$2100 per group","15.00%","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XJ3","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050011","Anthem Gold Pathway PPO 700","33670NV105",,"NVN001","NVS007","NVF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050011-01","Anthem Gold Pathway X PPO 700","Standard Gold On Exchange Plan","79.55%","0.808085083961487","Yes","Yes","Yes","52%","48%","$700","$800","$1,600","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","15.00%","$700","$700 per person","$2100 per group","15.00%","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XKY","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050011","Anthem Gold Pathway PPO 700","33670NV105",,"NVN001","NVS007","NVF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050011-02","Anthem Gold Pathway X PPO 700 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XKZ","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050011","Anthem Gold Pathway PPO 700","33670NV105",,"NVN001","NVS007","NVF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050011-03","Anthem Gold Pathway X PPO 700","Limited Cost Sharing Plan Variation","79.55%","0.808085083961487","Yes","Yes","Yes","52%","48%","$700","$800","$1,600","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","15.00%","$700","$700 per person","$2100 per group","15.00%","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XKY","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050002","Anthem Bronze Pathway PPO 4600","33670NV105",,"NVN001","NVS007","NVF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050002-00","Anthem Bronze Pathway PPO 4600","Standard Bronze Off Exchange Plan","61.82%","0.636258780956268","Yes","Yes","Yes","52%","48%","$4,600","$500","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","20.00%","$4,600","$4600 per person","$9200 per group","20.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZZ9","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","Yes","84-0747736","33670NV0980003","Anthem Dental Family","33670NV098",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215622.pdf",
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","Yes","84-0747736","33670NV0980003","Anthem Dental Family","33670NV098",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215622.pdf",
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050002","Anthem Bronze Pathway PPO 4600","33670NV105",,"NVN001","NVS007","NVF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050002-01","Anthem Bronze Pathway X PPO 4600","Standard Bronze On Exchange Plan","61.82%","0.636258780956268","Yes","Yes","Yes","52%","48%","$4,600","$500","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","20.00%","$4,600","$4600 per person","$9200 per group","20.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X84","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050002","Anthem Bronze Pathway PPO 4600","33670NV105",,"NVN001","NVS007","NVF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050002-02","Anthem Bronze Pathway X PPO 4600 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X85","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050002","Anthem Bronze Pathway PPO 4600","33670NV105",,"NVN001","NVS007","NVF007","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050002-03","Anthem Bronze Pathway X PPO 4600","Limited Cost Sharing Plan Variation","61.82%","0.636258780956268","Yes","Yes","Yes","52%","48%","$4,600","$500","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","20.00%","$4,600","$4600 per person","$9200 per group","20.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X84","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway PPO 3500","33670NV105",,"NVN001","NVS007","NVF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-00","Anthem Silver Pathway PPO 3500","Standard Silver Off Exchange Plan","71.98%","0.736172020435333","Yes","Yes","Yes","52%","48%","$3,500","$600","$300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZZF","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","Yes","84-0747736","33670NV0980004","Anthem Dental Family Enhanced","33670NV098",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.867","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215623.pdf",
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","Yes","84-0747736","33670NV0980004","Anthem Dental Family Enhanced","33670NV098",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.867","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215623.pdf",
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway PPO 3500","33670NV105",,"NVN001","NVS007","NVF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-01","Anthem Silver Pathway X PPO 3500","Standard Silver On Exchange Plan","71.98%","0.736172020435333","Yes","Yes","Yes","52%","48%","$3,500","$600","$300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8F","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway PPO 3500","33670NV105",,"NVN001","NVS007","NVF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-02","Anthem Silver Pathway X PPO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X8K","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway PPO 3500","33670NV105",,"NVN001","NVS007","NVF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-03","Anthem Silver Pathway X PPO 3500","Limited Cost Sharing Plan Variation","71.98%","0.736172020435333","Yes","Yes","Yes","52%","48%","$3,500","$600","$300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8F","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway PPO 3500","33670NV105",,"NVN001","NVS007","NVF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-04","Anthem Silver Pathway X PPO 2800 S04","73% AV Level Silver Plan","74.00%","0.755096554756165","Yes","Yes","Yes","52%","48%","$2,800","$600","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","$12,250","$12250 per person","$24500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","0.00%","$2,800","$2800 per person","$5600 per group","0.00%","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8G","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway PPO 3500","33670NV105",,"NVN001","NVS007","NVF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-05","Anthem Silver Pathway X PPO 750 S05","87% AV Level Silver Plan","87.65%","0.878085911273956","Yes","Yes","Yes","52%","48%","$750","$500","$700","$0","$500","$1,500","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%","$750","$750 per person","$1500 per group","0.00%","$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8H","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway PPO 3500","33670NV105",,"NVN001","NVS007","NVF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-06","Anthem Silver Pathway X PPO 250 S06","94% AV Level Silver Plan","94.27%","0.941762685775757","Yes","Yes","Yes","52%","48%","$250","$300","$300","$0","$250","$600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","$2,125","$2125 per person","$4250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%","$250","$250 per person","$500 per group","0.00%","$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8J","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway PPO 2750","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-00","Anthem Silver Pathway PPO 2750","Standard Silver Off Exchange Plan","71.52%","0.724700212478638","Yes","Yes","Yes","52%","48%","$2,750","$600","$800","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","$6,875","$6875 per person","$13750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL3","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway PPO 2750","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-01","Anthem Silver Pathway X PPO 2750","Standard Silver On Exchange Plan","71.52%","0.724700212478638","Yes","Yes","Yes","52%","48%","$2,750","$600","$800","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","$6,875","$6875 per person","$13750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL4","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway PPO 2750","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-02","Anthem Silver Pathway X PPO 2750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XL5","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway PPO 2750","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-03","Anthem Silver Pathway X PPO 2750","Limited Cost Sharing Plan Variation","71.52%","0.724700212478638","Yes","Yes","Yes","52%","48%","$2,750","$600","$800","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","$6,875","$6875 per person","$13750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL4","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway PPO 2750","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-04","Anthem Silver Pathway X PPO 2500 S04","73% AV Level Silver Plan","73.83%","0.745593190193176","Yes","Yes","Yes","52%","48%","$2,500","$600","$800","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","$6,250","$6250 per person","$12500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL0","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway PPO 2750","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-05","Anthem Silver Pathway X PPO 800 S05","87% AV Level Silver Plan","87.32%","0.875062167644501","Yes","Yes","Yes","52%","48%","$800","$500","$500","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%","$800","$800 per person","$1600 per group","10.00%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL1","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway PPO 2750","33670NV105",,"NVN001","NVS007","NVF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-06","Anthem Silver Pathway X PPO 250 S06","94% AV Level Silver Plan","94.21%","0.943497180938721","Yes","Yes","Yes","52%","48%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL2","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050005","Anthem Bronze Pathway PPO 6200","33670NV105",,"NVN001","NVS007","NVF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050005-00","Anthem Bronze Pathway PPO 6200","Standard Bronze Off Exchange Plan","61.46%","0.614737451076508","Yes","Yes","Yes","52%","48%","$6,200","$0","$300","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%","$6,200","$6200 per person","$12400 per group","30.00%","$15,500","$15500 per person","$31000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZZ7","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050005","Anthem Bronze Pathway PPO 6200","33670NV105",,"NVN001","NVS007","NVF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050005-01","Anthem Bronze Pathway X PPO 6200","Standard Bronze On Exchange Plan","61.46%","0.614737451076508","Yes","Yes","Yes","52%","48%","$6,200","$0","$300","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%","$6,200","$6200 per person","$12400 per group","30.00%","$15,500","$15500 per person","$31000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X7X","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050005","Anthem Bronze Pathway PPO 6200","33670NV105",,"NVN001","NVS007","NVF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050005-02","Anthem Bronze Pathway X PPO 6200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X7Y","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050005","Anthem Bronze Pathway PPO 6200","33670NV105",,"NVN001","NVS007","NVF008","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050005-03","Anthem Bronze Pathway X PPO 6200","Limited Cost Sharing Plan Variation","61.46%","0.614737451076508","Yes","Yes","Yes","52%","48%","$6,200","$0","$300","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%","$6,200","$6200 per person","$12400 per group","30.00%","$15,500","$15500 per person","$31000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X7X","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050007","Anthem Catastrophic Pathway PPO 7150","33670NV105",,"NVN001","NVS007","NVF006","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050007-00","Anthem Catastrophic Pathway PPO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X86","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","33670","SERFF","2017-01-19 20:15:29","Individual","No","84-0747736","33670NV1050007","Anthem Catastrophic Pathway PPO 7150","33670NV105",,"NVN001","NVS007","NVF006","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Standard Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050007-01","Anthem Catastrophic Pathway X PPO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$17,875","$17875 per person","$35750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X87","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","34962","SERFF","2016-08-15 08:50:08","Individual","Yes","88-0244893","34962NV0010006","DeltaCare USA Basic Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010006-00","DeltaCare USA Basic Plan for Families","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010006-17","https://deltadentalins.com/hcx/nv/34962nv0010006-17"
"2017","NV","34962","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","88-0244893","34962NV0020006","DeltaCare USA Basic Plan for Families for Small Businesses","34962NV002",,"NVN001","NVS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0020006-01","DeltaCare USA Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0020006-17","https://deltadentalins.com/hcx/nv/34962nv0020006-17"
"2017","NV","34962","SERFF","2016-08-15 08:50:08","Individual","Yes","88-0244893","34962NV0010006","DeltaCare USA Basic Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010006-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010006-17","https://deltadentalins.com/hcx/nv/34962nv0010006-17"
"2017","NV","34962","SERFF","2016-08-15 08:50:08","Individual","Yes","88-0244893","34962NV0010004","DeltaCare USA Preferred Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010004-00","DeltaCare USA Preferred Plan for Families","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010004-17","https://deltadentalins.com/hcx/nv/34962nv0010004-17"
"2017","NV","34962","SERFF","2016-08-15 08:50:08","SHOP (Small Group)","Yes","88-0244893","34962NV0020004","DeltaCare USA Preferred Plan for Families for Small Businesses","34962NV002",,"NVN001","NVS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0020004-01","DeltaCare USA Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0020004-17","https://deltadentalins.com/hcx/nv/34962nv0020004-17"
"2017","NV","34962","SERFF","2016-08-15 08:50:08","Individual","Yes","88-0244893","34962NV0010004","DeltaCare USA Preferred Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010004-17","https://deltadentalins.com/hcx/nv/34962nv0010004-17"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230018","Anthem Catastrophic Pathway HMO 7150","60156NV023",,"NVN001","NVS001","NVF009","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230018-00","Anthem Catastrophic Pathway HMO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G37","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","SHOP (Small Group)","No","84-1017384","60156NV0240007","Anthem Bronze Pathway X HMO 5000 30 7150","60156NV024",,"NVN001","NVS001","NVF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9962",,,"2017-01-01",,"Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NVSelectdrugtier6","60156NV0240007-00","Anthem Bronze Pathway X HMO 5000 30 7150","Standard Bronze Off Exchange Plan","60.59%","0.643306851387024","No","Yes","Yes","57%","43%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25.00%","$500","$500 per person","$1000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HQT",
"2017","NV","60156","SERFF","2017-01-19 20:15:29","SHOP (Small Group)","No","84-1017384","60156NV0240007","Anthem Bronze Pathway X HMO 5000 30 7150","60156NV024",,"NVN001","NVS001","NVF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9962",,,"2017-01-01",,"Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NVSelectdrugtier6","60156NV0240007-01","Anthem Bronze Pathway X HMO 5000 30 7150","Standard Bronze On Exchange Plan","60.59%","0.643306851387024","No","Yes","Yes","57%","43%","$5,000","$200","$600","$0","$900","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%","$5,000","$5000 per person","$10000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25.00%","$500","$500 per person","$1000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HQT",
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230018","Anthem Catastrophic Pathway HMO 7150","60156NV023",,"NVN001","NVS001","NVF009","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230018-01","Anthem Catastrophic Pathway X HMO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2V","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","SHOP (Small Group)","No","84-1017384","60156NV0240009","Anthem Gold Pathway X HMO 1000 10 5500","60156NV024",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,"2017-01-01",,"Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NVSelectdrugtier6","60156NV0240009-00","Anthem Gold Pathway X HMO 1000 10 5500","Standard Gold Off Exchange Plan","81.10%","0.791734158992767","No","Yes","Yes","57%","43%","$1,000","$100","$600","$0","$700","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HQP",
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230019","Anthem Bronze Pathway HMO 6300 for HSA","60156NV023",,"NVN001","NVS001","NVF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230019-00","Anthem Bronze Pathway HMO 6300 for HSA","Standard Bronze Off Exchange Plan","61.85%","0.618557155132294","Yes","Yes","Yes","52%","48%","$6,300","$0","$10","$0","$1,200","$0","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%","$6,300","$6300 per person","$12600 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G2Y","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230019","Anthem Bronze Pathway HMO 6300 for HSA","60156NV023",,"NVN001","NVS001","NVF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230019-01","Anthem Bronze Pathway X HMO 6300 for HSA","Standard Bronze On Exchange Plan","61.85%","0.618557155132294","Yes","Yes","Yes","52%","48%","$6,300","$0","$10","$0","$1,200","$0","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%","$6,300","$6300 per person","$12600 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G43","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","SHOP (Small Group)","No","84-1017384","60156NV0240009","Anthem Gold Pathway X HMO 1000 10 5500","60156NV024",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,"2017-01-01",,"Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NVSelectdrugtier6","60156NV0240009-01","Anthem Gold Pathway X HMO 1000 10 5500","Standard Gold On Exchange Plan","81.10%","0.791734158992767","No","Yes","Yes","57%","43%","$1,000","$100","$600","$0","$700","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","10.00%","$1,000","$1000 per person","$3000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HQP",
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230019","Anthem Bronze Pathway HMO 6300 for HSA","60156NV023",,"NVN001","NVS001","NVF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230019-02","Anthem Bronze Pathway X HMO 6300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G4H","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230019","Anthem Bronze Pathway HMO 6300 for HSA","60156NV023",,"NVN001","NVS001","NVF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230019-03","Anthem Bronze Pathway X HMO 6300 for HSA","Limited Cost Sharing Plan Variation","61.85%","0.618557155132294","Yes","Yes","Yes","52%","48%","$6,300","$0","$10","$0","$1,200","$0","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%","$6,300","$6300 per person","$12600 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G43","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230020","Anthem Bronze Pathway HMO 6800","60156NV023",,"NVN001","NVS001","NVF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230020-00","Anthem Bronze Pathway HMO 6800","Standard Bronze Off Exchange Plan","61.97%","0.621575891971588","Yes","Yes","Yes","52%","48%","$6,800","$100","$80","$0","$3,300","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","20.00%","$6,800","$6800 per person","$13600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G30","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230020","Anthem Bronze Pathway HMO 6800","60156NV023",,"NVN001","NVS001","NVF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230020-01","Anthem Bronze Pathway X HMO 6800","Standard Bronze On Exchange Plan","61.97%","0.621575891971588","Yes","Yes","Yes","52%","48%","$6,800","$100","$80","$0","$3,300","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","20.00%","$6,800","$6800 per person","$13600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G47","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230020","Anthem Bronze Pathway HMO 6800","60156NV023",,"NVN001","NVS001","NVF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230020-02","Anthem Bronze Pathway X HMO 6800 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G4G","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230020","Anthem Bronze Pathway HMO 6800","60156NV023",,"NVN001","NVS001","NVF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230020-03","Anthem Bronze Pathway X HMO 6800","Limited Cost Sharing Plan Variation","61.97%","0.621575891971588","Yes","Yes","Yes","52%","48%","$6,800","$100","$80","$0","$3,300","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","20.00%","$6,800","$6800 per person","$13600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G47","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-00","Anthem Silver Pathway HMO 2250","Standard Silver Off Exchange Plan","71.95%","0.728389799594879","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20.00%","$2,250","$2250 per person","$4500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G32","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-01","Anthem Silver Pathway X HMO 2250","Standard Silver On Exchange Plan","71.95%","0.728389799594879","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20.00%","$2,250","$2250 per person","$4500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4P","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-02","Anthem Silver Pathway X HMO 2250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1Q1U","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-03","Anthem Silver Pathway X HMO 2250","Limited Cost Sharing Plan Variation","71.95%","0.728389799594879","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,300","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20.00%","$2,250","$2250 per person","$4500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4P","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-04","Anthem Silver Pathway X HMO 2150 S04","73% AV Level Silver Plan","73.96%","0.744924902915955","Yes","Yes","Yes","52%","48%","$2,150","$600","$1,400","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","20.00%","$2,150","$2150 per person","$4300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4R","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-05","Anthem Silver Pathway X HMO 750 S05","87% AV Level Silver Plan","87.35%","0.872122466564178","Yes","Yes","Yes","52%","48%","$750","$500","$600","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4S","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-06","Anthem Silver Pathway X HMO 175 S06","94% AV Level Silver Plan","93.60%","0.934095621109009","Yes","Yes","Yes","52%","48%","$175","$200","$500","$0","$175","$600","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20.00%","$175","$175 per person","$350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4T","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230028","Anthem Bronze Pathway HMO 6700","60156NV023",,"NVN001","NVS001","NVF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230028-00","Anthem Bronze Pathway HMO 6700","Standard Bronze Off Exchange Plan","61.95%","0.621437668800354","Yes","Yes","Yes","52%","48%","$6,700","$100","$200","$0","$3,300","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","35.00%","$6,700","$6700 per person","$13400 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZYY","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230028","Anthem Bronze Pathway HMO 6700","60156NV023",,"NVN001","NVS001","NVF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230028-01","Anthem Bronze Pathway X HMO 6700","Standard Bronze On Exchange Plan","61.95%","0.621437668800354","Yes","Yes","Yes","52%","48%","$6,700","$100","$200","$0","$3,300","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","35.00%","$6,700","$6700 per person","$13400 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8Y","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230028","Anthem Bronze Pathway HMO 6700","60156NV023",,"NVN001","NVS001","NVF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230028-02","Anthem Bronze Pathway X HMO 6700 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X8W","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230028","Anthem Bronze Pathway HMO 6700","60156NV023",,"NVN001","NVS001","NVF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230028-03","Anthem Bronze Pathway X HMO 6700","Limited Cost Sharing Plan Variation","61.95%","0.621437668800354","Yes","Yes","Yes","52%","48%","$6,700","$100","$200","$0","$3,300","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","35.00%","$6,700","$6700 per person","$13400 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8Y","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway HMO 2500","60156NV023",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-00","Anthem Silver Pathway HMO 2500","Standard Silver Off Exchange Plan","71.55%","0.716204106807709","Yes","Yes","Yes","52%","48%","$2,500","$600","$1,900","$0","$2,500","$500","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%","$2,500","$2500 per person","$5000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZZ5","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway HMO 2500","60156NV023",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-01","Anthem Silver Pathway X HMO 2500","Standard Silver On Exchange Plan","71.55%","0.716204106807709","Yes","Yes","Yes","52%","48%","$2,500","$600","$1,900","$0","$2,500","$500","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%","$2,500","$2500 per person","$5000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XJ1","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway HMO 2500","60156NV023",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-02","Anthem Silver Pathway X HMO 2500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XJ2","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway HMO 2500","60156NV023",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-03","Anthem Silver Pathway X HMO 2500","Limited Cost Sharing Plan Variation","71.55%","0.716204106807709","Yes","Yes","Yes","52%","48%","$2,500","$600","$1,900","$0","$2,500","$500","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%","$2,500","$2500 per person","$5000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XJ1","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway HMO 2500","60156NV023",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-04","Anthem Silver Pathway X HMO 2000 S04","73% AV Level Silver Plan","73.96%","0.73722767829895","Yes","Yes","Yes","52%","48%","$2,000","$900","$1,600","$0","$2,000","$500","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40.00%","$2,000","$2000 per person","$4000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9L","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway HMO 2500","60156NV023",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-05","Anthem Silver Pathway X HMO 1000 S05","87% AV Level Silver Plan","86.93%","0.867405235767365","Yes","Yes","Yes","52%","48%","$1,000","$300","$300","$0","$1,000","$200","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9M","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway HMO 2500","60156NV023",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-06","Anthem Silver Pathway X HMO 250 S06","94% AV Level Silver Plan","93.01%","0.933452725410461","Yes","Yes","Yes","52%","48%","$250","$20","$400","$0","$250","$100","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","40.00%","$250","$250 per person","$500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9N","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230038","Anthem Silver Core Pathway HMO 5300","60156NV023",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230038-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.02%","0.680177569389343","Yes","Yes","Yes","52%","48%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EEM","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230038","Anthem Silver Core Pathway HMO 5300","60156NV023",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230038-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.02%","0.680177569389343","Yes","Yes","Yes","52%","48%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EEL","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230038","Anthem Silver Core Pathway HMO 5300","60156NV023",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230038-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EEN","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230038","Anthem Silver Core Pathway HMO 5300","60156NV023",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230038-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.02%","0.680177569389343","Yes","Yes","Yes","52%","48%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EEL","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230038","Anthem Silver Core Pathway HMO 5300","60156NV023",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230038-04","Anthem Silver Core Pathway X HMO 3300 S04","73% AV Level Silver Plan","72.15%","0.721684396266937","Yes","Yes","Yes","52%","48%","$3,300","$60","$1,000","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","25.00%","$3,300","$3300 per person","$6600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EEP","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230038","Anthem Silver Core Pathway HMO 5300","60156NV023",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230038-05","Anthem Silver Core Pathway X HMO 1000 S05","87% AV Level Silver Plan","86.93%","0.860397577285767","Yes","Yes","Yes","52%","48%","$1,000","$40","$700","$0","$500","$1,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EEQ","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230038","Anthem Silver Core Pathway HMO 5300","60156NV023",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230038-06","Anthem Silver Core Pathway X HMO 300 S06","94% AV Level Silver Plan","93.11%","0.931106328964233","Yes","Yes","Yes","52%","48%","$300","$40","$400","$0","$300","$400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","25.00%","$300","$300 per person","$600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EER","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230022","Anthem Bronze Pathway HMO 5000","60156NV023",,"NVN001","NVS001","NVF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230022-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.81%","0.617080569267273","Yes","Yes","Yes","52%","48%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G38","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","SHOP (Small Group)","No","84-1017384","60156NV0240008","Anthem Silver Pathway X HMO 4750 30 7150","60156NV024",,"NVN001","NVS001","NVF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9964",,,"2017-01-01",,"Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NVSelectdrugtier6","60156NV0240008-00","Anthem Silver Pathway X HMO 4750 30 7150","Standard Silver Off Exchange Plan","71.43%","0.674821197986603","No","Yes","Yes","57%","43%","$4,750","$100","$700","$0","$400","$1,900","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","30.00%","$4,750","$4750 per person","$9500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HQD",
"2017","NV","60156","SERFF","2017-01-19 20:15:29","SHOP (Small Group)","No","84-1017384","60156NV0240008","Anthem Silver Pathway X HMO 4750 30 7150","60156NV024",,"NVN001","NVS001","NVF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9964",,,"2017-01-01",,"Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/NVSelectdrugtier6","60156NV0240008-01","Anthem Silver Pathway X HMO 4750 30 7150","Standard Silver On Exchange Plan","71.43%","0.674821197986603","No","Yes","Yes","57%","43%","$4,750","$100","$700","$0","$400","$1,900","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","30.00%","$4,750","$4750 per person","$9500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2HQD",
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230022","Anthem Bronze Pathway HMO 5000","60156NV023",,"NVN001","NVS001","NVF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230022-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.81%","0.617080569267273","Yes","Yes","Yes","52%","48%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230022","Anthem Bronze Pathway HMO 5000","60156NV023",,"NVN001","NVS001","NVF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230022-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G4E","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230022","Anthem Bronze Pathway HMO 5000","60156NV023",,"NVN001","NVS001","NVF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230022-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.81%","0.617080569267273","Yes","Yes","Yes","52%","48%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G3Z","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-00","Anthem Silver Pathway HMO 2250","Standard Silver Off Exchange Plan","71.60%","0.719149947166443","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,700","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%","$2,250","$2250 per person","$4500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G31","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-01","Anthem Silver Pathway X HMO 2250","Standard Silver On Exchange Plan","71.60%","0.719149947166443","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,700","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%","$2,250","$2250 per person","$4500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4J","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-02","Anthem Silver Pathway X HMO 2250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1Q1T","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-03","Anthem Silver Pathway X HMO 2250","Limited Cost Sharing Plan Variation","71.60%","0.719149947166443","Yes","Yes","Yes","52%","48%","$2,250","$600","$1,700","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%","$2,250","$2250 per person","$4500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4J","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-04","Anthem Silver Pathway X HMO 1500 S04","73% AV Level Silver Plan","73.97%","0.743148565292358","Yes","Yes","Yes","52%","48%","$1,500","$1,100","$1,900","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%","$1,500","$1500 per person","$3000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4L","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-05","Anthem Silver Pathway X HMO 700 S05","87% AV Level Silver Plan","87.16%","0.869858920574188","Yes","Yes","Yes","52%","48%","$700","$500","$500","$0","$500","$1,000","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","30.00%","$700","$700 per person","$1400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4M","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway HMO 2250","60156NV023",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-06","Anthem Silver Pathway X HMO 175 S06","94% AV Level Silver Plan","94.70%","0.944147765636444","Yes","Yes","Yes","52%","48%","$175","$30","$400","$0","$175","$400","$30","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30.00%","$175","$175 per person","$350 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4N","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230029","Anthem Bronze Pathway HMO 4950","60156NV023",,"NVN001","NVS001","NVF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230029-00","Anthem Bronze Pathway HMO 4950","Standard Bronze Off Exchange Plan","61.92%","0.612289369106293","Yes","Yes","Yes","52%","48%","$4,950","$200","$900","$0","$4,900","$300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","$6,100","$6100 per person","$12200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZYZ","http://editiondigital.net/view/IU65/2017/OFF_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230029","Anthem Bronze Pathway HMO 4950","60156NV023",,"NVN001","NVS001","NVF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230029-01","Anthem Bronze Pathway X HMO 4950","Standard Bronze On Exchange Plan","61.92%","0.612289369106293","Yes","Yes","Yes","52%","48%","$4,950","$200","$900","$0","$4,900","$300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","$6,100","$6100 per person","$12200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X91","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230029","Anthem Bronze Pathway HMO 4950","60156NV023",,"NVN001","NVS001","NVF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230029-02","Anthem Bronze Pathway X HMO 4950 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X8Z","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","60156","SERFF","2017-01-19 20:15:29","Individual","No","84-1017384","60156NV0230029","Anthem Bronze Pathway HMO 4950","60156NV023",,"NVN001","NVS001","NVF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230029-03","Anthem Bronze Pathway X HMO 4950","Limited Cost Sharing Plan Variation","61.92%","0.612289369106293","Yes","Yes","Yes","52%","48%","$4,950","$200","$900","$0","$4,900","$300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","$6,100","$6100 per person","$12200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X91","http://editiondigital.net/view/IU65/2017/ON_HIX_NV_KIT_2017"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010007","BESTDental Premium","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Premium_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","Individual","Yes","95-6042390","75719NV0020003","BESTOne Advantage Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/20176/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","Individual","Yes","95-6042390","75719NV0020003","BESTOne Advantage Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010007","BESTDental Premium","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Premium_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010008","BESTDental Standard - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Standard-H_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","Individual","Yes","95-6042390","75719NV0020004","BESTOne Plus Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","Individual","Yes","95-6042390","75719NV0020004","BESTOne Plus Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010008","BESTDental Standard - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Standard-H_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010010","BESTDental Choice - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Choice-H_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010010","BESTDental Choice - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Choice-H_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010009","BESTDental Standard - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Standard-L_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","Individual","Yes","95-6042390","75719NV0020005","BESTOne Plus Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","Individual","Yes","95-6042390","75719NV0020005","BESTOne Plus Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010009","BESTDental Standard - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Standard-L_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010011","BESTDental Choice - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Choice-L_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","Individual","Yes","95-6042390","75719NV0020006","BESTOne Basic Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","Individual","Yes","95-6042390","75719NV0020006","BESTOne Basic Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010011","BESTDental Choice - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Choice-L_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010012","BESTDental Value","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010012-00","BESTDental Value","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Value_Plan.pdf"
"2017","NV","75719","SERFF","2016-08-05 04:04:33","SHOP (Small Group)","Yes","95-6042390","75719NV0010012","BESTDental Value","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010012-01","BESTDental Value","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2017/NV_BESTDental_Value_Plan.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030052-00","MyHPN Bronze 7","Standard Bronze Off Exchange Plan",,"0.616642475128174","No","Yes","No","100%",,"$5,600","$600","$0","$0","$0","$2,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze7.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030052-01","MyHPN Bronze 7","Standard Bronze On Exchange Plan",,"0.616642475128174","No","Yes","No","100%",,"$5,600","$600","$0","$0","$0","$2,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze7.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030052-02","MyHPN Bronze 7","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze7.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030052-03","MyHPN Bronze 7","Limited Cost Sharing Plan Variation",,"0.616642475128174","No","Yes","No","100%",,"$5,600","$600","$0","$0","$0","$2,400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030053-00","MyHPN Bronze 8","Standard Bronze Off Exchange Plan",,"0.609745264053345","No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,600","$6600 per person","$13200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze8.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030053-01","MyHPN Bronze 8","Standard Bronze On Exchange Plan",,"0.609745264053345","No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,600","$6600 per person","$13200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze8.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030053-02","MyHPN Bronze 8","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030053-03","MyHPN Bronze 8","Limited Cost Sharing Plan Variation",,"0.609745264053345","No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,600","$6600 per person","$13200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze8.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030055-00","MyHPN Bronze 10","Standard Bronze Off Exchange Plan",,"0.613161146640778","No","Yes","No","100%",,"$6,000","$200","$0","$0","$100","$2,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze10.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030055-01","MyHPN Bronze 10","Standard Bronze On Exchange Plan",,"0.613161146640778","No","Yes","No","100%",,"$6,000","$200","$0","$0","$100","$2,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze10.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030055-02","MyHPN Bronze 10","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030055-03","MyHPN Bronze 10","Limited Cost Sharing Plan Variation",,"0.613161146640778","No","Yes","No","100%",,"$6,000","$200","$0","$0","$100","$2,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnbronze10.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030045-00","MyHPN Gold 5","Standard Gold Off Exchange Plan",,"0.780939996242523","No","Yes","No","100%",,"$3,000","$300","$500","$0","$0","$1,900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpngold5.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030045-01","MyHPN Gold 5","Standard Gold On Exchange Plan",,"0.780939996242523","No","Yes","No","100%",,"$3,000","$300","$500","$0","$0","$1,900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpngold5.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030045-02","MyHPN Gold 5","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030045-03","MyHPN Gold 5","Limited Cost Sharing Plan Variation",,"0.780939996242523","No","Yes","No","100%",,"$3,000","$300","$500","$0","$0","$1,900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpngold5.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030018-00","MyHPN Silver 1.1","Standard Silver Off Exchange Plan",,"0.706677377223969","No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030018-01","MyHPN Silver 1.1","Standard Silver On Exchange Plan",,"0.706677377223969","No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030018-02","MyHPN Silver 1.1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030018-03","MyHPN Silver 1.1","Limited Cost Sharing Plan Variation",,"0.706677377223969","No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030018-04","MyHPN Silver 1.1 - 73","73% AV Level Silver Plan",,"0.729985594749451","No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,900","$4900 per person","$9800 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1 73.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030018-05","MyHPN Silver 1.1 - 87","87% AV Level Silver Plan",,"0.876059830188751","No","Yes","No","100%",,"$0","$500","$1,500","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1 87.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030018-06","MyHPN Silver 1.1 - 94","94% AV Level Silver Plan",,"0.942494213581085","No","Yes","No","100%",,"$0","$500","$0","$0","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1 94.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030014-00","MyHPN Silver 3.1","Standard Silver Off Exchange Plan",,"0.694139122962952","No","Yes","No","100%",,"$4,000","$500","$500","$0","$0","$2,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver3 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030014-01","MyHPN Silver 3.1","Standard Silver On Exchange Plan",,"0.694139122962952","No","Yes","No","100%",,"$4,000","$500","$500","$0","$0","$2,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver3 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030014-02","MyHPN Silver 3.1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030014-03","MyHPN Silver 3.1","Limited Cost Sharing Plan Variation",,"0.694139122962952","No","Yes","No","100%",,"$4,000","$500","$500","$0","$0","$2,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver3 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030014-04","MyHPN Silver 3.1 - 73","73% AV Level Silver Plan",,"0.737398326396942","No","Yes","No","100%",,"$4,000","$500","$200","$0","$0","$2,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver3 1 73.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030014-05","MyHPN Silver 3.1 - 87","87% AV Level Silver Plan",,"0.877890288829803","No","Yes","No","100%",,"$0","$500","$1,200","$0","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver3 1 87.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030014-06","MyHPN Silver 3.1 - 94","94% AV Level Silver Plan",,"0.940536797046661","No","Yes","No","100%",,"$0","$300","$400","$0","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver3 1 94.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030019-00","MyHPN Silver 4.1","Standard Silver Off Exchange Plan",,"0.70341694355011","No","Yes","No","100%",,"$3,000","$500","$500","$0","$0","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver4 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030019-01","MyHPN Silver 4.1","Standard Silver On Exchange Plan",,"0.70341694355011","No","Yes","No","100%",,"$3,000","$500","$500","$0","$0","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver4 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030019-02","MyHPN Silver 4.1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030019-03","MyHPN Silver 4.1","Limited Cost Sharing Plan Variation",,"0.70341694355011","No","Yes","No","100%",,"$3,000","$500","$500","$0","$0","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver4 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030019-04","MyHPN Silver 4.1 - 73","73% AV Level Silver Plan",,"0.724500715732574","No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,700","$4700 per person","$9400 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver4 1 73.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030019-05","MyHPN Silver 4.1 - 87","87% AV Level Silver Plan",,"0.875823378562927","No","Yes","No","100%",,"$0","$500","$1,300","$0","$0","$1,600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver4 1 87.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030019-06","MyHPN Silver 4.1 - 94","94% AV Level Silver Plan",,"0.939715445041656","No","Yes","No","100%",,"$0","$300","$400","$0","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver4 1 94.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030047-00","MyHPN Silver 5","Standard Silver Off Exchange Plan",,"0.69432920217514","No","Yes","No","100%",,"$5,000","$500","$200","$0","$0","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver5.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030047-01","MyHPN Silver 5","Standard Silver On Exchange Plan",,"0.69432920217514","No","Yes","No","100%",,"$5,000","$500","$200","$0","$0","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver5.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030047-02","MyHPN Silver 5","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030047-03","MyHPN Silver 5","Limited Cost Sharing Plan Variation",,"0.69432920217514","No","Yes","No","100%",,"$5,000","$500","$200","$0","$0","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver5.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030047-04","MyHPN Silver 5 - 73","73% AV Level Silver Plan",,"0.728015124797821","No","Yes","No","100%",,"$2,500","$500","$900","$0","$0","$2,300","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver5 73.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030047-05","MyHPN Silver 5 - 87","87% AV Level Silver Plan",,"0.871726512908936","No","Yes","No","100%",,"$0","$500","$1,400","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver5 87.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030047-06","MyHPN Silver 5 - 94","94% AV Level Silver Plan",,"0.941360056400299","No","Yes","No","100%",,"$0","$300","$400","$0","$0","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver5 94.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030048-00","MyHPN Silver 6/Medicaid Transition Plan","Standard Silver Off Exchange Plan",,"0.693288683891296","No","Yes","No","100%",,"$4,500","$500","$300","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver6medicaidtransitionplan.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030048-01","MyHPN Silver 6/Medicaid Transition Plan","Standard Silver On Exchange Plan",,"0.693288683891296","No","Yes","No","100%",,"$4,500","$500","$300","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver6medicaidtransitionplan.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030048-02","MyHPN Silver 6/Medicaid Transition Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnzcs.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030048-03","MyHPN Silver 6/Medicaid Transition Plan","Limited Cost Sharing Plan Variation",,"0.693288683891296","No","Yes","No","100%",,"$4,500","$500","$300","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver6medicaidtransitionplan.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030048-04","MyHPN Silver 6/Medicaid Transition Plan - 73","73% AV Level Silver Plan",,"0.730224311351776","No","Yes","No","100%",,"$4,500","$500","$300","$0","$0","$1,900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver6medicaidtransitionplan73.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030048-05","MyHPN Silver 6/Medicaid Transition Plan - 87","87% AV Level Silver Plan",,"0.879408240318298","No","Yes","No","100%",,"$0","$500","$1,500","$0","$0","$2,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver6medicaidtransitionplan87.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030048-06","MyHPN Silver 6/Medicaid Transition Plan - 94","94% AV Level Silver Plan",,"0.93567568063736","No","Yes","No","100%",,"$0","$750","$0","$0","$0","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver6medicaidtransitionplan94.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030023","MyHPN Catastrophic Plan","95865NV003",,"NVN001","NVS001","NVF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030023-00","MyHPN Catastrophic Plan","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$200","$0","$0","$5,000","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpncatastrophicplan.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","NV","95865","SERFF","2016-08-18 04:06:30","Individual","No","88-0201035","95865NV0030023","MyHPN Catastrophic Plan","95865NV003",,"NVN001","NVS001","NVF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","ALL",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","No",,"Yes","EMERGENT AND URGENT","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2017/IndPDL.pdf","95865NV0030023-01","MyHPN Catastrophic Plan","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$200","$0","$0","$5,000","$200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpncatastrophicplan.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","Yes","21-0706531","23340OH0030001","MedMutual Pediatric Dental","23340OH003",,"OHN003","OHS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030001-00","MedMutual Pediatric Dental","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010001","Market HMO 1200 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010001-00","Market HMO 1200 - Mercy","Standard Gold Off Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005495000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010001","Market HMO 1200 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010001-01","Market HMO 1200 - Mercy","Standard Gold On Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005495000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010001","Market HMO 1200 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010001-02","Market HMO 1200 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005496000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010001","Market HMO 1200 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010001-03","Market HMO 1200 - Mercy","Limited Cost Sharing Plan Variation",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005497000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010021","Market HMO 1200 - ProMedica","23340OH001",,"OHN002","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010021-00","Market HMO 1200 - ProMedica","Standard Gold Off Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005489000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010021","Market HMO 1200 - ProMedica","23340OH001",,"OHN002","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010021-01","Market HMO 1200 - ProMedica","Standard Gold On Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005489000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010021","Market HMO 1200 - ProMedica","23340OH001",,"OHN002","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010021-02","Market HMO 1200 - ProMedica","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005490000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010021","Market HMO 1200 - ProMedica","23340OH001",,"OHN002","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010021-03","Market HMO 1200 - ProMedica","Limited Cost Sharing Plan Variation",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005491000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-00","Market HMO 1750 - Mercy","Standard Silver Off Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005510000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","Yes","21-0706531","23340OH0030002","MedMutual Dental 1","23340OH003",,"OHN003","OHS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030002-00","MedMutual Dental 1","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-01","Market HMO 1750 - Mercy","Standard Silver On Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005510000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-02","Market HMO 1750 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005515000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-03","Market HMO 1750 - Mercy","Limited Cost Sharing Plan Variation",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005651000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-04","Market HMO 1750 - Mercy","73% AV Level Silver Plan",,"0.739519774913788","No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$1,600","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005513000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-05","Market HMO 1750 - Mercy","87% AV Level Silver Plan",,"0.861778557300568","No","Yes","No","100%",,"$800","$20","$400","$200","$800","$1,200","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005514000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-06","Market HMO 1750 - Mercy","94% AV Level Silver Plan",,"0.934927046298981","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005511000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-00","Market HMO 1750 - ProMedica","Standard Silver Off Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005504000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-01","Market HMO 1750 - ProMedica","Standard Silver On Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005504000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-02","Market HMO 1750 - ProMedica","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005508000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-03","Market HMO 1750 - ProMedica","Limited Cost Sharing Plan Variation",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005509000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-04","Market HMO 1750 - ProMedica","73% AV Level Silver Plan",,"0.739519774913788","No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$1,600","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005507000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-05","Market HMO 1750 - ProMedica","87% AV Level Silver Plan",,"0.861778557300568","No","Yes","No","100%",,"$800","$20","$400","$200","$800","$1,200","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005506000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-06","Market HMO 1750 - ProMedica","94% AV Level Silver Plan",,"0.934927046298981","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005505000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-00","Market HMO 4000 HSA - Mercy","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005528000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","Yes","21-0706531","23340OH0030003","MedMutual Dental 2","23340OH003",,"OHN003","OHS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030003-00","MedMutual Dental 2","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-01","Market HMO 4000 HSA - Mercy","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005528000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-02","Market HMO 4000 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005532000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-03","Market HMO 4000 - Mercy","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005533000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-04","Market HMO 4000 HSA - Mercy","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005531000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-05","Market HMO 4000 - Mercy","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005530000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-06","Market HMO 4000 - Mercy","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005529000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-00","Market HMO 4000 HSA - ProMedica","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005522000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-01","Market HMO 4000 HSA - ProMedica","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005522000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-02","Market HMO 4000 - ProMedica","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005526000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-03","Market HMO 4000 - ProMedica","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005527000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-04","Market HMO 4000 HSA - ProMedica","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005525000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-05","Market HMO 4000 - ProMedica","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005524000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-06","Market HMO 4000 - ProMedica","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005523000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","Yes","21-0706531","23340OH0030004","MedMutual Dental 3","23340OH003",,"OHN003","OHS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030004-00","MedMutual Dental 3","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010007","Market HMO 6400 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010007-00","Market HMO 6400 HSA - Mercy","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005540000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010007","Market HMO 6400 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010007-01","Market HMO 6400 HSA - Mercy","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005540000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010007","Market HMO 6400 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010007-02","Market HMO 6400 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005541000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010007","Market HMO 6400 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010007-03","Market HMO 6400 - Mercy","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005542000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010013","Market HMO 6400 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010013-00","Market HMO 6400 HSA - ProMedica","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005537000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010013","Market HMO 6400 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010013-01","Market HMO 6400 HSA - ProMedica","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005537000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010013","Market HMO 6400 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010013-02","Market HMO 6400 - ProMedica","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005538000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010013","Market HMO 6400 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010013-03","Market HMO 6400 - ProMedica","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005539000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010016","Market HMO 7150 - Mercy","23340OH001",,"OHN001","OHS001","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010016-00","Market HMO 7150 - Mercy","Standard Bronze Off Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005557000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010016","Market HMO 7150 - Mercy","23340OH001",,"OHN001","OHS001","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010016-01","Market HMO 7150 - Mercy","Standard Bronze On Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005557000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010016","Market HMO 7150 - Mercy","23340OH001",,"OHN001","OHS001","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010016-02","Market HMO 7150 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005558000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010016","Market HMO 7150 - Mercy","23340OH001",,"OHN001","OHS001","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010016-03","Market HMO 7150 - Mercy","Limited Cost Sharing Plan Variation",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005559000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010019","Market HMO 7150 - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010019-00","Market HMO 7150 - ProMedica","Standard Bronze Off Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005613000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010019","Market HMO 7150 - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010019-01","Market HMO 7150 - ProMedica","Standard Bronze On Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005613000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010019","Market HMO 7150 - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010019-02","Market HMO 7150 - ProMedica","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005614000000000",
"2017","OH","23340","SERFF","2017-03-23 15:56:55","Individual","No","21-0706531","23340OH0010019","Market HMO 7150 - ProMedica","23340OH001",,"OHN002","OHS001","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010019-03","Market HMO 7150 - ProMedica","Limited Cost Sharing Plan Variation",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005620000000000",
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010001","Premier Health One Gold 1750","26734OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010001-00","Premier Health One Gold 1750","Standard Gold Off Exchange Plan",,"0.787590205669403","Yes","Yes","No","100%",,"$1,750","$720","$1,501","$60","$1,750","$900","$279","$55","$913","$240","$161","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Gold%201750%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010001","Premier Health One Gold 1750","26734OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010001-01","Premier Health One Gold 1750","Standard Gold On Exchange Plan",,"0.787590205669403","Yes","Yes","No","100%",,"$1,750","$720","$1,501","$60","$1,750","$900","$279","$55","$913","$240","$161","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Gold%201750%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010001","Premier Health One Gold 1750","26734OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010001-02","Premier Health One Gold 1750","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Gold%201750%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010001","Premier Health One Gold 1750","26734OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010001-03","Premier Health One Gold 1750","Limited Cost Sharing Plan Variation",,"0.787590205669403","Yes","Yes","No","100%",,"$1,750","$720","$1,501","$60","$1,750","$900","$279","$55","$913","$240","$161","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Gold%201750%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4750","26734OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-00","Premier Health One Silver 4750","Standard Silver Off Exchange Plan",,"0.683162450790405","No","Yes","No","100%",,"$4,750","$920","$2,001","$60","$2,989","$1,105","$372","$55","$1,305","$150","$326","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$4,750","$4750 per person","$9500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Silver%204750%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4750","26734OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-01","Premier Health One Silver 4750","Standard Silver On Exchange Plan",,"0.683162450790405","No","Yes","No","100%",,"$4,750","$920","$2,001","$60","$2,989","$1,105","$372","$55","$1,305","$150","$326","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$4,750","$4750 per person","$9500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204750%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4750","26734OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-02","Premier Health One Silver 4750","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204750%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4750","26734OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-03","Premier Health One Silver 4750","Limited Cost Sharing Plan Variation",,"0.683162450790405","No","Yes","No","100%",,"$4,750","$920","$2,001","$60","$2,989","$1,105","$372","$55","$1,305","$150","$326","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$4,750","$4750 per person","$9500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204750%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4750","26734OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-04","Premier Health One Silver 4750","73% AV Level Silver Plan",,"0.722148954868317","No","Yes","No","100%",,"$3,800","$920","$2,001","$60","$2,989","$1,105","$372","$55","$1,305","$150","$326","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204750%2073CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4750","26734OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-05","Premier Health One Silver 4750","87% AV Level Silver Plan",,"0.86783766746521","No","Yes","No","100%",,"$300","$920","$2,001","$60","$900","$1,105","$372","$55","$300","$150","$326","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","$300","$300 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204750%2087CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4750","26734OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-06","Premier Health One Silver 4750","94% AV Level Silver Plan",,"0.931143224239349","No","Yes","No","100%",,"$80","$465","$1,001","$60","$600","$935","$186","$55","$80","$75","$163","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","$80","$80 per person","$160 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","$160 per group","$520","$520 per person","$1040 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$520","$520 per person","$1040 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204750%2094CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3250","26734OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-00","Premier Health One Silver 3250","Standard Silver Off Exchange Plan",,"0.685180425643921","Yes","Yes","No","100%",,"$3,250","$250","$367","$60","$3,250","$0","$718","$55","$1,733","$0","$193","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","Yes",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Silver%203250%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3250","26734OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-01","Premier Health One Silver 3250","Standard Silver On Exchange Plan",,"0.685180425643921","Yes","Yes","No","100%",,"$3,250","$250","$367","$60","$3,250","$0","$718","$55","$1,733","$0","$193","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","Yes",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203250%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3250","26734OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-02","Premier Health One Silver 3250","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203250%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3250","26734OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-03","Premier Health One Silver 3250","Limited Cost Sharing Plan Variation",,"0.685180425643921","Yes","Yes","No","100%",,"$3,250","$250","$367","$60","$3,250","$0","$718","$55","$1,733","$0","$193","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","Yes",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203250%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3250","26734OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-04","Premier Health One Silver 3250","73% AV Level Silver Plan",,"0.73064249753952","Yes","Yes","No","100%",,"$2,425","$250","$367","$60","$2,425","$0","$718","$55","$1,733","$0","$193","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,300","$5300 per person","$10600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,425","$2425 per person","$4850 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,425","$2425 per person","$4850 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203250%2073CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3250","26734OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-05","Premier Health One Silver 3250","87% AV Level Silver Plan",,"0.861795365810394","Yes","Yes","No","100%",,"$800","$250","$367","$60","$825","$0","$718","$55","$800","$0","$193","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203250%2087CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3250","26734OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-06","Premier Health One Silver 3250","94% AV Level Silver Plan",,"0.930207371711731","Yes","Yes","No","100%",,"$225","$250","$367","$60","$225","$0","$718","$55","$225","$0","$193","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$975","$975 per person","$1950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$975","$975 per person","$1950 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$225","$225 per person","$450 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203250%2094CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010004","Premier Health One Bronze 6250","26734OH001",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010004-00","Premier Health One Bronze 6250","Standard Bronze Off Exchange Plan",,"0.614020943641663","Yes","Yes","No","100%",,"$6,250","$910","$1,151","$60","$3,687","$1,710","$778","$55","$1,204","$0","$985","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Bronze%206250%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010004","Premier Health One Bronze 6250","26734OH001",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010004-01","Premier Health One Bronze 6250","Standard Bronze On Exchange Plan",,"0.614020943641663","Yes","Yes","No","100%",,"$6,250","$910","$1,151","$60","$3,687","$1,710","$778","$55","$1,204","$0","$985","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206250%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010004","Premier Health One Bronze 6250","26734OH001",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010004-02","Premier Health One Bronze 6250","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206250%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010004","Premier Health One Bronze 6250","26734OH001",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010004-03","Premier Health One Bronze 6250","Limited Cost Sharing Plan Variation",,"0.614020943641663","Yes","Yes","No","100%",,"$6,250","$910","$1,151","$60","$3,687","$1,710","$778","$55","$1,204","$0","$985","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206250%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010005","Premier Health One Bronze 6550","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010005-00","Premier Health One Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$2,189","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","Yes",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Bronze%206550%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010005","Premier Health One Bronze 6550","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010005-01","Premier Health One Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$2,189","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","Yes",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206550%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010005","Premier Health One Bronze 6550","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010005-02","Premier Health One Bronze 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206550%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010005","Premier Health One Bronze 6550","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010005-03","Premier Health One Bronze 6550","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$2,189","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","Yes",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206550%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-00","Premier Health One Silver 3000","Standard Silver Off Exchange Plan",,"0.687022626399994","Yes","Yes","No","100%",,"$3,000","$720","$688","$60","$3,000","$1,205","$427","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Silver%203000%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-01","Premier Health One Silver 3000","Standard Silver On Exchange Plan",,"0.687022626399994","Yes","Yes","No","100%",,"$3,000","$720","$688","$60","$3,000","$1,205","$427","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203000%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-02","Premier Health One Silver 3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203000%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-03","Premier Health One Silver 3000","Limited Cost Sharing Plan Variation",,"0.687022626399994","Yes","Yes","No","100%",,"$3,000","$720","$688","$60","$3,000","$1,205","$427","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203000%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-04","Premier Health One Silver 3000","73% AV Level Silver Plan",,"0.724180221557617","Yes","Yes","No","100%",,"$2,500","$720","$688","$60","$2,500","$1,205","$427","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203000%2073CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-05","Premier Health One Silver 3000","87% AV Level Silver Plan",,"0.868263900279999","Yes","Yes","No","100%",,"$450","$720","$688","$60","$450","$1,205","$427","$55","$450","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203000%2087CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-06","Premier Health One Silver 3000","94% AV Level Silver Plan",,"0.930022895336151","Yes","Yes","No","100%",,"$100","$125","$344","$60","$100","$925","$213","$55","$100","$0","$193","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%203000%2094CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 5000","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-00","Premier Health One Silver 5000","Standard Silver Off Exchange Plan",,"0.689076840877533","Yes","Yes","No","100%",,"$5,000","$70","$3,455","$60","$4,141","$1,105","$518","$55","$1,142","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Silver%205000%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 5000","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-01","Premier Health One Silver 5000","Standard Silver On Exchange Plan",,"0.689076840877533","Yes","Yes","No","100%",,"$5,000","$70","$3,455","$60","$4,141","$1,105","$518","$55","$1,142","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%205000%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 5000","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-02","Premier Health One Silver 5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%205000%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 5000","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-03","Premier Health One Silver 5000","Limited Cost Sharing Plan Variation",,"0.689076840877533","Yes","Yes","No","100%",,"$5,000","$70","$3,455","$60","$4,141","$1,105","$518","$55","$1,142","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%205000%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 5000","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-04","Premier Health One Silver 5000","73% AV Level Silver Plan",,"0.723444700241089","Yes","Yes","No","100%",,"$3,800","$70","$3,455","$60","$3,800","$1,105","$518","$55","$1,142","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%205000%2073CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 5000","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-05","Premier Health One Silver 5000","87% AV Level Silver Plan",,"0.861106634140015","Yes","Yes","No","100%",,"$850","$70","$3,455","$60","$850","$1,105","$518","$55","$850","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%205000%2087CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 5000","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-06","Premier Health One Silver 5000","94% AV Level Silver Plan",,"0.931761980056763","Yes","Yes","No","100%",,"$50","$50","$1,152","$60","$50","$975","$173","$55","$50","$75","$163","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%205000%2094CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4500","26734OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-00","Premier Health One Silver 4500","Standard Silver Off Exchange Plan",,"0.689343214035034","Yes","Yes","No","100%",,"$4,500","$80","$3,455","$60","$4,141","$1,145","$518","$55","$1,142","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Silver%204500%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4500","26734OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-01","Premier Health One Silver 4500","Standard Silver On Exchange Plan",,"0.689343214035034","Yes","Yes","No","100%",,"$4,500","$80","$3,455","$60","$4,141","$1,145","$518","$55","$1,142","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204500%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4500","26734OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-02","Premier Health One Silver 4500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204500%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4500","26734OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-03","Premier Health One Silver 4500","Limited Cost Sharing Plan Variation",,"0.689343214035034","Yes","Yes","No","100%",,"$4,500","$80","$3,455","$60","$4,141","$1,145","$518","$55","$1,142","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204500%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4500","26734OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-04","Premier Health One Silver 4500","73% AV Level Silver Plan",,"0.739530980587006","Yes","Yes","No","100%",,"$2,250","$80","$3,455","$60","$2,250","$1,145","$518","$55","$1,142","$150","$490","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204500%2073CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4500","26734OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-05","Premier Health One Silver 4500","87% AV Level Silver Plan",,"0.860657632350922","Yes","Yes","No","100%",,"$450","$80","$2,304","$60","$450","$1,145","$346","$55","$450","$150","$326","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204500%2087CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4500","26734OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-06","Premier Health One Silver 4500","94% AV Level Silver Plan",,"0.930346667766571","Yes","Yes","No","100%",,"$80","$40","$1,152","$60","$80","$925","$173","$55","$80","$60","$163","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$80","$80 per person","$160 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","$160 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Silver%204500%2094CSR%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010009","Premier Health One Bronze 6500","26734OH001",,"OHN001","OHS001","OHF009","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010009-00","Premier Health One Bronze 6500","Standard Bronze Off Exchange Plan",,"0.613777816295624","Yes","Yes","No","100%",,"$6,500","$1,140","$1,023","$60","$3,773","$1,630","$691","$55","$1,313","$0","$876","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Bronze%206500%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010009","Premier Health One Bronze 6500","26734OH001",,"OHN001","OHS001","OHF009","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010009-01","Premier Health One Bronze 6500","Standard Bronze On Exchange Plan",,"0.613777816295624","Yes","Yes","No","100%",,"$6,500","$1,140","$1,023","$60","$3,773","$1,630","$691","$55","$1,313","$0","$876","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206500%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010009","Premier Health One Bronze 6500","26734OH001",,"OHN001","OHS001","OHF009","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010009-02","Premier Health One Bronze 6500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206500%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010009","Premier Health One Bronze 6500","26734OH001",,"OHN001","OHS001","OHF009","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010009-03","Premier Health One Bronze 6500","Limited Cost Sharing Plan Variation",,"0.613777816295624","Yes","Yes","No","100%",,"$6,500","$1,140","$1,023","$60","$3,773","$1,630","$691","$55","$1,313","$0","$876","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%206500%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010010","Premier Health One Bronze 7150","26734OH001",,"OHN001","OHS001","OHF010","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010010-00","Premier Health One Bronze 7150","Standard Bronze Off Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$6,777","$0","$0","$55","$2,189","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/PD%20Bronze%207150%20SBC%20Off-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010010","Premier Health One Bronze 7150","26734OH001",,"OHN001","OHS001","OHF010","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010010-01","Premier Health One Bronze 7150","Standard Bronze On Exchange Plan",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$6,777","$0","$0","$55","$2,189","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%207150%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010010","Premier Health One Bronze 7150","26734OH001",,"OHN001","OHS001","OHF010","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010010-02","Premier Health One Bronze 7150","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%207150%20ZCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","26734","SERFF","2016-11-15 22:15:57","Individual","No","46-3024049","26734OH0010010","Premier Health One Bronze 7150","26734OH001",,"OHN001","OHS001","OHF010","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"No",,"No",,"http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010010-03","Premier Health One Bronze 7150","Limited Cost Sharing Plan Variation",,"0.594339609146118","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$6,777","$0","$0","$55","$2,189","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://premierhealthdocs.org/sbc/files/pdf/Bronze%207150%20LCS%20SBC%20On-Exchange%202017.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060049-00","AultCare Gold 350","Standard Gold Off Exchange Plan",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200005","AultCare Pediatric Dental High Plan OON PPO 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200005-00","AultCare Pediatric Dental High Plan OON PPO 50","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2052017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200006","AultCare Pediatric Dental High Plan OON PPO <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200006-00","AultCare Pediatric Dental High Plan OON PPO <50","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2062017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060049-02","AultCare Gold 350","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060031-01","AultCare Gold 1200 Select","Standard Gold On Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6312017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060044-00","AultCare Silver 2500","Standard Silver Off Exchange Plan",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6442017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060037-00","AultCare Bronze 6000","Standard Bronze Off Exchange Plan",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6372017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060037-01","AultCare Bronze 6000","Standard Bronze On Exchange Plan",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6372017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090048","AultCare Platinum 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090048-00","AultCare Platinum 500","Standard Platinum Off Exchange Plan",,"0.895383298397064","No","Yes","No","100%",,"$500","$20","$750","$30","$500","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9482017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9482017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090048","AultCare Platinum 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090048-01","AultCare Platinum 500","Standard Platinum On Exchange Plan",,"0.895383298397064","No","Yes","No","100%",,"$500","$20","$750","$30","$500","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9482017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9482017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060049-03","AultCare Gold 350","Limited Cost Sharing Plan Variation",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200007","AultCare Pediatric Dental High Plan OON 75 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200007-00","AultCare Pediatric Dental High Plan OON 75 85","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2072017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200008","AultCare Pediatric Dental High Plan OON 75 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200008-00","AultCare Pediatric Dental High Plan OON 75 50","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2082017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060048-00","AultCare Gold 750","Standard Gold Off Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6482017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090047","AultCare Platinum 1000","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090047-00","AultCare Platinum 1000","Standard Platinum Off Exchange Plan",,"0.916168808937073","No","Yes","No","100%",,"$1,000","$20","$0","$30","$620","$380","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9472017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9472017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090047","AultCare Platinum 1000","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090047-01","AultCare Platinum 1000","Standard Platinum On Exchange Plan",,"0.916168808937073","No","Yes","No","100%",,"$1,000","$20","$0","$30","$620","$380","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9472017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9472017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060048-01","AultCare Gold 750","Standard Gold On Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6482017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200009","AultCare Pediatric Dental High Plan OON 75 <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200009-00","AultCare Pediatric Dental High Plan OON 75 <50","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2092017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060048-02","AultCare Gold 750","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090043","AultCare Gold 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090043-00","AultCare Gold 500","Standard Gold Off Exchange Plan",,"0.814924597740173","No","Yes","No","100%",,"$500","$20","$2,030","$30","$500","$740","$510","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9432017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9432017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200010","AultCare Pediatric Dental High Plan OON 90 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200010-00","AultCare Pediatric Dental High Plan OON 90 85","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2102017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090043","AultCare Gold 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090043-01","AultCare Gold 500","Standard Gold On Exchange Plan",,"0.814924597740173","No","Yes","No","100%",,"$500","$20","$2,030","$30","$500","$740","$510","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9432017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9432017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060048-03","AultCare Gold 750","Limited Cost Sharing Plan Variation",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6482017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200011","AultCare Pediatric Dental High Plan OON 90 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200011-00","AultCare Pediatric Dental High Plan OON 90 50","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2112017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200012","AultCare Pediatric Dental High Plan OON 90 <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200012-00","AultCare Pediatric Dental High Plan OON 90 <50","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2122017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060046-00","AultCare Gold 1200","Standard Gold Off Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6462017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6462017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090042","AultCare Gold 750","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090042-00","AultCare Gold 750","Standard Gold Off Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9422017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9422017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090042","AultCare Gold 750","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090042-01","AultCare Gold 750","Standard Gold On Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9422017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9422017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060070-03","AultCare Silver 6850 Select","Limited Cost Sharing Plan Variation",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6702017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060029-06","AultCare Silver 2500 Select","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0.00%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629894017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060023-00","AultCare Bronze 5000 Select","Standard Bronze Off Exchange Plan",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6232017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060023-01","AultCare Bronze 5000 Select","Standard Bronze On Exchange Plan",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6232017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090028","AultCare Platinum 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090028-00","AultCare Platinum 500 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.895383298397064","No","Yes","No","100%",,"$500","$20","$750","$30","$500","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9282017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9282017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060046-01","AultCare Gold 1200","Standard Gold On Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6462017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6462017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200002","AultCare Pediatric Dental Low Plan OON PPO 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200002-00","AultCare Pediatric Dental Low Plan OON PPO 85","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2022017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200013","AultCare Pediatric Dental Low Plan OON PPO 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200013-00","AultCare Pediatric Dental Low Plan OON PPO 50","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2132017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060046-02","AultCare Gold 1200","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090041","AultCare Gold 1200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090041-00","AultCare Gold 1200","Standard Gold Off Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9412017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9412017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090041","AultCare Gold 1200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090041-01","AultCare Gold 1200","Standard Gold On Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9412017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9412017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060046-03","AultCare Gold 1200","Limited Cost Sharing Plan Variation",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6462017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6462017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200014","AultCare Pediatric Dental Low Plan OON PPO <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200014-00","AultCare Pediatric Dental Low Plan OON PPO <50","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2142017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060042-00","AultCare Silver 3000","Standard Silver Off Exchange Plan",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6422017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200015","AultCare Pediatric Dental Low Plan OON 75 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200015-00","AultCare Pediatric Dental Low Plan OON 75 85","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2152017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090058","AultCare Gold 2500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090058-00","AultCare Gold 2500","Standard Gold Off Exchange Plan",,"0.794217646121979","No","Yes","No","100%",,"$2,500","$20","$480","$30","$1,850","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9582017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9582017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090058","AultCare Gold 2500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090058-01","AultCare Gold 2500","Standard Gold On Exchange Plan",,"0.794217646121979","No","Yes","No","100%",,"$2,500","$20","$480","$30","$1,850","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9582017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9582017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060042-01","AultCare Silver 3000","Standard Silver On Exchange Plan",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6422017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200016","AultCare Pediatric Dental Low Plan OON 75 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200016-00","AultCare Pediatric Dental Low Plan OON 75 50","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2162017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200017","AultCare Pediatric Dental Low Plan OON 75 <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200017-00","AultCare Pediatric Dental Low Plan OON 75 <50","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2172017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060042-02","AultCare Silver 3000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090038","AultCare Silver 1400","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090038-00","AultCare Silver 1400","Standard Silver Off Exchange Plan",,"0.719157040119171","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50.00%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9382017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9382017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090038","AultCare Silver 1400","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090038-01","AultCare Silver 1400","Standard Silver On Exchange Plan",,"0.719157040119171","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50.00%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9382017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9382017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060042-03","AultCare Silver 3000","Limited Cost Sharing Plan Variation",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6422017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200018","AultCare Pediatric Dental Low Plan OON 90 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200018-00","AultCare Pediatric Dental Low Plan OON 90 85","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2182017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200019","AultCare Pediatric Dental Low Plan OON 90 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200019-00","AultCare Pediatric Dental Low Plan OON 90 50","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2192017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060042-04","AultCare Silver 3000","73% AV Level Silver Plan",,"0.733608245849609","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,850","$740","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090036","AultCare Silver 2000 70","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090036-00","AultCare Silver 2000 70","Standard Silver Off Exchange Plan",,"0.718485057353973","No","Yes","No","100%",,"$2,000","$20","$1,580","$30","$1,850","$810","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9362017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9362017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090036","AultCare Silver 2000 70","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090036-01","AultCare Silver 2000 70","Standard Silver On Exchange Plan",,"0.718485057353973","No","Yes","No","100%",,"$2,000","$20","$1,580","$30","$1,850","$810","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9362017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9362017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","Yes","34-1624818","28162OH0200020","AultCare Pediatric Dental Low Plan OON 90 <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200020-00","AultCare Pediatric Dental Low Plan OON 90 <50","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2202017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060042-05","AultCare Silver 3000","87% AV Level Silver Plan",,"0.879758775234222","No","Yes","No","100%",,"$1,000","$20","$500","$30","$1,000","$740","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060042-06","AultCare Silver 3000","94% AV Level Silver Plan",,"0.948672771453857","No","Yes","No","100%",,"$230","$20","$280","$30","$200","$300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090060","AultCare Silver 3500 90","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090060-00","AultCare Silver 3500 90","Standard Silver Off Exchange Plan",,"0.71109801530838","No","Yes","No","100%",,"$3,500","$20","$380","$30","$1,850","$740","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9602017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9602017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090060","AultCare Silver 3500 90","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090060-01","AultCare Silver 3500 90","Standard Silver On Exchange Plan",,"0.71109801530838","No","Yes","No","100%",,"$3,500","$20","$380","$30","$1,850","$740","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9602017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9602017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060041-00","AultCare Silver 5000","Standard Silver Off Exchange Plan",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6412017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060041-01","AultCare Silver 5000","Standard Silver On Exchange Plan",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6412017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060041-02","AultCare Silver 5000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060041-03","AultCare Silver 5000","Limited Cost Sharing Plan Variation",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6412017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060041-04","AultCare Silver 5000","73% AV Level Silver Plan",,"0.734754204750061","No","Yes","No","100%",,"$4,000","$20","$480","$30","$1,850","$790","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060041-05","AultCare Silver 5000","87% AV Level Silver Plan",,"0.878593564033508","No","Yes","No","100%",,"$900","$20","$600","$30","$900","$790","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060041-06","AultCare Silver 5000","94% AV Level Silver Plan",,"0.945695281028748","No","Yes","No","100%",,"$250","$20","$130","$30","$250","$150","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060068-00","AultCare Silver 6850","Standard Silver Off Exchange Plan",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6682017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060068-01","AultCare Silver 6850","Standard Silver On Exchange Plan",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6682017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060068-02","AultCare Silver 6850","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060068-03","AultCare Silver 6850","Limited Cost Sharing Plan Variation",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6682017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060068-04","AultCare Silver 6850","73% AV Level Silver Plan",,"0.737187564373016","Yes","Yes","No","100%",,"$5,430","$20","$0","$30","$1,850","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060068-05","AultCare Silver 6850","87% AV Level Silver Plan",,"0.87350469827652","Yes","Yes","No","100%",,"$1,730","$20","$0","$30","$1,110","$640","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060068-06","AultCare Silver 6850","94% AV Level Silver Plan",,"0.9456866979599","Yes","Yes","No","100%",,"$580","$20","$0","$30","$470","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060034-00","AultCare Gold 350 Select","Standard Gold Off Exchange Plan",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6342017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060034-01","AultCare Gold 350 Select","Standard Gold On Exchange Plan",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6342017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060034-02","AultCare Gold 350 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060034-03","AultCare Gold 350 Select","Limited Cost Sharing Plan Variation",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6342017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060033-00","AultCare Gold 750 Select","Standard Gold Off Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6332017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060033-01","AultCare Gold 750 Select","Standard Gold On Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6332017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060033-02","AultCare Gold 750 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060033-03","AultCare Gold 750 Select","Limited Cost Sharing Plan Variation",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6332017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060031-00","AultCare Gold 1200 Select","Standard Gold Off Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6312017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060031-02","AultCare Gold 1200 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060031-03","AultCare Gold 1200 Select","Limited Cost Sharing Plan Variation",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6312017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060027-00","AultCare Silver 3000 Select","Standard Silver Off Exchange Plan",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6272017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060027-01","AultCare Silver 3000 Select","Standard Silver On Exchange Plan",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6272017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060027-02","AultCare Silver 3000 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060027-03","AultCare Silver 3000 Select","Limited Cost Sharing Plan Variation",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6272017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060027-04","AultCare Silver 3000 Select","73% AV Level Silver Plan",,"0.733608245849609","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,850","$740","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060027-05","AultCare Silver 3000 Select","87% AV Level Silver Plan",,"0.879758775234222","No","Yes","No","100%",,"$1,000","$20","$500","$30","$1,000","$740","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060027-06","AultCare Silver 3000 Select","94% AV Level Silver Plan",,"0.948672771453857","No","Yes","No","100%",,"$230","$20","$280","$30","$200","$300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060026-00","AultCare Silver 5000 Select","Standard Silver Off Exchange Plan",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6262017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060026-01","AultCare Silver 5000 Select","Standard Silver On Exchange Plan",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6262017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060026-02","AultCare Silver 5000 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060026-03","AultCare Silver 5000 Select","Limited Cost Sharing Plan Variation",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6262017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060026-04","AultCare Silver 5000 Select","73% AV Level Silver Plan",,"0.734754204750061","No","Yes","No","100%",,"$4,000","$20","$480","$30","$1,850","$790","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060026-05","AultCare Silver 5000 Select","87% AV Level Silver Plan",,"0.878593564033508","No","Yes","No","100%",,"$900","$20","$600","$30","$900","$790","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060026-06","AultCare Silver 5000 Select","94% AV Level Silver Plan",,"0.945695281028748","No","Yes","No","100%",,"$250","$20","$130","$30","$250","$150","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060070-00","AultCare Silver 6850 Select","Standard Silver Off Exchange Plan",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6702017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060070-01","AultCare Silver 6850 Select","Standard Silver On Exchange Plan",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6702017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060070-02","AultCare Silver 6850 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060070-04","AultCare Silver 6850 Select","73% AV Level Silver Plan",,"0.737187564373016","Yes","Yes","No","100%",,"$5,430","$20","$0","$30","$1,850","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060070-05","AultCare Silver 6850 Select","87% AV Level Silver Plan",,"0.87350469827652","Yes","Yes","No","100%",,"$1,730","$20","$0","$30","$1,110","$640","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060070-06","AultCare Silver 6850 Select","94% AV Level Silver Plan",,"0.9456866979599","Yes","Yes","No","100%",,"$580","$20","$0","$30","$470","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090049","AultCare Platinum 250","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090049-00","AultCare Platinum 250","Standard Platinum Off Exchange Plan",,"0.889586925506592","Yes","Yes","No","100%",,"$250","$0","$710","$30","$250","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9492017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9492017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090049","AultCare Platinum 250","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090049-01","AultCare Platinum 250","Standard Platinum On Exchange Plan",,"0.889586925506592","Yes","Yes","No","100%",,"$250","$0","$710","$30","$250","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9492017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9492017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060044-01","AultCare Silver 2500","Standard Silver On Exchange Plan",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6442017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060044-02","AultCare Silver 2500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090046","AultCare Platinum 1500 Health Savings 500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090046-00","AultCare Platinum 1500 Health Savings 500","Standard Platinum Off Exchange Plan",,"0.909943044185638","Yes","Yes","No","100%",,"$1,500","$0","$0","$30","$1,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0.00%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9462017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9462017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090046","AultCare Platinum 1500 Health Savings 500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090046-01","AultCare Platinum 1500 Health Savings 500","Standard Platinum On Exchange Plan",,"0.909943044185638","Yes","Yes","No","100%",,"$1,500","$0","$0","$30","$1,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0.00%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9462017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9462017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060044-03","AultCare Silver 2500","Limited Cost Sharing Plan Variation",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6442017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060044-04","AultCare Silver 2500","73% AV Level Silver Plan",,"0.739498674869537","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090040","AultCare Gold 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090040-00","AultCare Gold 1350","Standard Gold Off Exchange Plan",,"0.814737617969513","Yes","Yes","No","100%",,"$1,350","$0","$600","$30","$1,350","$0","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9402017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9402017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090040","AultCare Gold 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090040-01","AultCare Gold 1350","Standard Gold On Exchange Plan",,"0.814737617969513","Yes","Yes","No","100%",,"$1,350","$0","$600","$30","$1,350","$0","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9402017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9402017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060044-05","AultCare Silver 2500","87% AV Level Silver Plan",,"0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$30","$1,200","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0.00%",,,,,"$3,600","per person not applicable","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060044-06","AultCare Silver 2500","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0.00%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090057","AultCare Gold 2000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090057-00","AultCare Gold 2000","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9572017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9572017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090057","AultCare Gold 2000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090057-01","AultCare Gold 2000","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9572017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9572017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060038-00","AultCare Bronze 5000","Standard Bronze Off Exchange Plan",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6382017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060038-01","AultCare Bronze 5000","Standard Bronze On Exchange Plan",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6382017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090037","AultCare Silver 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090037-00","AultCare Silver 1350","Standard Silver Off Exchange Plan",,"0.715570867061615","Yes","Yes","No","100%",,"$1,350","$0","$1,810","$30","$1,350","$0","$1,180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9372017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9372017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090037","AultCare Silver 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090037-01","AultCare Silver 1350","Standard Silver On Exchange Plan",,"0.715570867061615","Yes","Yes","No","100%",,"$1,350","$0","$1,810","$30","$1,350","$0","$1,180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9372017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9372017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060038-02","AultCare Bronze 5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060038-03","AultCare Bronze 5000","Limited Cost Sharing Plan Variation",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6382017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090035","AultCare Silver 2000 80","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090035-00","AultCare Silver 2000 80","Standard Silver Off Exchange Plan",,"0.71371853351593","Yes","Yes","No","100%",,"$2,000","$0","$1,070","$30","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9352017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9352017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090035","AultCare Silver 2000 80","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090035-01","AultCare Silver 2000 80","Standard Silver On Exchange Plan",,"0.71371853351593","Yes","Yes","No","100%",,"$2,000","$0","$1,070","$30","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9352017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9352017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090059","AultCare Silver 4000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090059-00","AultCare Silver 4000","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$30","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9592017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9592017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090059","AultCare Silver 4000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090059-01","AultCare Silver 4000","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$30","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9592017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9592017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060037-02","AultCare Bronze 6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060037-03","AultCare Bronze 6000","Limited Cost Sharing Plan Variation",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6372017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090031","AultCare Bronze 4500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090031-00","AultCare Bronze 4500","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,390","$30","$4,500","$0","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9312017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9312017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090031","AultCare Bronze 4500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090031-01","AultCare Bronze 4500","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,390","$30","$4,500","$0","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9312017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9312017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6600","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060075-00","AultCare Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6752017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6752017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6600","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060075-01","AultCare Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6752017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6752017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090062","AultCare Bronze 6600","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090062-00","AultCare Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9622017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9622017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090062","AultCare Bronze 6600","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090062-01","AultCare Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9622017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9622017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6600","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060075-02","AultCare Bronze 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6600","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060075-03","AultCare Bronze 6550","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6752017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6752017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060036","AultCare Catastrophic","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060036-00","AultCare Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$4,570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6362017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6362017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060036","AultCare Catastrophic","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060036-01","AultCare Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$4,570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6362017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6362017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060029-00","AultCare Silver 2500 Select","Standard Silver Off Exchange Plan",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6292017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060029-01","AultCare Silver 2500 Select","Standard Silver On Exchange Plan",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6292017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060029-02","AultCare Silver 2500 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060029-03","AultCare Silver 2500 Select","Limited Cost Sharing Plan Variation",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6292017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060029-04","AultCare Silver 2500 Select","73% AV Level Silver Plan",,"0.739498674869537","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060029-05","AultCare Silver 2500 Select","87% AV Level Silver Plan",,"0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$30","$1,200","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0.00%",,,,,"$3,600","per person not applicable","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060023-02","AultCare Bronze 5000 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060012-05","AultCare Silver 3000 No Pediatric Dental","87% AV Level Silver Plan",,"0.879758775234222","No","Yes","No","100%",,"$1,000","$20","$500","$30","$1,000","$740","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090016","AultCare Silver 2000 70 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090016-01","AultCare Silver 2000 70 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.718485057353973","No","Yes","No","100%",,"$2,000","$20","$1,580","$30","$1,850","$810","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9162017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9162017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090054","AultCare Silver 3500 90 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090054-00","AultCare Silver 3500 90 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.71109801530838","No","Yes","No","100%",,"$3,500","$20","$380","$30","$1,850","$740","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9542017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9542017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060054-03","AultCare Gold 750 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6542017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6600 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060077-01","AultCare Bronze 6550 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6772017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090056","AultCare Bronze 6600 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090056-00","AultCare Bronze 6550 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9562017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9562017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090056","AultCare Bronze 6600 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090056-01","AultCare Bronze 6550 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9562017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9562017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060023-03","AultCare Bronze 5000 Select","Limited Cost Sharing Plan Variation",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6232017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060022-00","AultCare Bronze 6000 Select","Standard Bronze Off Exchange Plan",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6222017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060022-01","AultCare Bronze 6000 Select","Standard Bronze On Exchange Plan",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6222017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060022-02","AultCare Bronze 6000 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060022-03","AultCare Bronze 6000 Select","Limited Cost Sharing Plan Variation",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6222017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6600 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060076-00","AultCare Bronze 6550 Select","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6600 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060076-01","AultCare Bronze 6550 Select","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6600 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060076-02","AultCare Bronze 6550 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6600 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060076-03","AultCare Bronze 6550 Select","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060021","AultCare Catastrophic Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060021-00","AultCare Catastrophic Select","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$4,570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6212017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6212017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060021","AultCare Catastrophic Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060021-01","AultCare Catastrophic Select","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$4,570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6212017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6212017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090030","AultCare Platinum 200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090030-00","AultCare Platinum 200 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.897195279598236","No","Yes","No","100%",,"$200","$20","$710","$30","$200","$710","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9302017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9302017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060019-00","AultCare Gold 350 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6192017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060019-01","AultCare Gold 350 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6192017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090030","AultCare Platinum 200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090030-01","AultCare Platinum 200 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.897195279598236","No","Yes","No","100%",,"$200","$20","$710","$30","$200","$710","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9302017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9302017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060019-02","AultCare Gold 350 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060019-03","AultCare Gold 350 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6192017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090028","AultCare Platinum 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090028-01","AultCare Platinum 500 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.895383298397064","No","Yes","No","100%",,"$500","$20","$750","$30","$500","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9282017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9282017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090027","AultCare Platinum 1000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090027-00","AultCare Platinum 1000 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.916168808937073","No","Yes","No","100%",,"$1,000","$20","$0","$30","$620","$380","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9272017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9272017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060018-00","AultCare Gold 750 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6182017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060018-01","AultCare Gold 750 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6182017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090027","AultCare Platinum 1000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090027-01","AultCare Platinum 1000 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.916168808937073","No","Yes","No","100%",,"$1,000","$20","$0","$30","$620","$380","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9272017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9272017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090023","AultCare Gold 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090023-00","AultCare Gold 500 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.814924597740173","No","Yes","No","100%",,"$500","$20","$2,030","$30","$500","$740","$510","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9232017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9232017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060018-02","AultCare Gold 750 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060018-03","AultCare Gold 750 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6182017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090023","AultCare Gold 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090023-01","AultCare Gold 500 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.814924597740173","No","Yes","No","100%",,"$500","$20","$2,030","$30","$500","$740","$510","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9232017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9232017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090022","AultCare Gold 750 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090022-00","AultCare Gold 750 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9222017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9222017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060016-00","AultCare Gold 1200 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6162017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060016-01","AultCare Gold 1200 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6162017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090022","AultCare Gold 750 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090022-01","AultCare Gold 750 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9222017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9222017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090021","AultCare Gold 1200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090021-00","AultCare Gold 1200 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9212017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9212017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060016-02","AultCare Gold 1200 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060016-03","AultCare Gold 1200 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6162017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090021","AultCare Gold 1200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090021-01","AultCare Gold 1200 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9212017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9212017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090052","AultCare Gold 2500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090052-00","AultCare Gold 2500 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.794217646121979","No","Yes","No","100%",,"$2,500","$20","$480","$30","$1,850","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9522017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9522017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060012-00","AultCare Silver 3000 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060012-01","AultCare Silver 3000 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090052","AultCare Gold 2500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090052-01","AultCare Gold 2500 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.794217646121979","No","Yes","No","100%",,"$2,500","$20","$480","$30","$1,850","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9522017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9522017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090018","AultCare Silver 1400 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090018-00","AultCare Silver 1400 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.719157040119171","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50.00%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9182017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9182017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060053-02","AultCare Gold 350 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060074-00","AultCare Silver 6850 Select No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6742017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060074-01","AultCare Silver 6850 Select No Pediatric Dental","Standard Silver On Exchange Plan",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6742017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090017","AultCare Silver 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090017-01","AultCare Silver 1350 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.715570867061615","Yes","Yes","No","100%",,"$1,350","$0","$1,810","$30","$1,350","$0","$1,180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9172017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9172017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060079","AultCare Bronze Standard Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF004","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyd2017.aspx","28162OH0060079-02","AultCare Bronze Standard Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060079","AultCare Bronze Standard Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF004","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyd2017.aspx","28162OH0060079-03","AultCare Bronze Standard Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$300","$30","$5,140","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6792017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6792017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060012-02","AultCare Silver 3000 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060012-03","AultCare Silver 3000 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090018","AultCare Silver 1400 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090018-01","AultCare Silver 1400 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.719157040119171","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50.00%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9182017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9182017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090016","AultCare Silver 2000 70 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090016-00","AultCare Silver 2000 70 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.718485057353973","No","Yes","No","100%",,"$2,000","$20","$1,580","$30","$1,850","$810","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9162017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9162017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060012-04","AultCare Silver 3000 No Pediatric Dental","73% AV Level Silver Plan",,"0.733608245849609","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,850","$740","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060012-06","AultCare Silver 3000 No Pediatric Dental","94% AV Level Silver Plan",,"0.948672771453857","No","Yes","No","100%",,"$230","$20","$280","$30","$200","$300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090054","AultCare Silver 3500 90 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0090054-01","AultCare Silver 3500 90 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.71109801530838","No","Yes","No","100%",,"$3,500","$20","$380","$30","$1,850","$740","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9542017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9542017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060011-00","AultCare Silver 5000 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6112017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060011-01","AultCare Silver 5000 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6112017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060011-02","AultCare Silver 5000 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060011-03","AultCare Silver 5000 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6112017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060011-04","AultCare Silver 5000 No Pediatric Dental","73% AV Level Silver Plan",,"0.734754204750061","No","Yes","No","100%",,"$4,000","$20","$480","$30","$1,850","$790","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060011-05","AultCare Silver 5000 No Pediatric Dental","87% AV Level Silver Plan",,"0.878593564033508","No","Yes","No","100%",,"$900","$20","$600","$30","$900","$790","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060011-06","AultCare Silver 5000 No Pediatric Dental","94% AV Level Silver Plan",,"0.945695281028748","No","Yes","No","100%",,"$250","$20","$130","$30","$250","$150","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060072-00","AultCare Silver 6850 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6722017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060072-01","AultCare Silver 6850 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6722017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060072-02","AultCare Silver 6850 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060072-03","AultCare Silver 6850 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6722017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060072-04","AultCare Silver 6850 No Pediatric Dental","73% AV Level Silver Plan",,"0.737187564373016","Yes","Yes","No","100%",,"$5,430","$20","$0","$30","$1,850","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060072-05","AultCare Silver 6850 No Pediatric Dental","87% AV Level Silver Plan",,"0.87350469827652","Yes","Yes","No","100%",,"$1,730","$20","$0","$30","$1,110","$640","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060072-06","AultCare Silver 6850 No Pediatric Dental","94% AV Level Silver Plan",,"0.9456866979599","Yes","Yes","No","100%",,"$580","$20","$0","$30","$470","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060053-00","AultCare Gold 350 Select No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060053-01","AultCare Gold 350 Select No Pediatric Dental","Standard Gold On Exchange Plan",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060053-03","AultCare Gold 350 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.796355247497559","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060054-00","AultCare Gold 750 Select No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060054-01","AultCare Gold 750 Select No Pediatric Dental","Standard Gold On Exchange Plan",,"0.791567087173462","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6542017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060054-02","AultCare Gold 750 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060056-00","AultCare Gold 1200 Select No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6562017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060056-01","AultCare Gold 1200 Select No Pediatric Dental","Standard Gold On Exchange Plan",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6562017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060056-02","AultCare Gold 1200 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060056-03","AultCare Gold 1200 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.787556707859039","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6562017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060060-00","AultCare Silver 3000 Select No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6602017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6602017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060060-01","AultCare Silver 3000 Select No Pediatric Dental","Standard Silver On Exchange Plan",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6602017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6602017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060060-02","AultCare Silver 3000 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060060-03","AultCare Silver 3000 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.710201680660248","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6602017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6602017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060060-04","AultCare Silver 3000 Select No Pediatric Dental","73% AV Level Silver Plan",,"0.733608245849609","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,850","$740","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060060-05","AultCare Silver 3000 Select No Pediatric Dental","87% AV Level Silver Plan",,"0.879758775234222","No","Yes","No","100%",,"$1,000","$20","$500","$30","$1,000","$740","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060060-06","AultCare Silver 3000 Select No Pediatric Dental","94% AV Level Silver Plan",,"0.948672771453857","No","Yes","No","100%",,"$230","$20","$280","$30","$200","$300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060061-00","AultCare Silver 5000 Select No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6612017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060061-01","AultCare Silver 5000 Select No Pediatric Dental","Standard Silver On Exchange Plan",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6612017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060061-02","AultCare Silver 5000 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060061-03","AultCare Silver 5000 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.693730294704437","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6612017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060061-04","AultCare Silver 5000 Select No Pediatric Dental","73% AV Level Silver Plan",,"0.734754204750061","No","Yes","No","100%",,"$4,000","$20","$480","$30","$1,850","$790","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060061-05","AultCare Silver 5000 Select No Pediatric Dental","87% AV Level Silver Plan",,"0.878593564033508","No","Yes","No","100%",,"$900","$20","$600","$30","$900","$790","$260","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2017.aspx","28162OH0060061-06","AultCare Silver 5000 Select No Pediatric Dental","94% AV Level Silver Plan",,"0.945695281028748","No","Yes","No","100%",,"$250","$20","$130","$30","$250","$150","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060074-02","AultCare Silver 6850 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060074-03","AultCare Silver 6850 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.711242020130157","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6742017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060074-04","AultCare Silver 6850 Select No Pediatric Dental","73% AV Level Silver Plan",,"0.737187564373016","Yes","Yes","No","100%",,"$5,430","$20","$0","$30","$1,850","$660","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060074-05","AultCare Silver 6850 Select No Pediatric Dental","87% AV Level Silver Plan",,"0.87350469827652","Yes","Yes","No","100%",,"$1,730","$20","$0","$30","$1,110","$640","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2017.aspx","28162OH0060074-06","AultCare Silver 6850 Select No Pediatric Dental","94% AV Level Silver Plan",,"0.9456866979599","Yes","Yes","No","100%",,"$580","$20","$0","$30","$470","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060014-00","AultCare Silver 2500 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6142017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090029","AultCare Platinum 250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090029-00","AultCare Platinum 250 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.889586925506592","Yes","Yes","No","100%",,"$250","$0","$710","$30","$250","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9292017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9292017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090029","AultCare Platinum 250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090029-01","AultCare Platinum 250 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.889586925506592","Yes","Yes","No","100%",,"$250","$0","$710","$30","$250","$0","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9292017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9292017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060014-01","AultCare Silver 2500 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6142017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060014-02","AultCare Silver 2500 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090026","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090026-00","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.909943044185638","Yes","Yes","No","100%",,"$1,500","$0","$0","$30","$1,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0.00%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9262017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9262017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090026","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090026-01","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.909943044185638","Yes","Yes","No","100%",,"$1,500","$0","$0","$30","$1,500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0.00%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9262017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9262017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060014-03","AultCare Silver 2500 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6142017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060014-04","AultCare Silver 2500 No Pediatric Dental","73% AV Level Silver Plan",,"0.739498674869537","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090020","AultCare Gold 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090020-00","AultCare Gold 1350 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.814737617969513","Yes","Yes","No","100%",,"$1,350","$0","$600","$30","$1,350","$0","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9202017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9202017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090020","AultCare Gold 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090020-01","AultCare Gold 1350 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.814737617969513","Yes","Yes","No","100%",,"$1,350","$0","$600","$30","$1,350","$0","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9202017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9202017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060014-05","AultCare Silver 2500 No Pediatric Dental","87% AV Level Silver Plan",,"0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$30","$1,200","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0.00%",,,,,"$3,600","per person not applicable","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060014-06","AultCare Silver 2500 No Pediatric Dental","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0.00%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614942017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090051","AultCare Gold 2000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090051-00","AultCare Gold 2000 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9512017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9512017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090051","AultCare Gold 2000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090051-01","AultCare Gold 2000 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.814964413642883","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9512017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9512017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060008-00","AultCare Bronze 5000 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6082017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060008-01","AultCare Bronze 5000 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6082017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090017","AultCare Silver 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090017-00","AultCare Silver 1350 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.715570867061615","Yes","Yes","No","100%",,"$1,350","$0","$1,810","$30","$1,350","$0","$1,180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9172017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9172017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060008-02","AultCare Bronze 5000 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060008-03","AultCare Bronze 5000 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6082017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090015","AultCare Silver 2000 80 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090015-00","AultCare Silver 2000 80 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.71371853351593","Yes","Yes","No","100%",,"$2,000","$0","$1,070","$30","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9152017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9152017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090015","AultCare Silver 2000 80 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090015-01","AultCare Silver 2000 80 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.71371853351593","Yes","Yes","No","100%",,"$2,000","$0","$1,070","$30","$2,000","$0","$650","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9152017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9152017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060007-00","AultCare Bronze 6000 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6072017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060007-01","AultCare Bronze 6000 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6072017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090053","AultCare Silver 4000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090053-00","AultCare Silver 4000 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$30","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9532017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9532017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090053","AultCare Silver 4000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090053-01","AultCare Silver 4000 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$30","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9532017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9532017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060007-02","AultCare Bronze 6000 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060007-03","AultCare Bronze 6000 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6072017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090011","AultCare Bronze 4500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090011-00","AultCare Bronze 4500 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,390","$30","$4,500","$0","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9112017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9112017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","SHOP (Small Group)","No","34-1624818","28162OH0090011","AultCare Bronze 4500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0090011-01","AultCare Bronze 4500 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,390","$30","$4,500","$0","$390","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9112017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9112017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6600 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060077-00","AultCare Bronze 6550 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6772017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6600 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060077-02","AultCare Bronze 6550 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6600 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060077-03","AultCare Bronze 6550 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6772017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060051","AultCare Catastrophic No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060051-00","AultCare Catastrophic No Pediatric Dental","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$4,570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6512017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6512017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060051","AultCare Catastrophic No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060051-01","AultCare Catastrophic No Pediatric Dental","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$4,570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6512017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6512017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060058-00","AultCare Silver 2500 Select No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6582017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060058-01","AultCare Silver 2500 Select No Pediatric Dental","Standard Silver On Exchange Plan",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6582017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060058-02","AultCare Silver 2500 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060058-03","AultCare Silver 2500 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.691047966480255","Yes","Yes","No","100%",,"$2,500","$0","$970","$30","$2,500","$0","$550","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6582017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060058-04","AultCare Silver 2500 Select No Pediatric Dental","73% AV Level Silver Plan",,"0.739498674869537","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658732017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658732017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060058-05","AultCare Silver 2500 Select No Pediatric Dental","87% AV Level Silver Plan",,"0.876363337039948","Yes","Yes","No","100%",,"$1,200","$0","$0","$30","$1,200","$130","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0.00%",,,,,"$3,600","per person not applicable","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658872017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658872017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060058-06","AultCare Silver 2500 Select No Pediatric Dental","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0.00%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658894017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658942017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060064-00","AultCare Bronze 5000 Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6642017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060064-01","AultCare Bronze 5000 Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6642017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060064-02","AultCare Bronze 5000 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060064-03","AultCare Bronze 5000 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.618797957897186","Yes","Yes","No","100%",,"$5,000","$0","$800","$30","$5,000","$0","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6642017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060065-00","AultCare Bronze 6000 Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6652017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060065-01","AultCare Bronze 6000 Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6652017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060065-02","AultCare Bronze 6000 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060065-03","AultCare Bronze 6000 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.618971943855286","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6652017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6600 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060078-00","AultCare Bronze 6550 Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6782017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6600 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060078-01","AultCare Bronze 6550 Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6782017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6600 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060078-02","AultCare Bronze 6550 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6600 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060078-03","AultCare Bronze 6550 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,180","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6782017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060066","AultCare Catastrophic Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060066-00","AultCare Catastrophic Select No Pediatric Dental","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$4,570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6662017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6662017.pdf"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF019","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-01","Anthem Silver Pathway X PPO 10 for HSA","Standard Silver On Exchange Plan","69.34%","0.699308335781097","Yes","Yes","Yes","70%","30%","$2,700","$500","$1,200","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","$8,100","$8100 per person","$16200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EN2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF019","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-02","Anthem Silver Pathway X PPO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EN3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF019","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-03","Anthem Silver Pathway X PPO 10 for HSA","Limited Cost Sharing Plan Variation","69.34%","0.699308335781097","Yes","Yes","Yes","70%","30%","$2,700","$500","$1,200","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","$8,100","$8100 per person","$16200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EN2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF019","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-04","Anthem Silver Pathway X PPO 10 S04","73% AV Level Silver Plan","73.62%","0.741057872772217","Yes","Yes","Yes","70%","30%","$2,100","$900","$1,300","$0","$2,100","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","$5,050","$5050 per person","$10100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","10.00%","$2,100","$2100 per person","$4200 per group","10.00%","$8,100","$8100 per person","$16200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EN4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF019","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-05","Anthem Silver Pathway X PPO 10 S05","87% AV Level Silver Plan","87.64%","0.876363337039948","Yes","Yes","Yes","70%","30%","$1,200","$0","$0","$0","$1,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%","$1,200","$1200 per person","$2400 per group","0.00%","$8,100","$8100 per person","$16200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EN5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF019","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-06","Anthem Silver Pathway X PPO 10 S06","94% AV Level Silver Plan","94.28%","0.942757964134216","Yes","Yes","Yes","70%","30%","$500","$0","$0","$0","$500","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","$8,100","$8100 per person","$16200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EN6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 4050","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-00","Anthem Silver Pathway PPO 4050","Standard Silver Off Exchange Plan","71.44%","0.716383934020996","Yes","Yes","Yes","70%","30%","$4,050","$600","$300","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group","0.00%","$4,050","$4050 per person","$8100 per group","0.00%","$12,150","$12150 per person","$24300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2END","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060066","AultCare Catastrophic Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2017.aspx","28162OH0060066-01","AultCare Catastrophic Select No Pediatric Dental","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$4,570","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6662017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6662017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060079","AultCare Bronze Standard Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF004","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyd2017.aspx","28162OH0060079-00","AultCare Bronze Standard Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$300","$30","$5,140","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6792017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6792017.pdf"
"2017","OH","28162","SERFF","2016-08-22 03:53:59","Individual","No","34-1624818","28162OH0060079","AultCare Bronze Standard Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF004","New","PPO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyd2017.aspx","28162OH0060079-01","AultCare Bronze Standard Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$300","$30","$5,140","$140","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6792017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6792017.pdf"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740017","Anthem Catastrophic Pathway X PPO 7150","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740017-00","Anthem Catastrophic Pathway PPO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMK","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","Yes","31-1440175","29276OH0830005","Anthem Dental Family Value","29276OH083",,"OHN004","OHS002",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0830005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215627.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","No","31-1440175","29276OH0750113","Anthem Bronze Blue Access X PPO 6150EC 20 6550 Plus w HSA","29276OH075",,"OHN005","OHS001","OHF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0750113-00","Anthem Bronze Blue Access X PPO 6150EC 20 6550 Plus w HSA","Standard Bronze Off Exchange Plan","62.00%","0.621314227581024","Yes","Yes","No","100%",,"$6,150","$50","$200","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","20.00%",,,,,"$18,450","$18450 per person","$36900 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2GGN",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","Yes","31-1440175","29276OH0860003","Anthem Dental Family","29276OH086",,"OHN004","OHS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0860003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215625.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","Yes","31-1440175","29276OH0890005","Anthem Dental Family Value","29276OH089",,"OHN004","OHS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0890005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215627.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","No","31-1440175","29276OH0750113","Anthem Bronze Blue Access X PPO 6150EC 20 6550 Plus w HSA","29276OH075",,"OHN005","OHS001","OHF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9952",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0750113-01","Anthem Bronze Blue Access X PPO 6150EC 20 6550 Plus w HSA","Standard Bronze On Exchange Plan","62.00%","0.621314227581024","Yes","Yes","No","100%",,"$6,150","$50","$200","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","20.00%",,,,,"$18,450","$18450 per person","$36900 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2GGN",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740017","Anthem Catastrophic Pathway X PPO 7150","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740017-01","Anthem Catastrophic Pathway X PPO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMJ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","Yes","31-1440175","29276OH0800003","Anthem Dental Family","29276OH080",,"OHN004","OHS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0800003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215625.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-00","Anthem Silver Pathway PPO 3000","Standard Silver Off Exchange Plan","70.14%","0.706092953681946","Yes","Yes","Yes","70%","30%","$3,000","$500","$1,100","$0","$3,000","$200","$200","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EN1","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-01","Anthem Silver Pathway X PPO 3000","Standard Silver On Exchange Plan","70.14%","0.706092953681946","Yes","Yes","Yes","70%","30%","$3,000","$500","$1,100","$0","$3,000","$200","$200","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-02","Anthem Silver Pathway X PPO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EMX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-03","Anthem Silver Pathway X PPO 3000","Limited Cost Sharing Plan Variation","70.14%","0.706092953681946","Yes","Yes","Yes","70%","30%","$3,000","$500","$1,100","$0","$3,000","$200","$200","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-04","Anthem Silver Pathway X PPO 3000 S04","73% AV Level Silver Plan","73.68%","0.739583253860474","Yes","Yes","Yes","70%","30%","$2,550","$500","$1,300","$0","$2,550","$200","$200","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,550","$4550 per person","$9100 per group","$4,550","$4550 per person","$9100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,550","$2550 per person","$5100 per group","10.00%","$2,550","$2550 per person","$5100 per group","10.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMY","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-05","Anthem Silver Pathway X PPO 3000 S05","87% AV Level Silver Plan","87.80%","0.877312183380127","Yes","Yes","Yes","70%","30%","$800","$500","$400","$0","$800","$200","$400","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%","$800","$800 per person","$1600 per group","10.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-06","Anthem Silver Pathway X PPO 3000 S06","94% AV Level Silver Plan","94.57%","0.943876087665558","Yes","Yes","Yes","70%","30%","$200","$200","$400","$0","$200","$90","$500","$200","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","10.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EN0","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740018","Anthem Bronze Pathway X PPO 0 for HSA","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740018-00","Anthem Bronze Pathway PPO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","70%","30%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EMN","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","No","31-1440175","29276OH0750115","Anthem Gold Blue Access X PPO 1000 30 4500 Plus","29276OH075",,"OHN003","OHS001","OHF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/OHSelectdrugtier5","29276OH0750115-00","Anthem Gold Blue Access X PPO 1000 30 4500 Plus","Standard Gold Off Exchange Plan","78.23%","0.795313954353333","No","Yes","Yes","65%","35%","$1,000","$100","$1,800","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","30.00%","$1,000","$1000 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GFL",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","Yes","31-1440175","29276OH0830003","Anthem Dental Family","29276OH083",,"OHN004","OHS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0830003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215625.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","Yes","31-1440175","29276OH0800004","Anthem Dental Family Enhanced","29276OH080",,"OHN004","OHS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.823","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0800004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215626.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","Yes","31-1440175","29276OH0890003","Anthem Dental Family","29276OH089",,"OHN004","OHS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0890003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215625.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","No","31-1440175","29276OH0750115","Anthem Gold Blue Access X PPO 1000 30 4500 Plus","29276OH075",,"OHN003","OHS001","OHF002","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/OHSelectdrugtier5","29276OH0750115-01","Anthem Gold Blue Access X PPO 1000 30 4500 Plus","Standard Gold On Exchange Plan","78.23%","0.795313954353333","No","Yes","Yes","65%","35%","$1,000","$100","$1,800","$0","$400","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","30.00%","$1,000","$1000 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GFL",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","Yes","31-1440175","29276OH0860004","Anthem Dental Family Enhanced","29276OH086",,"OHN004","OHS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.823","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0860004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215626.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740018","Anthem Bronze Pathway X PPO 0 for HSA","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740018-01","Anthem Bronze Pathway X PPO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","70%","30%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EML","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740018","Anthem Bronze Pathway X PPO 0 for HSA","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740018-02","Anthem Bronze Pathway X PPO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EMM","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740018","Anthem Bronze Pathway X PPO 0 for HSA","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740018-03","Anthem Bronze Pathway X PPO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","70%","30%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EML","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF019","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-00","Anthem Silver Pathway PPO 10 for HSA","Standard Silver Off Exchange Plan","69.34%","0.699308335781097","Yes","Yes","Yes","70%","30%","$2,700","$500","$1,200","$0","$2,700","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","$8,100","$8100 per person","$16200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EN7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 4050","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-01","Anthem Silver Pathway X PPO 4050","Standard Silver On Exchange Plan","71.44%","0.716383934020996","Yes","Yes","Yes","70%","30%","$4,050","$600","$300","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group","0.00%","$4,050","$4050 per person","$8100 per group","0.00%","$12,150","$12150 per person","$24300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EN8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 4050","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-02","Anthem Silver Pathway X PPO 4050 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EN9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 4050","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-03","Anthem Silver Pathway X PPO 4050","Limited Cost Sharing Plan Variation","71.44%","0.716383934020996","Yes","Yes","Yes","70%","30%","$4,050","$600","$300","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group","0.00%","$4,050","$4050 per person","$8100 per group","0.00%","$12,150","$12150 per person","$24300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EN8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 4050","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-04","Anthem Silver Pathway X PPO 4050 S04","73% AV Level Silver Plan","73.48%","0.736318707466125","Yes","Yes","Yes","70%","30%","$3,700","$600","$400","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","0.00%","$3,700","$3700 per person","$7400 per group","0.00%","$12,150","$12150 per person","$24300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 4050","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-05","Anthem Silver Pathway X PPO 4050 S05","87% AV Level Silver Plan","87.59%","0.877539455890656","Yes","Yes","Yes","70%","30%","$1,100","$400","$300","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0.00%","$1,100","$1100 per person","$2200 per group","0.00%","$12,150","$12150 per person","$24300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 4050","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-06","Anthem Silver Pathway X PPO 4050 S06","94% AV Level Silver Plan","94.62%","0.947662651538849","Yes","Yes","Yes","70%","30%","$250","$200","$400","$0","$250","$600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%","$250","$250 per person","$500 per group","0.00%","$12,150","$12150 per person","$24300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENC","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-00","Anthem Silver Pathway PPO 2500","Standard Silver Off Exchange Plan","71.28%","0.720691025257111","Yes","Yes","Yes","70%","30%","$2,500","$600","$1,200","$0","$500","$2,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENR","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-01","Anthem Silver Pathway X PPO 2500","Standard Silver On Exchange Plan","71.28%","0.720691025257111","Yes","Yes","Yes","70%","30%","$2,500","$600","$1,200","$0","$500","$2,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENL","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-02","Anthem Silver Pathway X PPO 2500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ENM","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-03","Anthem Silver Pathway X PPO 2500","Limited Cost Sharing Plan Variation","71.28%","0.720691025257111","Yes","Yes","Yes","70%","30%","$2,500","$600","$1,200","$0","$500","$2,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENL","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-04","Anthem Silver Pathway X PPO 2500 S04","73% AV Level Silver Plan","73.47%","0.739891469478607","Yes","Yes","Yes","70%","30%","$2,350","$600","$1,300","$0","$500","$2,100","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","10.00%","$2,350","$2350 per person","$4700 per group","10.00%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENN","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-05","Anthem Silver Pathway X PPO 2500 S05","87% AV Level Silver Plan","87.66%","0.876894772052765","Yes","Yes","Yes","70%","30%","$750","$500","$600","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%","$750","$750 per person","$1500 per group","10.00%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENP","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-06","Anthem Silver Pathway X PPO 2500 S06","94% AV Level Silver Plan","94.67%","0.944883823394775","Yes","Yes","Yes","70%","30%","$200","$200","$300","$0","$200","$500","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","10.00%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENQ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740031","Anthem Bronze Pathway X PPO 5850","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740031-00","Anthem Bronze Pathway PPO 5850","Standard Bronze Off Exchange Plan","59.30%","0.59406316280365","Yes","Yes","Yes","70%","30%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","$17,550","$17550 per person","$35100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740031","Anthem Bronze Pathway X PPO 5850","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740031-01","Anthem Bronze Pathway X PPO 5850","Standard Bronze On Exchange Plan","59.30%","0.59406316280365","Yes","Yes","Yes","70%","30%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","$17,550","$17550 per person","$35100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740031","Anthem Bronze Pathway X PPO 5850","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740031-02","Anthem Bronze Pathway X PPO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EP0","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740031","Anthem Bronze Pathway X PPO 5850","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740031-03","Anthem Bronze Pathway X PPO 5850","Limited Cost Sharing Plan Variation","59.30%","0.59406316280365","Yes","Yes","Yes","70%","30%","$5,850","$0","$500","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","$17,550","$17550 per person","$35100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740019","Anthem Bronze Pathway X PPO 5150","29276OH074",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740019-00","Anthem Bronze Pathway PPO 5150","Standard Bronze Off Exchange Plan","61.93%","0.621841251850128","Yes","Yes","Yes","70%","30%","$5,150","$0","$500","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%","$5,150","$5150 per person","$10300 per group","25.00%","$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMR","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","Yes","31-1440175","29276OH0830004","Anthem Dental Family Enhanced","29276OH083",,"OHN004","OHS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.823","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0830004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215626.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","No","31-1440175","29276OH0750112","Anthem Silver Blue Access X PPO 2000 30 5000 Plus","29276OH075",,"OHN003","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/OHSelectdrugtier5","29276OH0750112-00","Anthem Silver Blue Access X PPO 2000 30 5000 Plus","Standard Silver Off Exchange Plan","70.93%","0.730297923088074","No","Yes","Yes","65%","35%","$2,000","$80","$1,500","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%","$2,000","$2000 per person","$4000 per group","30.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%","Not Applicable","per person not applicable","per group not applicable","30.00%","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GFK",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","SHOP (Small Group)","No","31-1440175","29276OH0750112","Anthem Silver Blue Access X PPO 2000 30 5000 Plus","29276OH075",,"OHN003","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9962",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Standard Bluecard PPO Network","Yes",,"https://www.anthem.com/OHSelectdrugtier5","29276OH0750112-01","Anthem Silver Blue Access X PPO 2000 30 5000 Plus","Standard Silver On Exchange Plan","70.93%","0.730297923088074","No","Yes","Yes","65%","35%","$2,000","$80","$1,500","$0","$700","$1,600","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%","$2,000","$2000 per person","$4000 per group","30.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%","Not Applicable","per person not applicable","per group not applicable","30.00%","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2GFK",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","Yes","31-1440175","29276OH0890004","Anthem Dental Family Enhanced","29276OH089",,"OHN004","OHS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.823","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0890004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215626.pdf",
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740019","Anthem Bronze Pathway X PPO 5150","29276OH074",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740019-01","Anthem Bronze Pathway X PPO 5150","Standard Bronze On Exchange Plan","61.93%","0.621841251850128","Yes","Yes","Yes","70%","30%","$5,150","$0","$500","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%","$5,150","$5150 per person","$10300 per group","25.00%","$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMP","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740019","Anthem Bronze Pathway X PPO 5150","29276OH074",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740019-02","Anthem Bronze Pathway X PPO 5150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EMQ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740019","Anthem Bronze Pathway X PPO 5150","29276OH074",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740019-03","Anthem Bronze Pathway X PPO 5150","Limited Cost Sharing Plan Variation","61.93%","0.621841251850128","Yes","Yes","Yes","70%","30%","$5,150","$0","$500","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%","$5,150","$5150 per person","$10300 per group","25.00%","$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMP","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740021","Anthem Bronze Pathway X PPO 6800","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740021-00","Anthem Bronze Pathway PPO 6800","Standard Bronze Off Exchange Plan","61.73%","0.620486319065094","Yes","Yes","Yes","70%","30%","$6,800","$100","$100","$0","$500","$3,000","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","25.00%","$6,800","$6800 per person","$13600 per group","25.00%","$20,400","$20400 per person","$40800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMV","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740021","Anthem Bronze Pathway X PPO 6800","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740021-01","Anthem Bronze Pathway X PPO 6800","Standard Bronze On Exchange Plan","61.73%","0.620486319065094","Yes","Yes","Yes","70%","30%","$6,800","$100","$100","$0","$500","$3,000","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","25.00%","$6,800","$6800 per person","$13600 per group","25.00%","$20,400","$20400 per person","$40800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740021","Anthem Bronze Pathway X PPO 6800","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740021-02","Anthem Bronze Pathway X PPO 6800 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EMU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740021","Anthem Bronze Pathway X PPO 6800","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740021-03","Anthem Bronze Pathway X PPO 6800","Limited Cost Sharing Plan Variation","61.73%","0.620486319065094","Yes","Yes","Yes","70%","30%","$6,800","$100","$100","$0","$500","$3,000","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","25.00%","$6,800","$6800 per person","$13600 per group","25.00%","$20,400","$20400 per person","$40800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EMT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000","29276OH074",,"OHN001","OHS001","OHF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-00","Anthem Silver Pathway PPO 2000","Standard Silver Off Exchange Plan","71.10%","0.717750072479248","Yes","Yes","Yes","70%","30%","$2,000","$900","$1,500","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENK","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000","29276OH074",,"OHN001","OHS001","OHF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-01","Anthem Silver Pathway X PPO 2000","Standard Silver On Exchange Plan","71.10%","0.717750072479248","Yes","Yes","Yes","70%","30%","$2,000","$900","$1,500","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENE","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000","29276OH074",,"OHN001","OHS001","OHF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-02","Anthem Silver Pathway X PPO 2000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ENF","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000","29276OH074",,"OHN001","OHS001","OHF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-03","Anthem Silver Pathway X PPO 2000","Limited Cost Sharing Plan Variation","71.10%","0.717750072479248","Yes","Yes","Yes","70%","30%","$2,000","$900","$1,500","$0","$500","$1,900","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENE","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000","29276OH074",,"OHN001","OHS001","OHF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-04","Anthem Silver Pathway X PPO 2000 S04","73% AV Level Silver Plan","73.18%","0.736507833003998","Yes","Yes","Yes","70%","30%","$1,950","$1,000","$1,500","$0","$500","$1,800","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","20.00%","$1,950","$1950 per person","$3900 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENG","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000","29276OH074",,"OHN001","OHS001","OHF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-05","Anthem Silver Pathway X PPO 2000 S05","87% AV Level Silver Plan","87.73%","0.874947726726532","Yes","Yes","Yes","70%","30%","$750","$400","$400","$0","$500","$1,100","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENH","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000","29276OH074",,"OHN001","OHS001","OHF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-06","Anthem Silver Pathway X PPO 2000 S06","94% AV Level Silver Plan","94.64%","0.943144679069519","Yes","Yes","Yes","70%","30%","$200","$100","$300","$0","$200","$400","$20","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ENJ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-00","Anthem Silver Pathway PPO 3500","Standard Silver Off Exchange Plan","68.58%","0.693661034107208","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ENW","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-01","Anthem Silver Pathway X PPO 3500","Standard Silver On Exchange Plan","68.58%","0.693661034107208","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ENS","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-02","Anthem Silver Pathway X PPO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ENX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-03","Anthem Silver Pathway X PPO 3500","Limited Cost Sharing Plan Variation","68.58%","0.693661034107208","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ENS","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-04","Anthem Silver Pathway X PPO 3500 S04","73% AV Level Silver Plan","72.57%","0.730681002140045","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ENT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-05","Anthem Silver Pathway X PPO 3500 S05","87% AV Level Silver Plan","87.84%","0.878156661987305","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ENU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500","29276OH074",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Covered using OON Cost Shares","No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-06","Anthem Silver Pathway X PPO 3500 S06","94% AV Level Silver Plan","94.30%","0.939591825008392","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2ENV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920001","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920001-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920001","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920001-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920001","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920001-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920001","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920001-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920002","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920002-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920002","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920002-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920002","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920002-02","Anthem Bronze Pathway X  HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920002","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920002-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920010","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920010-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920010","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920010-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920010","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920010-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920010","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920010-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920011","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920011-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920011","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920011-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920011","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920011-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920011","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920011-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%","$5,000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920012","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920012-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920012","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920012-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920012","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920012-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920012","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920012-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920013","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920013-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920013","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920013-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920013","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920013-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920013","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920013-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920003","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS005","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920003-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920003","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS005","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920003-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920003","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS005","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920003-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920003","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS005","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920003-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS005","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS005","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS005","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS005","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS005","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.89%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS005","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.26%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS005","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.30%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920014","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920014-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920014","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920014-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920014","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920014-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920014","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS011","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920014-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920015","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS013","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920015-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920015","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS013","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920015-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920015","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS013","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920015-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920015","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS013","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920015-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%","$7,150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS011","OHF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS011","OHF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS011","OHF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS011","OHF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS011","OHF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.89%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS011","OHF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.26%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS011","OHF025","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.30%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS013","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS013","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS013","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS013","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.69%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS013","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.89%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS013","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.26%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS013","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.30%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920026","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS005","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920026-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.08%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920026","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS005","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920026-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.08%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920026","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS005","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920026-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920026","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS005","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920026-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.08%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920026","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS005","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920026-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.06%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920026","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS005","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920026-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.03%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920026","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS005","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920026-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.719281136989594","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.839092314243317","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$650","$650 per person","$1300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.920423626899719","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920008","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920008-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920008","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920008-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920008","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920008-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920008","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS005","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920008-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS011","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS011","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS011","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS011","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS011","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.719281136989594","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS011","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.839092314243317","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$650","$650 per person","$1300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS011","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.920423626899719","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS013","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS013","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS013","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS013","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS013","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.719281136989594","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS013","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.839092314243317","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$650","$650 per person","$1300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS013","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.920423626899719","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920022","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS011","OHF035","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920022-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920022","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS011","OHF035","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920022-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920022","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS011","OHF035","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920022-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920022","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS011","OHF035","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920022-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920023","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920023-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920023","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920023-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920023","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920023-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920023","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS013","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920023-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$4350 per group","20.00%","$1,450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920027","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS005","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920027-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920027","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS005","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920027-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920027","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS005","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920027-02","Anthem Bronze Pathway X HMO AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920027","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS005","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920027-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920028","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS005","OHF039","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920028-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3200","$3200 per person","$6400 per group","10.00%","$3200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920028","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS005","OHF039","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920028-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3200","$3200 per person","$6400 per group","10.00%","$3200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920028","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS005","OHF039","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920028-02","Anthem Silver Pathway X HMO AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920028","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS005","OHF039","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920028-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3200","$3200 per person","$6400 per group","10.00%","$3200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920028","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS005","OHF039","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920028-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.725013911724091","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4500","$4500 per person","$9000 per group","$4500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2750","$2750 per person","$5500 per group","10.00%","$2750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920028","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS005","OHF039","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920028-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861397087574005","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1950","$1950 per person","$3900 per group","$1950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$2000 per group","10.00%","$1000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920028","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS005","OHF039","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920028-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931726396083832","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1000","$1000 per person","$2000 per group","$1000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920029","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS005","OHF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920029-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.693696856498718","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5700","$5700 per person","$11400 per group","$5700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3500","$3500 per person","$7000 per group","25.00%","$3500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1000","$1000 per person","$2000 per group","40.00%","$1000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920029","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS005","OHF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920029-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.693696856498718","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5700","$5700 per person","$11400 per group","$5700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3500","$3500 per person","$7000 per group","25.00%","$3500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1000","$1000 per person","$2000 per group","40.00%","$1000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920029","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS005","OHF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920029-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920029","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS005","OHF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920029-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.693696856498718","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5700","$5700 per person","$11400 per group","$5700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3500","$3500 per person","$7000 per group","25.00%","$3500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1000","$1000 per person","$2000 per group","40.00%","$1000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920029","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS005","OHF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920029-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.730722784996033","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","$5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2250","$2250 per person","$4500 per group","25.00%","$2250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1000","$1000 per person","$2000 per group","40.00%","$1000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920029","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS005","OHF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920029-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.878178417682648","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1500","$1500 per person","$3000 per group","$1500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920029","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS005","OHF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920029-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.939601540565491","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920032","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920032-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920032","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920032-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920032","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920032-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920032","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920032-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920033","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920033-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920033","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920033-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920033","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920033-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920033","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920033-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920034","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920034-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920034","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920034-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920034","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920034-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920034","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920034-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920035","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920035-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920035","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920035-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920035","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920035-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920035","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920035-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920036","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920036-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920036","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920036-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920036","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920036-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920036","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920036-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920047","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920047-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920047","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920047-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920047","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920047-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920047","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920047-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920048","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920048-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920048","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920048-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920048","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920048-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920048","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920048-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920049","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920049-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920049","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920049-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920049","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920049-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920049","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920049-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920050","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920050-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920050","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920050-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920050","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920050-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920050","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920050-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920051","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920051-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920051","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920051-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920051","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920051-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920051","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920051-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920062","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS003","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920062-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920062","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS003","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920062-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920062","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS003","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920062-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920062","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS003","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920062-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920063","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS004","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920063-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920063","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS004","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920063-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920063","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS004","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920063-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920063","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS004","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920063-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920064","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS006","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920064-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920064","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS006","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920064-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920064","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS006","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920064-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920064","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS006","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920064-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920065","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS007","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920065-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920065","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS007","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920065-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920065","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS007","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920065-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920065","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS007","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920065-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920066","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS008","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920066-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920066","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS008","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920066-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920066","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS008","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920066-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920066","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS008","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920066-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920137","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920137-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920137","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920137-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920137","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920137-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920137","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS003","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920137-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920138","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920138-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920138","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920138-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920138","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920138-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920138","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS004","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920138-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920139","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920139-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920139","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920139-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920139","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920139-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920139","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS006","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920139-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920140","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920140-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920140","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920140-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920140","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920140-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920140","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS007","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920140-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920141","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920141-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920141","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920141-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920141","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920141-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920141","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS008","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920141-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920299","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920299-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920299","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920299-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920299","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920299-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920299","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920299-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920300","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920300-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920300","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920300-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920300","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920300-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920300","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920300-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920301","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920301-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920301","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920301-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920301","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920301-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920301","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920301-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920302","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920302-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920302","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920302-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920302","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920302-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920302","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920302-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920303","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920303-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920303","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920303-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920303","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920303-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920303","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920303-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920304","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920304-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920304","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920304-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920304","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920304-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920304","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920304-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920305","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920305-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920305","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920305-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920305","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920305-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920305","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920305-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920306","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920306-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920306","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920306-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920306","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920306-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920306","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920306-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920307","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920307-00","Anthem Bronze Pathway HMO 5000","Standard Bronze Off Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920307","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920307-01","Anthem Bronze Pathway X HMO 5000","Standard Bronze On Exchange Plan","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920307","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920307-02","Anthem Bronze Pathway X HMO 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920307","Anthem Bronze Pathway X HMO 5000","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920307-03","Anthem Bronze Pathway X HMO 5000","Limited Cost Sharing Plan Variation","61.90%","0.61889660358429","Yes","Yes","Yes","65%","35%","$5,000","$200","$900","$0","$4,500","$300","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5000","$5000 per person","$10000 per group","40.00%","$5000","$5000 per person","$10000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920310","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920310-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920310","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920310-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920310","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920310-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920310","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920310-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920311","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920311-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920311","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920311-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920311","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920311-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920311","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920311-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920312","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920312-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920312","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920312-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920312","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920312-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920312","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920312-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920313","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920313-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920313","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920313-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920313","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920313-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920313","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920313-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920314","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920314-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920314","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920314-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920314","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920314-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920314","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920314-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920315","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920315-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920315","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920315-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920315","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920315-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920315","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920315-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920316","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920316-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920316","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920316-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920316","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920316-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920316","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920316-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920317","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920317-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920317","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920317-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920317","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920317-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920317","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920317-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920318","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920318-00","Anthem Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920318","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920318-01","Anthem Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920318","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920318-02","Anthem Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920318","Anthem Bronze Pathway X HMO 5200","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920318-03","Anthem Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","61.40%","0.631052911281586","Yes","Yes","Yes","65%","35%","$5,200","$0","$400","$0","$4,500","$200","$0","$200","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5200","$5200 per person","$10400 per group","20.00%","$5200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2G","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920321","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS009","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920321-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920321","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS009","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920321-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920321","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS009","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920321-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920321","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS009","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920321-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920322","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS010","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920322-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920322","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS010","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920322-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920322","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS010","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920322-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920322","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS010","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920322-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920323","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS012","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920323-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920323","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS012","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920323-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920323","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS012","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920323-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920323","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS012","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920323-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920324","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS014","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920324-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920324","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS014","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920324-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920324","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS014","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920324-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920324","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS014","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920324-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920325","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS015","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920325-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920325","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS015","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920325-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920325","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS015","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920325-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920325","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS015","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920325-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920326","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS016","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920326-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920326","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS016","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920326-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920326","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS016","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920326-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920326","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS016","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920326-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920327","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS017","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920327-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920327","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS017","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920327-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920327","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS017","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920327-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920327","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS017","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920327-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920328","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS018","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920328-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920328","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS018","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920328-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920328","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS018","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920328-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920328","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS018","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920328-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920329","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS019","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920329-00","Anthem Bronze Pathway HMO 7150","Standard Bronze Off Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920329","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS019","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920329-01","Anthem Bronze Pathway X HMO 7150","Standard Bronze On Exchange Plan","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920329","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS019","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920329-02","Anthem Bronze Pathway X HMO 7150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920329","Anthem Bronze Pathway X HMO 7150","29276OH092",,"OHN002","OHS019","OHF023","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920329-03","Anthem Bronze Pathway X HMO 7150","Limited Cost Sharing Plan Variation","59.43%","0.594339609146118","Yes","Yes","Yes","65%","35%","$7,150","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","$7150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7150","$7150 per person","$14300 per group","0.00%","$7150","$7150 per person","$14300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920354","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920354-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920354","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920354-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920354","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920354-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920354","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS009","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920354-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920355","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920355-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920355","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920355-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920355","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920355-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920355","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS010","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920355-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920356","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920356-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920356","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920356-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920356","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920356-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920356","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS012","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920356-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920357","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920357-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920357","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920357-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920357","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920357-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920357","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS014","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920357-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920358","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920358-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920358","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920358-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920358","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920358-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920358","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS015","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920358-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920359","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920359-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920359","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920359-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920359","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920359-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920359","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS016","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920359-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920360","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920360-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920360","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920360-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920360","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920360-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920360","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS017","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920360-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920361","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920361-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920361","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920361-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920361","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920361-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920361","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS018","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920361-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920362","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920362-00","Anthem Gold Pathway HMO 1450","Standard Gold Off Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X38","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920362","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920362-01","Anthem Gold Pathway X HMO 1450","Standard Gold On Exchange Plan","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920362","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920362-02","Anthem Gold Pathway X HMO 1450 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X37","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920362","Anthem Gold Pathway X HMO 1450","29276OH092",,"OHN002","OHS019","OHF024","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920362-03","Anthem Gold Pathway X HMO 1450","Limited Cost Sharing Plan Variation","78.07%","0.761972963809967","No","Yes","Yes","65%","35%","$1,450","$1,000","$1,700","$0","$1,000","$1,200","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4200","$4200 per person","$8400 per group","$4200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1450","$1450 per person","$4350 per group","20.00%","$1450","$1450 per person","$4350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920374","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS009","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920374-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920374","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS009","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920374-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920374","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS009","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920374-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920374","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS009","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920374-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920375","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS010","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920375-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920375","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS010","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920375-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920375","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS010","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920375-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920375","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS010","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920375-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920376","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS012","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920376-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920376","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS012","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920376-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920376","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS012","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920376-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920376","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS012","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920376-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","$6550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6550","$6550 per person","$13100 per group","0.00%","$6550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920377","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS014","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920377-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920377","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS014","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920377-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920377","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS014","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920377-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920377","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS014","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920377-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920378","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS015","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920378-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920378","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS015","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920378-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920378","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS015","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920378-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920378","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS015","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920378-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920379","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS016","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920379-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920379","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS016","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920379-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920379","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS016","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920379-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920379","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS016","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920379-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920380","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS017","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920380-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920380","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS017","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920380-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920380","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS017","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920380-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920380","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS017","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920380-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920381","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS018","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920381-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920381","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS018","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920381-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920381","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS018","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920381-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920381","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS018","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920381-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920382","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS019","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920382-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920382","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS019","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920382-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920382","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS019","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920382-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920382","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS019","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920382-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920383","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS009","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920383-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920383","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS009","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920383-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920383","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS009","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920383-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920383","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS009","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920383-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920383","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS009","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920383-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724864542484283","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920383","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS009","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920383-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861250996589661","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920383","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS009","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920383-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931571125984192","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920384","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS010","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920384-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920384","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS010","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920384-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920384","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS010","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920384-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920384","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS010","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920384-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920384","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS010","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920384-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724864542484283","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920384","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS010","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920384-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861250996589661","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920384","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS010","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920384-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931571125984192","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920385","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS012","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920385-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920385","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS012","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920385-01","Anthem Silver Pathway HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920385","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS012","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920385-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920385","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS012","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920385-03","Anthem Silver Pathway HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920385","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS012","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920385-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724864542484283","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920385","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS012","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920385-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861250996589661","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920385","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS012","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920385-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931571125984192","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920386","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS014","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920386-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920386","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS014","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920386-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920386","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS014","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920386-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920386","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS014","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920386-03","Anthem Silver Pathway HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700747430324554","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920386","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS014","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920386-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724864542484283","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920386","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS014","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920386-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861250996589661","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920386","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS014","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920386-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931571125984192","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920387","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS015","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920387-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920387","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS015","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920387-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920387","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS015","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920387-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920387","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS015","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920387-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920387","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS015","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920387-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724854350090027","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920387","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS015","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920387-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861244142055511","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920387","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS015","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920387-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931567430496216","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920388","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS016","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920388-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920388","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS016","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920388-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920388","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS016","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920388-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920388","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS016","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920388-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920388","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS016","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920388-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724854350090027","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920388","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS016","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920388-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861244142055511","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920388","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS016","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920388-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931567430496216","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920389","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS017","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920389-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920389","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS017","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920389-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920389","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS017","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920389-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920389","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS017","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920389-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920389","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS017","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920389-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724854350090027","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920389","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS017","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920389-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861244142055511","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920389","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS017","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920389-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931567430496216","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920390","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS018","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920390-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920390","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS018","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920390-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920390","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS018","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920390-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920390","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS018","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920390-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920390","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS018","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920390-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724854350090027","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920390","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS018","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920390-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861244142055511","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920390","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS018","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920390-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931567430496216","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920391","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS019","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920391-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920391","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS019","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920391-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920391","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS019","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920391-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920391","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS019","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920391-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.700738131999969","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920391","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS019","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920391-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.724854350090027","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920391","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS019","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920391-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.861244142055511","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920391","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS019","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920391-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.931567430496216","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920392","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS009","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920392-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.694929182529449","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","28.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920392","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS009","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920392-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.693661034107208","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920392","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS009","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920392-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920392","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS009","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920392-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.693661034107208","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920392","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS009","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920392-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.730681002140045","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920392","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS009","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920392-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.878156661987305","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920392","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS009","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920392-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.939591825008392","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920393","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS010","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920393-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.693661034107208","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920393","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS010","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920393-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.693661034107208","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920393","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS010","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920393-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920393","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS010","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920393-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.693661034107208","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920393","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS010","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920393-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.730681002140045","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920393","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS010","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920393-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.878156661987305","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920393","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS010","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920393-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.939591825008392","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920394","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS012","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920394-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920394","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS012","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920394-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920394","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS012","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920394-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920394","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS012","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920394-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920394","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS012","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920394-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743112862110138","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920394","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS012","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920394-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882566273212433","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920394","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS012","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920394-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941202759742737","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920395","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS014","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920395-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920395","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS014","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920395-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920395","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS014","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920395-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920395","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS014","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920395-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920395","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS014","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920395-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743112862110138","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920395","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS014","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920395-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882566273212433","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920395","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS014","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920395-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941202759742737","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920396","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS015","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920396-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920396","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS015","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920396-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920396","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS015","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920396-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920396","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS015","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920396-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920396","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS015","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920396-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743112862110138","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920396","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS015","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920396-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882566273212433","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920396","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS015","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920396-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941202759742737","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920397","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS016","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920397-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920397","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS016","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920397-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920397","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS016","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920397-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920397","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS016","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920397-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920397","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS016","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920397-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743112862110138","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920397","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS016","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920397-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882566273212433","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920397","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS016","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920397-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941202759742737","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920398","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS017","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920398-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920398","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS017","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920398-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920398","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS017","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920398-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920398","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS017","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920398-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920398","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS017","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920398-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743112862110138","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920398","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS017","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920398-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882566273212433","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920398","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS017","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920398-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941202759742737","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920399","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS018","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920399-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920399","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS018","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920399-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920399","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS018","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920399-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920399","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS018","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920399-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920399","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS018","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920399-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743112862110138","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920399","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS018","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920399-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882566273212433","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920399","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS018","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920399-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941202759742737","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920400","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS019","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920400-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920400","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS019","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920400-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920400","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS019","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920400-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920400","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS019","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920400-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705187618732452","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920400","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS019","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920400-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743112862110138","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920400","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS019","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920400-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882566273212433","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920400","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS019","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920400-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941202759742737","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920077","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS003","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920077-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920077","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS003","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920077-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920077","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS003","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920077-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920077","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS003","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920077-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920077","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS003","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920077-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.719281136989594","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920077","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS003","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920077-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.839754045009613","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920077","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS003","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920077-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.920423626899719","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920078","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS004","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920078-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920078","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS004","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920078-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920078","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS004","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920078-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920078","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS004","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920078-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920078","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS004","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920078-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.719281136989594","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920078","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS004","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920078-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.839754045009613","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920078","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS004","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920078-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.920423626899719","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920079","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS006","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920079-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920079","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS006","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920079-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920079","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS006","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920079-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920079","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS006","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920079-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920079","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS006","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920079-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.719281136989594","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920079","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS006","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920079-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.839754045009613","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920079","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS006","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920079-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.920423626899719","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920080","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS007","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920080-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920080","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS007","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920080-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920080","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS007","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920080-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920080","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS007","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920080-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920080","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS007","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920080-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.719281136989594","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920080","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS007","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920080-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.839754045009613","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920080","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS007","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920080-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.920423626899719","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920081","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS008","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920081-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920081","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS008","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920081-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920081","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS008","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920081-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920081","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS008","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920081-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.693789958953857","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920081","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS008","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920081-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.719281136989594","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920081","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS008","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920081-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.839754045009613","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920081","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS008","OHF041","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920081-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.920423626899719","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920107","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS003","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920107-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920107","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS003","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920107-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920107","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS003","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920107-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920107","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS003","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920107-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920107","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS003","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920107-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920107","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS003","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920107-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920107","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS003","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920107-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920108","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS004","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920108-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920108","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS004","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920108-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920108","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS004","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920108-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920108","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS004","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920108-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920108","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS004","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920108-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920108","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS004","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920108-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920108","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS004","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920108-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920109","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS006","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920109-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920109","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS006","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920109-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920109","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS006","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920109-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920109","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS006","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920109-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920109","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS006","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920109-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920109","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS006","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920109-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920109","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS006","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920109-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920110","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS007","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920110-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920110","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS007","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920110-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920110","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS007","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920110-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920110","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS007","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920110-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920110","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS007","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920110-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920110","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS007","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920110-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920110","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS007","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920110-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920111","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS008","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920111-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920111","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS008","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920111-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920111","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS008","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920111-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920111","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS008","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920111-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920111","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS008","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920111-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920111","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS008","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920111-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920111","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS008","OHF035","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920111-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920152","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS011","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920152-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920152","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS011","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920152-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920152","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS011","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920152-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920152","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS011","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920152-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920152","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS011","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920152-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920152","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS011","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920152-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920152","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS011","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920152-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920153","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS013","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920153-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920153","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS013","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920153-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920153","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS013","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920153-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920153","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS013","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920153-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920153","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS013","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920153-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920153","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS013","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920153-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920153","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS013","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920153-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920154","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS003","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920154-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920154","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS003","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920154-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920154","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS003","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920154-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920154","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS003","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920154-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920154","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS003","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920154-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920154","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS003","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920154-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920154","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS003","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920154-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920155","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS004","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920155-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920155","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS004","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920155-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920155","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS004","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920155-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920155","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS004","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920155-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920155","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS004","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920155-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920155","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS004","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920155-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920155","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS004","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920155-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920156","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS006","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920156-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920156","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS006","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920156-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920156","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS006","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920156-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920156","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS006","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920156-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920156","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS006","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920156-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920156","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS006","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920156-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920156","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS006","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920156-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920157","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS007","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920157-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920157","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS007","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920157-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920157","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS007","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920157-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920157","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS007","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920157-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920157","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS007","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920157-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920157","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS007","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920157-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920157","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS007","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920157-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920158","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS008","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920158-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920158","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS008","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920158-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920158","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS008","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920158-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920158","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS008","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920158-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920158","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS008","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920158-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920158","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS008","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920158-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920158","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS008","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920158-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920194","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS011","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920194-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920194","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS011","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920194-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920194","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS011","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920194-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920194","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS011","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920194-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920195","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS013","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920195-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920195","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS013","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920195-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920195","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS013","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920195-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920195","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS013","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920195-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920196","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS003","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920196-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920196","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS003","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920196-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920196","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS003","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920196-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920196","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS003","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920196-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920197","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS004","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920197-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920197","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS004","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920197-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920197","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS004","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920197-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920197","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS004","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920197-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920198","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS006","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920198-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920198","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS006","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920198-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920198","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS006","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920198-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920198","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS006","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920198-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920199","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS007","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920199-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920199","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS007","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920199-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920199","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS007","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920199-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920199","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS007","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920199-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920200","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS008","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920200-00","Anthem Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE0","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920200","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS008","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920200-01","Anthem Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920200","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS008","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920200-02","Anthem Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE1","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920200","Anthem Bronze Pathway X HMO 0 for HSA","29276OH092",,"OHN002","OHS008","OHF023","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920200-03","Anthem Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","61.23%","0.612314343452454","Yes","Yes","Yes","65%","35%","$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%","$6,550","$6550 per person","$13100 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EDZ","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920215","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS011","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920215-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.712362051010132","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920215","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS011","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920215-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.712362051010132","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920215","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS011","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920215-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920215","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS011","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920215-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.712362051010132","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920215","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS011","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920215-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.735285222530365","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920215","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS011","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920215-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.865705788135529","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920215","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS011","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920215-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.93338543176651","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920216","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS013","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920216-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920216","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS013","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920216-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920216","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS013","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920216-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920216","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS013","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920216-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920216","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS013","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920216-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.726640045642853","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920216","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS013","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920216-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.862442314624786","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920216","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS013","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920216-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.93221527338028","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920217","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS003","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920217-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920217","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS003","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920217-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920217","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS003","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920217-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920217","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS003","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920217-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920217","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS003","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920217-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.726640045642853","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920217","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS003","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920217-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.862442314624786","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920217","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS003","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920217-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.93221527338028","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920218","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS004","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920218-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920218","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS004","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920218-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920218","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS004","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920218-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920218","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS004","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920218-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920218","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS004","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920218-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.726640045642853","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920218","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS004","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920218-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.862442314624786","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920218","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS004","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920218-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.93221527338028","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920219","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS006","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920219-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920219","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS006","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920219-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920219","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS006","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920219-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920219","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS006","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920219-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920219","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS006","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920219-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.726640045642853","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920219","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS006","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920219-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.862442314624786","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920219","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS006","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920219-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.93221527338028","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920220","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS007","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920220-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920220","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS007","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920220-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920220","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS007","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920220-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920220","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS007","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920220-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920220","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS007","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920220-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.726640045642853","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920220","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS007","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920220-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.862442314624786","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920220","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS007","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920220-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.93221527338028","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920221","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS008","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920221-00","Anthem Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE7","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920221","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS008","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920221-01","Anthem Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920221","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS008","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920221-02","Anthem Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EE6","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920221","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS008","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920221-03","Anthem Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","69.71%","0.702590346336365","Yes","Yes","Yes","65%","35%","$3,200","$500","$1,000","$0","$3,200","$0","$200","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE2","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920221","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS008","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920221-04","Anthem Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.13%","0.726640045642853","Yes","Yes","Yes","65%","35%","$2,750","$500","$1,200","$0","$2,750","$0","$300","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10.00%","$2,750","$2750 per person","$5500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2EE3","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920221","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS008","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920221-05","Anthem Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.05%","0.862442314624786","Yes","Yes","Yes","65%","35%","$1,000","$500","$500","$0","$1,000","$0","$400","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%","$1,000","$1000 per person","$2000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE4","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920221","Anthem Silver Pathway X HMO 10 for HSA","29276OH092",,"OHN002","OHS008","OHF039","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920221-06","Anthem Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.17%","0.93221527338028","Yes","Yes","Yes","65%","35%","$400","$200","$500","$0","$350","$0","$500","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EE5","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920257","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS011","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920257-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920257","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS011","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920257-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920257","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS011","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920257-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920257","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS011","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920257-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920257","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS011","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920257-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743852019309998","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920257","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS011","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920257-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882831811904907","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920257","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS011","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920257-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941295206546783","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920258","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS013","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920258-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920258","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS013","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920258-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920258","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS013","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920258-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920258","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS013","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920258-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920258","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS013","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920258-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743852019309998","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920258","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS013","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920258-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882831811904907","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920258","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS013","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920258-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941295206546783","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920259","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS003","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920259-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920259","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS003","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920259-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920259","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS003","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920259-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920259","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS003","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920259-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920259","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS003","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920259-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743852019309998","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920259","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS003","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920259-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882831811904907","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920259","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS003","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920259-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941295206546783","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920260","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS004","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920260-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920260","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS004","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920260-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920260","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS004","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920260-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920260","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS004","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920260-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920260","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS004","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920260-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743852019309998","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920260","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS004","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920260-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882831811904907","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920260","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS004","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920260-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941295206546783","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920261","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS006","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920261-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920261","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS006","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920261-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920261","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS006","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920261-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920261","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS006","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920261-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920261","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS006","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920261-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743852019309998","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920261","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS006","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920261-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882831811904907","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920261","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS006","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920261-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941295206546783","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920262","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS007","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920262-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920262","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS007","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920262-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920262","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS007","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920262-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920262","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS007","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920262-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920262","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS007","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920262-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743852019309998","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920262","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS007","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920262-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882831811904907","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920262","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS007","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920262-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941295206546783","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920263","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS008","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920263-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEC","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920263","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS008","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920263-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920263","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS008","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920263-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EED","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920263","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS008","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920263-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","68.58%","0.705787181854248","No","Yes","Yes","65%","35%","$3,500","$600","$800","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE8","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920263","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS008","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920263-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","72.57%","0.743852019309998","No","Yes","Yes","65%","35%","$2,250","$600","$1,100","$0","$1,400","$1,100","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EE9","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920263","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS008","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920263-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","87.84%","0.882831811904907","No","Yes","Yes","65%","35%","$750","$400","$300","$0","$700","$1,400","$30","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEA","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920263","Anthem Silver Pathway X HMO 3500","29276OH092",,"OHN002","OHS008","OHF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920263-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","94.30%","0.941295206546783","No","Yes","Yes","65%","35%","$250","$40","$300","$0","$250","$1,400","$70","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2EEB","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920332","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920332-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920332","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920332-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920332","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920332-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920332","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920332-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920332","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920332-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920332","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920332-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920332","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920332-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920333","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920333-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920333","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920333-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920333","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920333-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920333","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920333-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920333","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920333-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920333","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920333-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920333","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920333-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920334","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920334-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920334","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920334-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920334","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920334-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920334","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920334-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920334","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920334-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920334","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920334-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920334","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920334-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920335","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920335-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920335","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920335-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920335","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920335-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920335","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920335-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920335","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920335-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920335","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920335-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920335","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920335-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920336","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920336-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920336","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920336-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920336","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920336-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920336","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920336-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920336","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920336-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920336","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920336-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920336","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920336-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920337","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920337-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920337","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920337-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920337","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920337-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920337","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920337-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920337","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920337-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920337","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920337-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920337","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920337-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920338","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920338-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920338","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920338-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920338","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920338-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920338","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920338-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920338","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920338-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920338","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920338-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920338","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920338-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920339","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920339-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920339","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920339-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920339","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920339-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920339","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920339-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920339","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920339-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920339","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920339-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920339","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920339-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920340","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920340-00","Anthem Silver Pathway HMO 4250","Standard Silver Off Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2T","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920340","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920340-01","Anthem Silver Pathway X HMO 4250","Standard Silver On Exchange Plan","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920340","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920340-02","Anthem Silver Pathway X HMO 4250 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2S","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920340","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920340-03","Anthem Silver Pathway X HMO 4250","Limited Cost Sharing Plan Variation","69.15%","0.698366463184357","No","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%","$4,250","$4250 per person","$8500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920340","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920340-04","Anthem Silver Pathway X HMO 4250 S04","73% AV Level Silver Plan","72.06%","0.723452985286713","No","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%","$3,000","$3000 per person","$6000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920340","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920340-05","Anthem Silver Pathway X HMO 4250 S05","87% AV Level Silver Plan","86.10%","0.840617299079895","No","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30.00%","$600","$600 per person","$1200 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%","$400","$400 per person","$800 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920340","Anthem Silver Pathway X HMO 4250","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920340-06","Anthem Silver Pathway X HMO 4250 S06","94% AV Level Silver Plan","93.16%","0.917719960212708","No","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","40.00%","$150","$150 per person","$300 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920343","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920343-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920343","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920343-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920343","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920343-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920343","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920343-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920343","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920343-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.732909679412842","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920343","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920343-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872386455535889","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920343","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS009","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920343-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943982899188995","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920344","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920344-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920344","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920344-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920344","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920344-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920344","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920344-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920344","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920344-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.732909679412842","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920344","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920344-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872386455535889","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920344","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS010","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920344-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943982899188995","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920345","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920345-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920345","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920345-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920345","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920345-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920345","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920345-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.700111627578735","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920345","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920345-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.732909679412842","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920345","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920345-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872386455535889","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920345","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS012","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920345-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943982899188995","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920346","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920346-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920346","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920346-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920346","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920346-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920346","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920346-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920346","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920346-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920346","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920346-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920346","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS014","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920346-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920347","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920347-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920347","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920347-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920347","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920347-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920347","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920347-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920347","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920347-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920347","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920347-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920347","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS015","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920347-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920348","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920348-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920348","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920348-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920348","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920348-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920348","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920348-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920348","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920348-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920348","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920348-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920348","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS016","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920348-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920349","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920349-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920349","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920349-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920349","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920349-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920349","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920349-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920349","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920349-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920349","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920349-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920349","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS017","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920349-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920350","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920350-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920350","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920350-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920350","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920350-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920350","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920350-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920350","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920350-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920350","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920350-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920350","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS018","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920350-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920351","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920351-00","Anthem Silver Pathway HMO 2850","Standard Silver Off Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920351","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920351-01","Anthem Silver Pathway X HMO 2850","Standard Silver On Exchange Plan","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920351","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920351-02","Anthem Silver Pathway X HMO 2850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920351","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920351-03","Anthem Silver Pathway X HMO 2850","Limited Cost Sharing Plan Variation","70.13%","0.706949412822723","Yes","Yes","Yes","65%","35%","$2,850","$600","$1,200","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15.00%","$2,850","$2850 per person","$5700 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920351","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920351-04","Anthem Silver Pathway X HMO 2850 S04","73% AV Level Silver Plan","73.51%","0.738936007022858","Yes","Yes","Yes","65%","35%","$2,650","$600","$1,300","$0","$500","$2,000","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","15.00%","$2,650","$2650 per person","$5300 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920351","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920351-05","Anthem Silver Pathway X HMO 2850 S05","87% AV Level Silver Plan","87.32%","0.872619688510895","Yes","Yes","Yes","65%","35%","$1,000","$400","$400","$0","$500","$1,300","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%","$1,000","$1000 per person","$2000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920351","Anthem Silver Pathway X HMO 2850","29276OH092",,"OHN002","OHS019","OHF032","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920351-06","Anthem Silver Pathway X HMO 2850 S06","94% AV Level Silver Plan","94.42%","0.943035900592804","Yes","Yes","Yes","65%","35%","$250","$200","$300","$0","$250","$500","$10","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%","$250","$250 per person","$500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920365","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS009","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920365-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920365","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS009","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920365-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920365","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS009","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920365-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920365","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS009","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920365-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920365","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS009","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920365-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920365","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS009","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920365-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920365","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS009","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920365-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920366","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS010","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920366-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920366","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS010","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920366-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920366","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS010","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920366-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920366","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS010","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920366-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920366","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS010","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920366-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920366","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS010","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920366-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920366","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS010","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920366-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920367","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS012","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920367-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920367","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS012","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920367-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920367","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS012","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920367-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920367","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS012","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920367-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920367","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS012","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920367-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920367","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS012","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920367-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920367","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS012","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920367-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920368","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS014","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920368-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920368","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS014","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920368-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920368","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS014","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920368-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920368","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS014","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920368-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920368","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS014","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920368-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920368","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS014","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920368-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920368","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS014","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920368-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920369","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS015","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920369-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920369","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS015","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920369-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920369","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS015","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920369-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920369","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS015","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920369-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920369","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS015","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920369-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920369","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS015","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920369-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920369","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS015","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920369-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920370","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS016","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920370-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920370","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS016","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920370-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920370","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS016","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920370-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920370","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS016","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920370-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920370","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS016","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920370-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920370","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS016","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920370-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860170304775238","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920370","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS016","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920370-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.929011702537537","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920371","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS017","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920371-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920371","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS017","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920371-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920371","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS017","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920371-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920371","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS017","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920371-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920371","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS017","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920371-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920371","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS017","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920371-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920371","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS017","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920371-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920372","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS018","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920372-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920372","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS018","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920372-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920372","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS018","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920372-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920372","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS018","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920372-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920372","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS018","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920372-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920372","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS018","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920372-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920372","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS018","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920372-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920373","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS019","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920373-00","Anthem Silver Core Pathway HMO 5300","Standard Silver Off Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDY","http://editiondigital.net/view/IU65/2017/OFF_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920373","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS019","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920373-01","Anthem Silver Core Pathway X HMO 5300","Standard Silver On Exchange Plan","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920373","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS019","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920373-02","Anthem Silver Core Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDX","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920373","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS019","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920373-03","Anthem Silver Core Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.04%","0.680799961090088","Yes","Yes","Yes","65%","35%","$5,300","$60","$500","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDT","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920373","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS019","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920373-04","Anthem Silver Core Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.02%","0.720459520816803","Yes","Yes","Yes","65%","35%","$3,750","$60","$1,200","$0","$500","$1,600","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDU","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920373","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS019","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920373-05","Anthem Silver Core Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.01%","0.860759079456329","Yes","Yes","Yes","65%","35%","$1,000","$40","$900","$0","$500","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDV","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","29276","SERFF","2016-11-23 10:27:03","Individual","No","31-1440175","29276OH0920373","Anthem Silver Core Pathway X HMO 5300","29276OH092",,"OHN002","OHS019","OHF025","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No",,"No","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920373-06","Anthem Silver Core Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.02%","0.930018603801727","Yes","Yes","Yes","65%","35%","$200","$40","$600","$0","$200","$600","$20","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDW","http://editiondigital.net/view/IU65/2017/ON_HIX_OH_KIT_2017"
"2017","OH","30042","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1119867","30042OH0010001","SDC-Kids Plan High","30042OH001",,"OHN001","OHS001",,"Existing","PPO","High","Design 1",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","No",,"","30042OH0010001-00","SDC-Kids Plan High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","30042","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1119867","30042OH0020001","SDC-Kids Plan Low","30042OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Design 2",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","No",,"","30042OH0020001-00","SDC-Kids Plan Low","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$150","per person not applicable","per group not applicable","$225","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","30042","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1119867","30042OH0030001","SDC-Preferred Kids Plan High","30042OH003",,"OHN001","OHS001",,"Existing","PPO","High","Design 1",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","No",,"","30042OH0030001-00","SDC-Preferred Kids Plan High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","30042","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1119867","30042OH0040001","SDC-Preferred Kids Plan Low","30042OH004",,"OHN001","OHS001",,"Existing","PPO","Low","Design 2",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","No",,"","30042OH0040001-00","SDC-Preferred Kids Plan Low","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$150","per person not applicable","per group not applicable","$225","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","34964","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","59-0397210","34964OH0040003","DentaQuest PPO Family High","34964OH004",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0040003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","34964OH0030001","DentaQuest PPO  Pediatric High","34964OH003",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","34964OH0030001","DentaQuest PPO  Pediatric High","34964OH003",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","59-0397210","34964OH0040003","DentaQuest PPO Family High","34964OH004",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0040003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","59-0397210","34964OH0040004","DentaQuest PPO Family Low","34964OH004",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0040004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","59-0397210","34964OH0040004","DentaQuest PPO Family Low","34964OH004",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0040004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","34964OH0030003","DentaQuest PPO Family High","34964OH003",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","34964OH0030003","DentaQuest PPO Family High","34964OH003",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","34964OH0030004","DentaQuest PPO Family Low","34964OH003",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34964","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","34964OH0030004","DentaQuest PPO Family Low","34964OH003",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2017","OH","34968","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","34968OH0150002","EHB Basic Dental Plan (Low)","34968OH015",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0150002-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","34968","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","34968OH0170002","Family Basic Dental Plan (Low)","34968OH017",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0170002-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","34968","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","34968OH0170001","Family Basic Dental Plan (Low)","34968OH017",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0170001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49115"
"2017","OH","34968","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","34968OH0180001","Family Enhanced Dental Plan (High)","34968OH018",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.86","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0180001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49117"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2017)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010024-05","Ambetter Balanced Care 12 (2017)","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$20","$900","$200","$700","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010024-05.pdf","https://api.centene.com/Brochures/2017/41047OH0010024-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2017)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010024-06","Ambetter Balanced Care 12 (2017)","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$300","$200","$250","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010024-06.pdf","https://api.centene.com/Brochures/2017/41047OH0010024-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-00","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020018-00.pdf","https://api.centene.com/Brochures/2017/41047OH0020018-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-01","Ambetter Balanced Care 1 (2017) + Vision","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020018-01.pdf","https://api.centene.com/Brochures/2017/41047OH0020018-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-02","Ambetter Balanced Care 1 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020018-02.pdf","https://api.centene.com/Brochures/2017/41047OH0020018-02.pdf"
"2017","OH","34968","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","34968OH0180002","Family Enhanced Dental Plan (High)","34968OH018",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.86","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0180002-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010004-00","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/41047OH0010004-00.pdf","https://api.centene.com/Brochures/2017/41047OH0010004-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010004-01","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/41047OH0010004-01.pdf","https://api.centene.com/Brochures/2017/41047OH0010004-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010004-02","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/41047OH0010004-02.pdf","https://api.centene.com/Brochures/2017/41047OH0010004-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010004-03","Ambetter Secure Care 1 (2017) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794931471347809","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$300","$80","$0","$0","$0","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/41047OH0010004-03.pdf","https://api.centene.com/Brochures/2017/41047OH0010004-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-00","Ambetter Balanced Care 1 (2017)","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010018-00.pdf","https://api.centene.com/Brochures/2017/41047OH0010018-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-01","Ambetter Balanced Care 1 (2017)","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010018-01.pdf","https://api.centene.com/Brochures/2017/41047OH0010018-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-02","Ambetter Balanced Care 1 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010018-02.pdf","https://api.centene.com/Brochures/2017/41047OH0010018-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-03","Ambetter Balanced Care 1 (2017)","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010018-03.pdf","https://api.centene.com/Brochures/2017/41047OH0010018-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-04","Ambetter Balanced Care 1 (2017)","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010018-04.pdf","https://api.centene.com/Brochures/2017/41047OH0010018-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-05","Ambetter Balanced Care 1 (2017)","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010018-05.pdf","https://api.centene.com/Brochures/2017/41047OH0010018-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-06","Ambetter Balanced Care 1 (2017)","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010018-06.pdf","https://api.centene.com/Brochures/2017/41047OH0010018-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2017)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-00","Ambetter Balanced Care 10 (2017)","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010021-00.pdf","https://api.centene.com/Brochures/2017/41047OH0010021-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2017)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-01","Ambetter Balanced Care 10 (2017)","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010021-01.pdf","https://api.centene.com/Brochures/2017/41047OH0010021-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2017)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-02","Ambetter Balanced Care 10 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010021-02.pdf","https://api.centene.com/Brochures/2017/41047OH0010021-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2017)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-03","Ambetter Balanced Care 10 (2017)","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010021-03.pdf","https://api.centene.com/Brochures/2017/41047OH0010021-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2017)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-04","Ambetter Balanced Care 10 (2017)","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010021-04.pdf","https://api.centene.com/Brochures/2017/41047OH0010021-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2017)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-05","Ambetter Balanced Care 10 (2017)","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010021-05.pdf","https://api.centene.com/Brochures/2017/41047OH0010021-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2017)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-06","Ambetter Balanced Care 10 (2017)","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010021-06.pdf","https://api.centene.com/Brochures/2017/41047OH0010021-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-00","Ambetter Balanced Care 2 (2017)","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010019-00.pdf","https://api.centene.com/Brochures/2017/41047OH0010019-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-01","Ambetter Balanced Care 2 (2017)","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010019-01.pdf","https://api.centene.com/Brochures/2017/41047OH0010019-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-02","Ambetter Balanced Care 2 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010019-02.pdf","https://api.centene.com/Brochures/2017/41047OH0010019-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-03","Ambetter Balanced Care 2 (2017)","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010019-03.pdf","https://api.centene.com/Brochures/2017/41047OH0010019-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-04","Ambetter Balanced Care 2 (2017)","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010019-04.pdf","https://api.centene.com/Brochures/2017/41047OH0010019-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-05","Ambetter Balanced Care 2 (2017)","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010019-05.pdf","https://api.centene.com/Brochures/2017/41047OH0010019-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2017)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-06","Ambetter Balanced Care 2 (2017)","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010019-06.pdf","https://api.centene.com/Brochures/2017/41047OH0010019-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2017)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010024-00","Ambetter Balanced Care 12 (2017)","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010024-00.pdf","https://api.centene.com/Brochures/2017/41047OH0010024-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2017)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010024-01","Ambetter Balanced Care 12 (2017)","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010024-01.pdf","https://api.centene.com/Brochures/2017/41047OH0010024-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2017)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010024-02","Ambetter Balanced Care 12 (2017)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010024-02.pdf","https://api.centene.com/Brochures/2017/41047OH0010024-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2017)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010024-03","Ambetter Balanced Care 12 (2017)","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$50","$300","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010024-03.pdf","https://api.centene.com/Brochures/2017/41047OH0010024-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2017)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010024-04","Ambetter Balanced Care 12 (2017)","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$50","$400","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0010024-04.pdf","https://api.centene.com/Brochures/2017/41047OH0010024-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-03","Ambetter Balanced Care 1 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020018-03.pdf","https://api.centene.com/Brochures/2017/41047OH0020018-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-04","Ambetter Balanced Care 1 (2017) + Vision","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020018-04.pdf","https://api.centene.com/Brochures/2017/41047OH0020018-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-05","Ambetter Balanced Care 1 (2017) + Vision","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020018-05.pdf","https://api.centene.com/Brochures/2017/41047OH0020018-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9849",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-06","Ambetter Balanced Care 1 (2017) + Vision","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020018-06.pdf","https://api.centene.com/Brochures/2017/41047OH0020018-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-00","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020019-00.pdf","https://api.centene.com/Brochures/2017/41047OH0020019-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-01","Ambetter Balanced Care 2 (2017) + Vision","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020019-01.pdf","https://api.centene.com/Brochures/2017/41047OH0020019-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-02","Ambetter Balanced Care 2 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020019-02.pdf","https://api.centene.com/Brochures/2017/41047OH0020019-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-03","Ambetter Balanced Care 2 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020019-03.pdf","https://api.centene.com/Brochures/2017/41047OH0020019-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-04","Ambetter Balanced Care 2 (2017) + Vision","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020019-04.pdf","https://api.centene.com/Brochures/2017/41047OH0020019-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-05","Ambetter Balanced Care 2 (2017) + Vision","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020019-05.pdf","https://api.centene.com/Brochures/2017/41047OH0020019-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-06","Ambetter Balanced Care 2 (2017) + Vision","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020019-06.pdf","https://api.centene.com/Brochures/2017/41047OH0020019-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-00","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020020-00.pdf","https://api.centene.com/Brochures/2017/41047OH0020020-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-01","Ambetter Balanced Care 10 (2017) + Vision","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020020-01.pdf","https://api.centene.com/Brochures/2017/41047OH0020020-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-02","Ambetter Balanced Care 10 (2017) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020020-02.pdf","https://api.centene.com/Brochures/2017/41047OH0020020-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-03","Ambetter Balanced Care 10 (2017) + Vision","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020020-03.pdf","https://api.centene.com/Brochures/2017/41047OH0020020-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-04","Ambetter Balanced Care 10 (2017) + Vision","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020020-04.pdf","https://api.centene.com/Brochures/2017/41047OH0020020-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-05","Ambetter Balanced Care 10 (2017) + Vision","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020020-05.pdf","https://api.centene.com/Brochures/2017/41047OH0020020-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2017) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-06","Ambetter Balanced Care 10 (2017) + Vision","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0020020-06.pdf","https://api.centene.com/Brochures/2017/41047OH0020020-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9436",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030018-00","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030018-00.pdf","https://api.centene.com/Brochures/2017/41047OH0030018-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9436",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030018-01","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030018-01.pdf","https://api.centene.com/Brochures/2017/41047OH0030018-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9436",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030018-02","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030018-02.pdf","https://api.centene.com/Brochures/2017/41047OH0030018-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9436",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030018-03","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.694443106651306","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030018-03.pdf","https://api.centene.com/Brochures/2017/41047OH0030018-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9436",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030018-04","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739764750003815","Yes","Yes","No","100%",,"$3,500","$30","$300","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030018-04.pdf","https://api.centene.com/Brochures/2017/41047OH0030018-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9436",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030018-05","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879916667938232","Yes","Yes","No","100%",,"$450","$10","$900","$200","$450","$200","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030018-05.pdf","https://api.centene.com/Brochures/2017/41047OH0030018-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9436",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030018-06","Ambetter Balanced Care 1 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948486089706421","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030018-06.pdf","https://api.centene.com/Brochures/2017/41047OH0030018-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9438",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030019-00","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030019-00.pdf","https://api.centene.com/Brochures/2017/41047OH0030019-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9438",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030019-01","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030019-01.pdf","https://api.centene.com/Brochures/2017/41047OH0030019-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9438",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030019-02","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030019-02.pdf","https://api.centene.com/Brochures/2017/41047OH0030019-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9438",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030019-03","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.693365633487701","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030019-03.pdf","https://api.centene.com/Brochures/2017/41047OH0030019-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9438",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030019-04","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.736009478569031","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030019-04.pdf","https://api.centene.com/Brochures/2017/41047OH0030019-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9438",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030019-05","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879646778106689","Yes","Yes","No","100%",,"$1,750","$0","$0","$200","$1,700","$20","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030019-05.pdf","https://api.centene.com/Brochures/2017/41047OH0030019-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9438",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030019-06","Ambetter Balanced Care 2 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949882209300995","Yes","Yes","No","100%",,"$575","$0","$0","$200","$575","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030019-06.pdf","https://api.centene.com/Brochures/2017/41047OH0030019-06.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9388",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030020-00","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030020-00.pdf","https://api.centene.com/Brochures/2017/41047OH0030020-00.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9388",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030020-01","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030020-01.pdf","https://api.centene.com/Brochures/2017/41047OH0030020-01.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9388",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030020-02","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030020-02.pdf","https://api.centene.com/Brochures/2017/41047OH0030020-02.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9388",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030020-03","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.707363426685333","Yes","Yes","No","100%",,"$4,500","$40","$100","$200","$2,400","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030020-03.pdf","https://api.centene.com/Brochures/2017/41047OH0030020-03.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9388",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030020-04","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73779308795929","Yes","Yes","No","100%",,"$4,000","$20","$200","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030020-04.pdf","https://api.centene.com/Brochures/2017/41047OH0030020-04.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9388",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030020-05","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87982302904129","Yes","Yes","No","100%",,"$1,000","$0","$750","$200","$1,000","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030020-05.pdf","https://api.centene.com/Brochures/2017/41047OH0030020-05.pdf"
"2017","OH","41047","SERFF","2016-08-21 07:17:17","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9388",,,"2017-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0030020-06","Ambetter Balanced Care 10 (2017) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949103534221649","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$50","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2017/41047OH0030020-06.pdf","https://api.centene.com/Brochures/2017/41047OH0030020-06.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","Individual","Yes","95-6042390","47509OH0020003","BESTOne Advantage Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/2017/OH_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010007","BESTDental Premium","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2017/OH_BESTDental_Premium_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010007","BESTDental Premium","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2017/OH_BESTDental_Premium_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","Individual","Yes","95-6042390","47509OH0020003","BESTOne Advantage Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/2017/OH_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010008","BESTDental Standard - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2017/OH_BESTDental_Standard-H_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","Individual","Yes","95-6042390","47509OH0020004","BESTOne Plus Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/2017/OH_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","Individual","Yes","95-6042390","47509OH0020004","BESTOne Plus Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/2017/OH_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010008","BESTDental Standard - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2017/OH_BESTDental_Standard-H_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010010","BESTDental Choice - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2017/OH_BESTDental_Choice-H_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010010","BESTDental Choice - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2017/OH_BESTDental_Choice-H_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","Individual","Yes","95-6042390","47509OH0020005","BESTOne Plus Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/2017/OH_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010009","BESTDental Standard - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/2017/OH_BESTDental_Standard-L_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010009","BESTDental Standard - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/2017/OH_BESTDental_Standard-L_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","Individual","Yes","95-6042390","47509OH0020005","BESTOne Plus Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/2017/OH_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","Individual","Yes","95-6042390","47509OH0020006","BESTOne Basic Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/2017/OH_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010011","BESTDental Choice - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/2017/OH_BESTDental_Choice-L_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010011","BESTDental Choice - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/2017/OH_BESTDental_Choice-L_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","Individual","Yes","95-6042390","47509OH0020006","BESTOne Basic Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/2017/OH_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010012","BESTDental Value","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/2017/OH_BESTDental_Value_Plan.pdf"
"2017","OH","47509","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","95-6042390","47509OH0010012","BESTDental Value","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/2017/OH_BESTDental_Value_Plan.pdf"
"2017","OH","48333","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","48333OH0040002","EHB High PPO","48333OH004",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","48333OH0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","48333","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","48333OH0040001","EHB Low PPO","48333OH004",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","48333OH0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490614","SummaCare Bronze 6000-17","52664OH149","7730182830","OHN002","OHS003","OHF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490614-00","SummaCare Bronze 6000-17","Standard Bronze Off Exchange Plan",,"0.59959352016449","No","Yes","No","100%",,"$6,000","$120","$2,480","$60","$1,489","$1,280","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490614","SummaCare Bronze 6000-17","52664OH149","7730182830","OHN002","OHS003","OHF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490614-01","SummaCare Bronze 6000-17","Standard Bronze On Exchange Plan",,"0.59959352016449","No","Yes","No","100%",,"$6,000","$120","$2,480","$60","$1,489","$1,280","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490615","SummaCare Bronze 6000-17","52664OH149","7730182830","OHN002","OHS004","OHF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490615-00","SummaCare Bronze 6000-17","Standard Bronze Off Exchange Plan",,"0.59959352016449","No","Yes","No","100%",,"$6,000","$120","$2,480","$60","$1,489","$1,280","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490615","SummaCare Bronze 6000-17","52664OH149","7730182830","OHN002","OHS004","OHF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490615-01","SummaCare Bronze 6000-17","Standard Bronze On Exchange Plan",,"0.59959352016449","No","Yes","No","100%",,"$6,000","$120","$2,480","$60","$1,489","$1,280","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490616","SummaCare Bronze 6000-17","52664OH149","7730182830","OHN001","OHS002","OHF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490616-00","SummaCare Bronze 6000-17","Standard Bronze Off Exchange Plan",,"0.59959352016449","No","Yes","No","100%",,"$6,000","$120","$2,480","$60","$1,489","$1,280","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6000-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6000-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490616","SummaCare Bronze 6000-17","52664OH149","7730182830","OHN001","OHS002","OHF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490616-01","SummaCare Bronze 6000-17","Standard Bronze On Exchange Plan",,"0.59959352016449","No","Yes","No","100%",,"$6,000","$120","$2,480","$60","$1,489","$1,280","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$28,600","$28600 per person","$57200 per group","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6000-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6000-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510038-03","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.689517617225647","No","Yes","No","100%",,"$5,000","$40","$3,720","$60","$1,303","$985","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50.00%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver5000-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver5000-LimitedSCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510038-04","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","73% AV Level Silver Plan",,"0.731975376605988","No","Yes","No","100%",,"$3,000","$40","$3,720","$60","$1,303","$985","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$30,000","$30000 per person","$60000 per group","$35,700","$35700 per person","$71400 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","$13,000","$13000 per person","$26000 per group","$500","$500 per person","per group not applicable","50.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver5000-73SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver5000-73SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510038-05","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","87% AV Level Silver Plan",,"0.86961430311203","No","Yes","No","100%",,"$750","$30","$2,480","$60","$750","$625","$372","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$20,000","$20000 per person","$40000 per group","$22,250","$22250 per person","$44500 per group","$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","$200","$200 per person","per group not applicable","50.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver5000-87SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver5000-87SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510038-06","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","94% AV Level Silver Plan",,"0.939340591430664","No","Yes","No","100%",,"$100","$30","$1,240","$60","$100","$625","$186","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,500","$11500 per person","$23000 per group","$100","$100 per person","$200 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","$100","$100 per person","per group not applicable","50.00%",,,,,"$300","$300 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver5000-94SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver5000-94SCConnectNetwork.sflb"
"2017","OH","48333","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","48333OH0030002","EHB High Passive","48333OH003",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","48333OH0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","48333","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","48333OH0030001","EHB Low Passive","48333OH003",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","48333OH0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500155","SummaCare Bronze 5500 HSA-17","52664OH150","7730182830","OHN002","OHS003","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500155-00","SummaCare Bronze 5500 HSA-17","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$2,527","$60","$5,500","$0","$1,437","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510032-00","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","Standard Silver Off Exchange Plan",,"0.717269599437714","Yes","Yes","No","100%",,"$3,000","$40","$3,720","$60","$1,303","$995","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver3000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver3000SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510032-01","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","Standard Silver On Exchange Plan",,"0.717269599437714","Yes","Yes","No","100%",,"$3,000","$40","$3,720","$60","$1,303","$995","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver3000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver3000SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500155","SummaCare Bronze 5500 HSA-17","52664OH150","7730182830","OHN002","OHS003","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500155-01","SummaCare Bronze 5500 HSA-17","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$2,527","$60","$5,500","$0","$1,437","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500156","SummaCare Bronze 5500 HSA-17","52664OH150","7730182830","OHN002","OHS004","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500156-00","SummaCare Bronze 5500 HSA-17","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$2,527","$60","$5,500","$0","$1,437","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510032-02","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver3000-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver3000-100SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510032-03","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.717269599437714","Yes","Yes","No","100%",,"$3,000","$40","$3,720","$60","$1,303","$995","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver3000-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver3000-LimitedSCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500156","SummaCare Bronze 5500 HSA-17","52664OH150","7730182830","OHN002","OHS004","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500156-01","SummaCare Bronze 5500 HSA-17","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$2,527","$60","$5,500","$0","$1,437","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500157","SummaCare Bronze 5500 HSA-17","52664OH150","7730182830","OHN001","OHS002","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500157-00","SummaCare Bronze 5500 HSA-17","Standard Bronze Off Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$2,527","$60","$5,500","$0","$1,437","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510032-04","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","73% AV Level Silver Plan",,"0.739407420158386","Yes","Yes","No","100%",,"$3,000","$40","$3,720","$60","$1,303","$995","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$30,000","$30000 per person","$60000 per group","$35,700","$35700 per person","$71400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","$13,000","$13000 per person","$26000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver3000-73SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver3000-73SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510032-05","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","87% AV Level Silver Plan",,"0.869203746318817","Yes","Yes","No","100%",,"$750","$40","$3,720","$60","$750","$995","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4600 per group",,,,"$20,000","$20000 per person","$40000 per group","$22,350","$22350 per person","$44600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver3000-87SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver3000-87SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500157","SummaCare Bronze 5500 HSA-17","52664OH150","7730182830","OHN001","OHS002","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500157-01","SummaCare Bronze 5500 HSA-17","Standard Bronze On Exchange Plan",,"0.618774354457855","Yes","Yes","No","100%",,"$5,500","$0","$2,527","$60","$5,500","$0","$1,437","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500158","SummaCare Silver 3500 HSA-17","52664OH150","7730182830","OHN002","OHS003","OHF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500158-00","SummaCare Silver 3500 HSA-17","Standard Silver Off Exchange Plan",,"0.696265876293182","Yes","Yes","No","100%",,"$3,500","$100","$0","$60","$3,500","$1,150","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$21000 per group","$13,500","$13500 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510032-06","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","94% AV Level Silver Plan",,"0.936107814311981","Yes","Yes","No","100%",,"$100","$30","$1,240","$60","$100","$625","$186","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,150","$11150 per person","$22300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver3000-94SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver3000-94SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500158","SummaCare Silver 3500 HSA-17","52664OH150","7730182830","OHN002","OHS003","OHF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500158-01","SummaCare Silver 3500 HSA-17","Standard Silver On Exchange Plan",,"0.696265876293182","Yes","Yes","No","100%",,"$3,500","$100","$0","$60","$3,500","$1,150","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$21000 per group","$13,500","$13500 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500159","SummaCare Silver 3500 HSA-17","52664OH150","7730182830","OHN002","OHS004","OHF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500159-00","SummaCare Silver 3500 HSA-17","Standard Silver Off Exchange Plan",,"0.696265876293182","Yes","Yes","No","100%",,"$3,500","$100","$0","$60","$3,500","$1,150","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$21000 per group","$13,500","$13500 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500159","SummaCare Silver 3500 HSA-17","52664OH150","7730182830","OHN002","OHS004","OHF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500159-01","SummaCare Silver 3500 HSA-17","Standard Silver On Exchange Plan",,"0.696265876293182","Yes","Yes","No","100%",,"$3,500","$100","$0","$60","$3,500","$1,150","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$21000 per group","$13,500","$13500 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500160","SummaCare Silver 3500 HSA-17","52664OH150","7730182830","OHN001","OHS002","OHF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500160-00","SummaCare Silver 3500 HSA-17","Standard Silver Off Exchange Plan",,"0.696265876293182","Yes","Yes","No","100%",,"$3,500","$100","$0","$60","$3,500","$1,150","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$21000 per group","$13,500","$13500 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1500160","SummaCare Silver 3500 HSA-17","52664OH150","7730182830","OHN001","OHS002","OHF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1500160-01","SummaCare Silver 3500 HSA-17","Standard Silver On Exchange Plan",,"0.696265876293182","Yes","Yes","No","100%",,"$3,500","$100","$0","$60","$3,500","$1,150","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$10,000","$10000 per person","$21000 per group","$13,500","$13500 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510038-00","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","Standard Silver Off Exchange Plan",,"0.689517617225647","No","Yes","No","100%",,"$5,000","$40","$3,720","$60","$1,303","$985","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50.00%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver5000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver5000SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510038-01","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","Standard Silver On Exchange Plan",,"0.689517617225647","No","Yes","No","100%",,"$5,000","$40","$3,720","$60","$1,303","$985","$558","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50.00%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver5000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver5000SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510038-02","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilver5000-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilver5000-100SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510050-00","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.793179750442505","Yes","Yes","No","100%",,"$750","$40","$2,480","$60","$750","$985","$372","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$30,000","$30000 per person","$60000 per group","$37,150","$37150 per person","$74300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareGold750SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareGold750SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510050-01","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.793179750442505","Yes","Yes","No","100%",,"$750","$40","$2,480","$60","$750","$985","$372","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$30,000","$30000 per person","$60000 per group","$37,150","$37150 per person","$74300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareGold750SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareGold750SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510050-02","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareGold750-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareGold750-100SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510050-03","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.793179750442505","Yes","Yes","No","100%",,"$750","$40","$2,480","$60","$750","$985","$372","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$30,000","$30000 per person","$60000 per group","$37,150","$37150 per person","$74300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareGold750-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareGold750-LimitedSCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490617","SummaCare Silver 5000-17 80","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490617-00","SummaCare Silver 5000-17 80","Standard Silver Off Exchange Plan",,"0.695670783519745","No","Yes","No","100%",,"$5,000","$120","$2,480","$60","$1,489","$1,260","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","$26,400","$26400 per person","$52800 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-1780SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-1780SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490617","SummaCare Silver 5000-17 80","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490617-01","SummaCare Silver 5000-17 80","Standard Silver On Exchange Plan",,"0.695670783519745","No","Yes","No","100%",,"$5,000","$120","$2,480","$60","$1,489","$1,260","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","$26,400","$26400 per person","$52800 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-1780SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-1780SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490618","SummaCare Silver 5000-17 80","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490618-00","SummaCare Silver 5000-17 80","Standard Silver Off Exchange Plan",,"0.695670783519745","No","Yes","No","100%",,"$5,000","$120","$2,480","$60","$1,489","$1,260","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","$26,400","$26400 per person","$52800 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-1780SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-1780SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490618","SummaCare Silver 5000-17 80","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490618-01","SummaCare Silver 5000-17 80","Standard Silver On Exchange Plan",,"0.695670783519745","No","Yes","No","100%",,"$5,000","$120","$2,480","$60","$1,489","$1,260","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","$26,400","$26400 per person","$52800 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-1780SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-1780SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490619","SummaCare Silver 5000-17 80","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490619-00","SummaCare Silver 5000-17 80","Standard Silver Off Exchange Plan",,"0.695670783519745","No","Yes","No","100%",,"$5,000","$120","$2,480","$60","$1,489","$1,260","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","$26,400","$26400 per person","$52800 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-1780SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-1780SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490619","SummaCare Silver 5000-17 80","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490619-01","SummaCare Silver 5000-17 80","Standard Silver On Exchange Plan",,"0.695670783519745","No","Yes","No","100%",,"$5,000","$120","$2,480","$60","$1,489","$1,260","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","$26,400","$26400 per person","$52800 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-1780SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-1780SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490620","SummaCare Gold 2000-17","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490620-00","SummaCare Gold 2000-17","Standard Gold Off Exchange Plan",,"0.80820769071579","No","Yes","No","100%",,"$2,000","$110","$2,480","$60","$1,489","$1,210","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490620","SummaCare Gold 2000-17","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490620-01","SummaCare Gold 2000-17","Standard Gold On Exchange Plan",,"0.80820769071579","No","Yes","No","100%",,"$2,000","$110","$2,480","$60","$1,489","$1,210","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490621","SummaCare Gold 2000-17","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490621-00","SummaCare Gold 2000-17","Standard Gold Off Exchange Plan",,"0.80820769071579","No","Yes","No","100%",,"$2,000","$110","$2,480","$60","$1,489","$1,210","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490621","SummaCare Gold 2000-17","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490621-01","SummaCare Gold 2000-17","Standard Gold On Exchange Plan",,"0.80820769071579","No","Yes","No","100%",,"$2,000","$110","$2,480","$60","$1,489","$1,210","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490622","SummaCare Gold 2000-17","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490622-00","SummaCare Gold 2000-17","Standard Gold Off Exchange Plan",,"0.80820769071579","No","Yes","No","100%",,"$2,000","$110","$2,480","$60","$1,489","$1,210","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1520029","SummaCare Value with SCConnect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN001","OHS002","OHF005","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1520029-00","SummaCare Value with SCConnect Network and 3 Free PCP Visits","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$7,150","$0","$0","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,150","$27150 per person","$54300 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareValueSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareValueSCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1520029","SummaCare Value with SCConnect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN001","OHS002","OHF005","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1520029-01","SummaCare Value with SCConnect Network and 3 Free PCP Visits","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$7,150","$0","$0","$55","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,150","$27150 per person","$54300 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareValueSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareValueSCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490622","SummaCare Gold 2000-17","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490622-01","SummaCare Gold 2000-17","Standard Gold On Exchange Plan",,"0.80820769071579","No","Yes","No","100%",,"$2,000","$110","$2,480","$60","$1,489","$1,210","$372","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","per group not applicable","20.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490623","SummaCare Gold 3000-17","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490623-00","SummaCare Gold 3000-17","Standard Gold Off Exchange Plan",,"0.807040095329285","No","Yes","No","100%",,"$3,000","$120","$0","$60","$1,862","$1,260","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","per group not applicable","0.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold3000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold3000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490623","SummaCare Gold 3000-17","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490623-01","SummaCare Gold 3000-17","Standard Gold On Exchange Plan",,"0.807040095329285","No","Yes","No","100%",,"$3,000","$120","$0","$60","$1,862","$1,260","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","per group not applicable","0.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold3000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold3000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490624","SummaCare Gold 3000-17","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490624-00","SummaCare Gold 3000-17","Standard Gold Off Exchange Plan",,"0.807040095329285","No","Yes","No","100%",,"$3,000","$120","$0","$60","$1,862","$1,260","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","per group not applicable","0.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold3000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold3000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490624","SummaCare Gold 3000-17","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490624-01","SummaCare Gold 3000-17","Standard Gold On Exchange Plan",,"0.807040095329285","No","Yes","No","100%",,"$3,000","$120","$0","$60","$1,862","$1,260","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","per group not applicable","0.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold3000-17SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold3000-17SCSelectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490625","SummaCare Gold 3000-17","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490625-00","SummaCare Gold 3000-17","Standard Gold Off Exchange Plan",,"0.807040095329285","No","Yes","No","100%",,"$3,000","$120","$0","$60","$1,862","$1,260","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","per group not applicable","0.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold3000-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold3000-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","SHOP (Small Group)","No","34-1809108","52664OH1490625","SummaCare Gold 3000-17","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1490625-01","SummaCare Gold 3000-17","Standard Gold On Exchange Plan",,"0.807040095329285","No","Yes","No","100%",,"$3,000","$120","$0","$60","$1,862","$1,260","$0","$55","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","per group not applicable","0.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold3000-17SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold3000-17SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510054","SummaCare Silver 3500 Standard with SCConnect Network","52664OH151","7730182830","OHN001","OHS002","OHF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510054-00","SummaCare Silver 3500 Standard with SCConnect Network","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$2,480","$60","$1,489","$1,330","$372","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilverStandard3500SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilverStandard3500SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510054","SummaCare Silver 3500 Standard with SCConnect Network","52664OH151","7730182830","OHN001","OHS002","OHF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510054-01","SummaCare Silver 3500 Standard with SCConnect Network","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$2,480","$60","$1,489","$1,330","$372","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilverStandard3500SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilverStandard3500SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510054","SummaCare Silver 3500 Standard with SCConnect Network","52664OH151","7730182830","OHN001","OHS002","OHF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510054-02","SummaCare Silver 3500 Standard with SCConnect Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilverStandard3500-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilverStandard3500-100SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510054","SummaCare Silver 3500 Standard with SCConnect Network","52664OH151","7730182830","OHN001","OHS002","OHF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510054-03","SummaCare Silver 3500 Standard with SCConnect Network","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$100","$2,480","$60","$1,489","$1,330","$372","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","$47,150","$47150 per person","$94300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilverStandard3500-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilverStandard3500-LimitedSCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510054","SummaCare Silver 3500 Standard with SCConnect Network","52664OH151","7730182830","OHN001","OHS002","OHF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510054-04","SummaCare Silver 3500 Standard with SCConnect Network","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$80","$2,480","$60","$1,489","$1,175","$372","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$30,000","$30000 per person","$60000 per group","$35,700","$35700 per person","$71400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$13,000","$13000 per person","$26000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilverStandard3500-73SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilverStandard3500-73SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510054","SummaCare Silver 3500 Standard with SCConnect Network","52664OH151","7730182830","OHN001","OHS002","OHF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510054-05","SummaCare Silver 3500 Standard with SCConnect Network","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$40","$2,480","$60","$700","$610","$372","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$20,000","$20000 per person","$40000 per group","$22,000","$22000 per person","$44000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,700","$5700 per person","$11400 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilverStandard3500-87SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilverStandard3500-87SCConnectNetwork.sflb"
"2017","OH","52664","SERFF","2016-10-19 03:51:02","Individual","No","34-1809108","52664OH1510054","SummaCare Silver 3500 Standard with SCConnect Network","52664OH151","7730182830","OHN001","OHS002","OHF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9963",,,"2017-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2017Formulary.sflb","52664OH1510054-06","SummaCare Silver 3500 Standard with SCConnect Network","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$22","$620","$60","$250","$228","$93","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,250","$11250 per person","$22500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,250","$5250 per person","$10500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2017SummaCareSilverStandard3500-94SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2017SummaCareSilverStandard3500-94SCConnectNetwork.sflb"
"2017","OH","55371","SERFF","2017-03-15 20:15:30","SHOP (Small Group)","Yes","75-1233841","55371OH0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","55371OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0020007-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0020007-17"
"2017","OH","55371","SERFF","2017-03-15 20:15:30","Individual","Yes","75-1233841","55371OH0010007","Dentegra Dental PPO Pediatric Basic Plan","55371OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010007-17"
"2017","OH","55371","SERFF","2017-03-15 20:15:30","Individual","Yes","75-1233841","55371OH0010011","Dentegra Dental PPO Family Basic Plan","55371OH001",,"OHN001","OHS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010011-17"
"2017","OH","55371","SERFF","2017-03-15 20:15:30","SHOP (Small Group)","Yes","75-1233841","55371OH0020011","Dentegra Dental PPO for Small Businesses Family Basic Plan","55371OH002",,"OHN001","OHS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0020011-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0020011-17"
"2017","OH","55371","SERFF","2017-03-15 20:15:30","SHOP (Small Group)","Yes","75-1233841","55371OH0020012","Dentegra Dental PPO for Small Businesses Family Preferred Plan","55371OH002",,"OHN001","OHS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0020012-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0020012-17"
"2017","OH","55371","SERFF","2017-03-15 20:15:30","Individual","Yes","75-1233841","55371OH0010012","Dentegra Dental PPO Family Preferred Plan","55371OH001",,"OHN001","OHS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010012-17"
"2017","OH","64156","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","64156OH0040002","EHB High PPO","64156OH004",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","64156OH0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","64156","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","64156OH0040001","EHB Low PPO","64156OH004",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","64156OH0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030001-04","Molina Marketplace Options Silver 200 Plan","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610001","Humana Basic 7150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610001-01","Humana Basic 7150/Cincinnati/Northern KY HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849912",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610014","Humana Gold 1400/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610014-00","Humana Gold 1400/Dayton HMOx","Standard Gold Off Exchange Plan",,"0.783521115779877","No","Yes","Yes","97%","3%","$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%","$0","$0 per person","$0 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850146",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610014","Humana Gold 1400/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610014-01","Humana Gold 1400/Dayton HMOx","Standard Gold On Exchange Plan",,"0.783521115779877","No","Yes","Yes","97%","3%","$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%","$0","$0 per person","$0 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850146",
"2017","OH","73292","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","73292OH0010002","KCL EHB High PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","73292","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","73292OH0010004","KCL EHB High PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010004-00","KCL EHB High PPO","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","73292","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","73292OH0010006","KCL EHB High PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010006-00","KCL EHB High PPO","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","73292","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","73292OH0010008","KCL EHB High PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010008-00","KCL EHB High PPO","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210010","Paramount Silver Standard","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210010-00","Paramount Silver Standard","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$200","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-SilverStandard.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","64156","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","64156OH0030002","EHB High Passive","64156OH003",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","64156OH0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","64156","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","64156OH0030001","EHB Low Passive","64156OH003",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","64156OH0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010001-00","Molina Marketplace Gold Plan","Standard Gold Off Exchange Plan",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010001-01","Molina Marketplace Gold Plan","Standard Gold On Exchange Plan",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010001-02","Molina Marketplace Gold Zero Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010001-03","Molina Marketplace Gold LCS Plan","Limited Cost Sharing Plan Variation",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010002-00","Molina Marketplace Silver 250 Plan","Standard Silver Off Exchange Plan",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010002-01","Molina Marketplace Silver 250 Plan","Standard Silver On Exchange Plan",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010002-02","Molina Marketplace Silver Zero Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010002-03","Molina Marketplace Silver LCS Plan","Limited Cost Sharing Plan Variation",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010002-04","Molina Marketplace Silver 200 Plan","73% AV Level Silver Plan",,"0.739960968494415","No","Yes","No","100%",,"$2,270","$290","$1,340","$150","$2,270","$400","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,275","$2275 per person","$4550 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,275","$2275 per person","$4550 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010002-05","Molina Marketplace Silver 150 Plan","87% AV Level Silver Plan",,"0.879880011081696","No","Yes","No","100%",,"$500","$180","$890","$150","$500","$320","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010002-06","Molina Marketplace Silver 100 Plan","94% AV Level Silver Plan",,"0.9497309923172","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010003-00","Molina Marketplace Bronze Plan","Standard Bronze Off Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010003-01","Molina Marketplace Bronze Plan","Standard Bronze On Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010003-02","Molina Marketplace Bronze Zero Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0010003-03","Molina Marketplace Bronze LCS Plan","Limited Cost Sharing Plan Variation",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030001-00","Molina Marketplace Options Silver 250 Plan","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030001-01","Molina Marketplace Options Silver 250 Plan","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030001-02","Molina Marketplace Options Silver Zero Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030001-03","Molina Marketplace Options Silver LCS Plan","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030001-05","Molina Marketplace Options Silver 150 Plan","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,010","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030001-06","Molina Marketplace Options Silver 100 Plan","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030002","Molina Marketplace Options Bronze Plan","64353OH003",,"OHN001","OHS002","OHF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030002-00","Molina Marketplace Options Bronze Plan","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030002","Molina Marketplace Options Bronze Plan","64353OH003",,"OHN001","OHS002","OHF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030002-01","Molina Marketplace Options Bronze Plan","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030002","Molina Marketplace Options Bronze Plan","64353OH003",,"OHN001","OHS002","OHF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030002-02","Molina Marketplace Options Bronze Zero Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","64353","SERFF","2016-11-15 22:15:57","Individual","No","20-0750134","64353OH0030002","Molina Marketplace Options Bronze Plan","64353OH003",,"OHN001","OHS002","OHF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2017.pdf","64353OH0030002-03","Molina Marketplace Options Bronze LCS Plan","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","OH","65869","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","65869OH0040001","Delta Dental Individual PPO, EHB Certified","65869OH004",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","65869OH0040001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","65869","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0397286","65869OH0030001","Renaissance Group Dental PPO, EHB Certified","65869OH003",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","65869OH0030001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","65869","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0397286","65869OH0030002","Renaissance Group Dental PPO, EHB Certified","65869OH003",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","65869OH0030002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","65869","SERFF","2016-08-20 11:23:22","Individual","Yes","47-0397286","65869OH0040002","Delta Dental Individual PPO, EHB Certified","65869OH004",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","65869OH0040002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","65869","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0397286","65869OH0030003","Renaissance Group Dental PPO, EHB Certified","65869OH003",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","65869OH0030003-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","65869","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0397286","65869OH0030004","Renaissance Group Dental PPO, EHB Certified","65869OH003",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","65869OH0030004-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610001","Humana Basic 7150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610001-00","Humana Basic 7150/Cincinnati/Northern KY HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849912",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610011","Humana Basic 7150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610011-00","Humana Basic 7150/Dayton HMOx","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849964",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610011","Humana Basic 7150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610011-01","Humana Basic 7150/Dayton HMOx","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$30","$5,000","$50","$0","$20","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2849964",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610002","Humana Bronze 6550/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610002-00","Humana Bronze 6550/Cincinnati/Northern KY HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2849990",
"2017","OH","68158","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","68158OH0210001","Guardian Basics for Families and Individuals","68158OH021",,"OHN002","OHS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","68158OH0210001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","OH","68158","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","68158OH0210001","Guardian Basics for Families and Individuals","68158OH021",,"OHN002","OHS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","68158OH0210001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","OH","73292","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","73292OH0010001","KCL EHB Low PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","73292","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","73292OH0010003","KCL EHB Low PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010003-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","73292","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","73292OH0010005","KCL EHB Low PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010005-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","73292","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","44-0308260","73292OH0010007","KCL EHB Low PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010007-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610002","Humana Bronze 6550/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610002-01","Humana Bronze 6550/Cincinnati/Northern KY HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2849990",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610002","Humana Bronze 6550/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610002-02","Humana Bronze 6550/Cincinnati/Northern KY HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850003",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610002","Humana Bronze 6550/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610002-03","Humana Bronze 6550/Cincinnati/Northern KY HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850016",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610012","Humana Bronze 6550/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610012-00","Humana Bronze 6550/Dayton HMOx","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2850094",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610012","Humana Bronze 6550/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610012-01","Humana Bronze 6550/Dayton HMOx","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2850094",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610012","Humana Bronze 6550/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610012-02","Humana Bronze 6550/Dayton HMOx","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850107",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610012","Humana Bronze 6550/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-HDHP-Plus-OH","66083OH0610012-03","Humana Bronze 6550/Dayton HMOx","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2850120",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610003","Humana Silver 4150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610003-00","Humana Silver 4150/Cincinnati/Northern KY HMOx","Standard Silver Off Exchange Plan",,"0.680905401706696","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850276",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610003","Humana Silver 4150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610003-01","Humana Silver 4150/Cincinnati/Northern KY HMOx","Standard Silver On Exchange Plan",,"0.680905401706696","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850276",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610003","Humana Silver 4150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610003-02","Humana Silver 4150/Cincinnati/Northern KY HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850289",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610003","Humana Silver 4150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610003-03","Humana Silver 4150/Cincinnati/Northern KY HMOx","Limited Cost Sharing Plan Variation",,"0.680905401706696","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850302",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610003","Humana Silver 4150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610003-04","Humana Silver 3500/Cincinnati/Northern KY HMOx","73% AV Level Silver Plan",,"0.722803235054016","No","Yes","Yes","97%","3%","$3,500","$10","$800","$30","$3,200","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%","$3,500","$3500 per person","$7000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850237",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610003","Humana Silver 4150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610003-05","Humana Silver 900/Cincinnati/Northern KY HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850432",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610003","Humana Silver 4150/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610003-06","Humana Silver 250/Cincinnati/Northern KY HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850198",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610013","Humana Silver 4150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610013-00","Humana Silver 4150/Dayton HMOx","Standard Silver Off Exchange Plan",,"0.680905401706696","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850380",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610013","Humana Silver 4150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610013-01","Humana Silver 4150/Dayton HMOx","Standard Silver On Exchange Plan",,"0.680905401706696","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850380",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610013","Humana Silver 4150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610013-02","Humana Silver 4150/Dayton HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850393",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610013","Humana Silver 4150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610013-03","Humana Silver 4150/Dayton HMOx","Limited Cost Sharing Plan Variation",,"0.680905401706696","No","Yes","Yes","97%","3%","$4,150","$20","$600","$30","$4,150","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,150","$4150 per person","$8300 per group","20.00%","$4,150","$4150 per person","$8300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850406",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610013","Humana Silver 4150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610013-04","Humana Silver 3500/Dayton HMOx","73% AV Level Silver Plan",,"0.722803235054016","No","Yes","Yes","97%","3%","$3,500","$10","$800","$30","$3,200","$200","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%","$3,500","$3500 per person","$7000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850263",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610013","Humana Silver 4150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610013-05","Humana Silver 900/Dayton HMOx","87% AV Level Silver Plan",,"0.863941550254822","No","Yes","Yes","97%","3%","$900","$0","$1,200","$30","$700","$400","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","$2,050","$2050 per person","$4100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%","$900","$900 per person","$1800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850458",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610013","Humana Silver 4150/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610013-06","Humana Silver 250/Dayton HMOx","94% AV Level Silver Plan",,"0.931144297122955","No","Yes","Yes","97%","3%","$250","$0","$600","$30","$250","$200","$20","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850224",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610014","Humana Gold 1400/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610014-02","Humana Gold 1400/Dayton HMOx","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850159",
"2017","OH","66083","SERFF","2016-08-24 05:44:16","Individual","No","31-1154200","66083OH0610014","Humana Gold 1400/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","https://www.humana.com/2017-Rx5-Plus-OH","66083OH0610014-03","Humana Gold 1400/Dayton HMOx","Limited Cost Sharing Plan Variation",,"0.783521115779877","No","Yes","Yes","97%","3%","$1,400","$10","$1,200","$30","$1,400","$500","$10","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%","$1,400","$1400 per person","$2800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%","$0","$0 per person","$0 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2850185",
"2017","OH","68158","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","68158OH0190001","Guardian Essentials for Families and Individuals","68158OH019",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","68158OH0190001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","OH","68158","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","68158OH0130003","Guardian Pediatric Advantage","68158OH013",,"OHN001","OHS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","68158OH0130003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","OH","68158","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","68158OH0190001","Guardian Essentials for Families and Individuals","68158OH019",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","68158OH0190001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","OH","68158","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","68158OH0140003","Guardian Pediatric Essentials","68158OH014",,"OHN001","OHS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","68158OH0140003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","OH","68158","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","68158OH0200001","Guardian Select for Families and Individuals","68158OH020",,"OHN002","OHS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","68158OH0200001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","OH","68158","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","68158OH0200001","Guardian Select for Families and Individuals","68158OH020",,"OHN002","OHS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","68158OH0200001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210010","Paramount Silver Standard","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210010-01","Paramount Silver Standard","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$200","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-SilverStandard.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210010","Paramount Silver Standard","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210010-02","Paramount Silver Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-SilverStandard-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210010","Paramount Silver Standard","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210010-03","Paramount Silver Standard","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$200","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-SilverStandard-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210006-03","Paramount Silver 2","Limited Cost Sharing Plan Variation",,"0.712430059909821","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$500","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver2-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210006-04","Paramount Silver 2","73% AV Level Silver Plan",,"0.739747226238251","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$540","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver2-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210006-05","Paramount Silver 2","87% AV Level Silver Plan",,"0.878642022609711","No","Yes","No","100%",,"$500","$50","$510","$150","$500","$670","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver2-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210006-06","Paramount Silver 2","94% AV Level Silver Plan",,"0.948069214820862","No","Yes","No","100%",,"$150","$10","$440","$150","$150","$380","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver2-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010019","CareSource Gold","77552OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9901",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010019-00","CareSource Gold","Standard Gold Off Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-gold-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210008-00","Paramount Bronze 1 HSA","Standard Bronze Off Exchange Plan",,"0.618689239025116","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Bronze1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210008-01","Paramount Bronze 1 HSA","Standard Bronze On Exchange Plan",,"0.618689239025116","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Bronze1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210008-02","Paramount Bronze 1 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Bronze1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210008-03","Paramount Bronze 1 HSA","Limited Cost Sharing Plan Variation",,"0.618689239025116","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Bronze1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210010","Paramount Silver Standard","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210010-04","Paramount Silver Standard","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-SilverStandard-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210010","Paramount Silver Standard","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210010-05","Paramount Silver Standard","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$40","$1,010","$150","$700","$280","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-SilverStandard-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210010","Paramount Silver Standard","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210010-06","Paramount Silver Standard","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-SilverStandard-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210011","Paramount Bronze Standard","74313OH021",,"OHN001","OHS001","OHF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210011-00","Paramount Bronze Standard","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-BronzeStandard.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210011","Paramount Bronze Standard","74313OH021",,"OHN001","OHS001","OHF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210011-01","Paramount Bronze Standard","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-BronzeStandard.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210011","Paramount Bronze Standard","74313OH021",,"OHN001","OHS001","OHF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210011-02","Paramount Bronze Standard","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-BronzeStandard-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210011","Paramount Bronze Standard","74313OH021",,"OHN001","OHS001","OHF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210011-03","Paramount Bronze Standard","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-BronzeStandard-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210001-00","Paramount Gold 1","Standard Gold Off Exchange Plan",,"0.782313466072083","No","Yes","No","100%",,"$1,500","$60","$1,010","$150","$1,500","$410","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Gold1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210001-01","Paramount Gold 1","Standard Gold On Exchange Plan",,"0.782313466072083","No","Yes","No","100%",,"$1,500","$60","$1,010","$150","$1,500","$410","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Gold1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210001-02","Paramount Gold 1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Gold1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210001-03","Paramount Gold 1","Limited Cost Sharing Plan Variation",,"0.782313466072083","No","Yes","No","100%",,"$1,500","$60","$1,010","$150","$1,500","$410","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Gold1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210002-00","Paramount Silver 1","Standard Silver Off Exchange Plan",,"0.694174587726593","No","Yes","No","100%",,"$3,250","$20","$1,600","$150","$3,250","$430","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210002-01","Paramount Silver 1","Standard Silver On Exchange Plan",,"0.694174587726593","No","Yes","No","100%",,"$3,250","$20","$1,600","$150","$3,250","$430","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210002-02","Paramount Silver 1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210002-03","Paramount Silver 1","Limited Cost Sharing Plan Variation",,"0.694174587726593","No","Yes","No","100%",,"$3,250","$20","$1,600","$150","$3,250","$430","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210002-04","Paramount Silver 1","73% AV Level Silver Plan",,"0.739560604095459","No","Yes","No","100%",,"$3,100","$20","$1,660","$150","$3,100","$250","$240","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver1-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210002-05","Paramount Silver 1","87% AV Level Silver Plan",,"0.879096269607544","No","Yes","No","100%",,"$750","$30","$1,220","$150","$750","$460","$430","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver1-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210002-06","Paramount Silver 1","94% AV Level Silver Plan",,"0.949650347232819","No","Yes","No","100%",,"$200","$10","$490","$150","$200","$350","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver1-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210006-00","Paramount Silver 2","Standard Silver Off Exchange Plan",,"0.712430059909821","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$500","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210006-01","Paramount Silver 2","Standard Silver On Exchange Plan",,"0.712430059909821","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$500","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","74313","SERFF","2016-08-24 05:44:16","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2017-01-01","2017-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2017-Marketplace-Formulary.pdf","74313OH0210006-02","Paramount Silver 2","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2017-Silver2-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2017.pdf"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010019","CareSource Gold","77552OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9901",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010019-01","CareSource Gold","Standard Gold On Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-gold-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010019","CareSource Gold","77552OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9901",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010019-02","CareSource Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-goldzero-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010019","CareSource Gold","77552OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9901",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010019-03","CareSource Gold Limited","Limited Cost Sharing Plan Variation",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-goldltd-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010064","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010064-00","CareSource Silver","Standard Silver Off Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010064","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010064-01","CareSource Silver","Standard Silver On Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010064","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010064-02","CareSource Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silverzero-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010064","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010064-03","CareSource Silver Limited","Limited Cost Sharing Plan Variation",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silverltd-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010064","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010064-04","CareSource Silver 1","73% AV Level Silver Plan",,"0.737353086471558","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver1-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010064","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010064-05","CareSource Silver 2","87% AV Level Silver Plan",,"0.874086737632751","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver2-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010064","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010064-06","CareSource Silver 3","94% AV Level Silver Plan",,"0.943850040435791","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver3-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010109","CareSource Bronze","77552OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9861",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010109-00","CareSource Bronze","Standard Bronze Off Exchange Plan","60.10%","0.630836367607117","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-oh-bronze-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010109","CareSource Bronze","77552OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9861",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010109-01","CareSource Bronze","Standard Bronze On Exchange Plan","60.10%","0.630836367607117","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-oh-bronze-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010109","CareSource Bronze","77552OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9861",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010109-02","CareSource Bronze Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/mp2017-oh-bronzezero-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0010109","CareSource Bronze","77552OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9861",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0010109-03","CareSource Bronze Limited","Limited Cost Sharing Plan Variation","60.10%","0.630836367607117","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-oh-bronzeltd-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020019","CareSource Gold Dental and Vision","77552OH002",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9305",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020019-00","CareSource Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-gold-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020019","CareSource Gold Dental and Vision","77552OH002",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9305",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020019-01","CareSource Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-gold-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020019","CareSource Gold Dental and Vision","77552OH002",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9305",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020019-02","CareSource Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-goldzero-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020019","CareSource Gold Dental and Vision","77552OH002",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9305",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020019-03","CareSource Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-goldltd-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020064","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.917",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020064-00","CareSource Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020064","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.917",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020064-01","CareSource Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020064","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.917",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020064-02","CareSource Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silverzero-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020064","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.917",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020064-03","CareSource Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silverltd-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020064","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.917",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020064-04","CareSource Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.737353086471558","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver1-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020064","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.917",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020064-05","CareSource Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.874086737632751","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver2-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020064","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.917",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020064-06","CareSource Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.94385153055191","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-oh-silver3-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030001","CareSource Federal Simple Choice Gold","77552OH003",,"OHN001","OHS001","OHF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030001-00","CareSource Federal Simple Choice Gold","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-gold-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030001","CareSource Federal Simple Choice Gold","77552OH003",,"OHN001","OHS001","OHF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030001-01","CareSource Federal Simple Choice Gold","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-gold-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030001","CareSource Federal Simple Choice Gold","77552OH003",,"OHN001","OHS001","OHF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030001-02","CareSource Federal Simple Choice Gold Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-goldzero-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030001","CareSource Federal Simple Choice Gold","77552OH003",,"OHN001","OHS001","OHF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030001-03","CareSource Federal Simple Choice Gold Limited","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-goldltd-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030002","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030002-00","CareSource Federal Simple Choice Silver","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-silver-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030002","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030002-01","CareSource Federal Simple Choice Silver","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-silver-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030002","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030002-02","CareSource Federal Simple Choice Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-silverzero-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030002","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030002-03","CareSource Federal Simple Choice Silver Limited","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-silverltd-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030002","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030002-04","CareSource Federal Simple Choice Silver 1","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-silver1-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030002","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030002-05","CareSource Federal Simple Choice Silver 2","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$40","$1,010","$150","$700","$280","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-silver2-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030002","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030002-06","CareSource Federal Simple Choice Silver 3","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-silver3-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030003","CareSource Federal Simple Choice Bronze","77552OH003",,"OHN001","OHS001","OHF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030003-00","CareSource Federal Simple Choice Bronze","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-bronze-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030003","CareSource Federal Simple Choice Bronze","77552OH003",,"OHN001","OHS001","OHF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030003-01","CareSource Federal Simple Choice Bronze","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-bronze-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030003","CareSource Federal Simple Choice Bronze","77552OH003",,"OHN001","OHS001","OHF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030003-02","CareSource Federal Simple Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-bronzezero-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0030003","CareSource Federal Simple Choice Bronze","77552OH003",,"OHN001","OHS001","OHF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0030003-03","CareSource Federal Simple Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-oh-bronzeltd-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0040001","CareSource Low Premium Silver","77552OH004",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0040001-00","CareSource Low Premium Silver","Standard Silver Off Exchange Plan",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-oh-silver-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0040001","CareSource Low Premium Silver","77552OH004",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0040001-01","CareSource Low Premium Silver","Standard Silver On Exchange Plan",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-oh-silver-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0040001","CareSource Low Premium Silver","77552OH004",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0040001-02","CareSource Low Premium Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-lp-oh-silverzero-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0040001","CareSource Low Premium Silver","77552OH004",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0040001-03","CareSource Low Premium Silver Limited","Limited Cost Sharing Plan Variation",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-oh-silverltd-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0040001","CareSource Low Premium Silver","77552OH004",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0040001-04","CareSource Low Premium Silver 1","73% AV Level Silver Plan",,"0.721862494945526","Yes","Yes","No","100%",,"$5,000","$0","$340","$150","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"https://caresource.com/documents/mp2017-lp-oh-silver1-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0040001","CareSource Low Premium Silver","77552OH004",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0040001-05","CareSource Low Premium Silver 2","87% AV Level Silver Plan",,"0.868183672428131","Yes","Yes","No","100%",,"$1,100","$30","$510","$150","$1,100","$90","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","No",,,"https://caresource.com/documents/mp2017-lp-oh-silver2-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0040001","CareSource Low Premium Silver","77552OH004",,"OHN001","OHS001","OHF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0040001-06","CareSource Low Premium Silver 3","94% AV Level Silver Plan",,"0.932700634002686","Yes","Yes","No","100%",,"$500","$10","$250","$150","$500","$50","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"https://caresource.com/documents/mp2017-lp-oh-silver3-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020109","CareSource Bronze Dental and Vision","77552OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.905",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020109-00","CareSource Bronze Dental and Vision","Standard Bronze Off Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$137000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-oh-bronze-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020109","CareSource Bronze Dental and Vision","77552OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.905",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020109-01","CareSource Bronze Dental and Vision","Standard Bronze On Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$137000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-oh-bronze-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020109","CareSource Bronze Dental and Vision","77552OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.905",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020109-02","CareSource Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/mp2017-oh-bronzezero-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","77552","SERFF","2017-01-25 20:15:24","Individual","No","31-1143265","77552OH0020109","CareSource Bronze Dental and Vision","77552OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.905",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","77552OH0020109-03","CareSource Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$137000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-oh-bronzeltd-dv-sum","https://www.caresource.com/documents/mp2017-oh-broch"
"2017","OH","79539","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0098400","79539OH0040002","EHB High PPO","79539OH004",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","79539","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0098400","79539OH0040001","EHB Low PPO","79539OH004",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0300004","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0300004-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","89819","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","89819OH0010001","TruAssure Basic Adult or Child Dental Plan","89819OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH"
"2017","OH","89819","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-3757528","89819OH0030001","TruAssure Dental Small Group Basic Plan","89819OH003",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.94","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","89819OH0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","89819","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-3757528","89819OH0040001","TruAssure Dental Small Group Preferred Plan","89819OH004",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.94","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","89819OH0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","89819","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","89819OH0010001","TruAssure Basic Adult or Child Dental Plan","89819OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH"
"2017","OH","89819","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","89819OH0020001","TruAssure Preferred Adult or Child Dental Plan","89819OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH"
"2017","OH","89819","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","89819OH0020001","TruAssure Preferred Adult or Child Dental Plan","89819OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH"
"2017","OH","91261","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","57-0523959","91261OH0020001","Group Dental Policy","91261OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","91261OH0020001-00","Group Dental Policy","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","79539","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0098400","79539OH0030002","EHB High Passive","79539OH003",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","79539","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0098400","79539OH0030001","EHB Low Passive","79539OH003",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","Individual","Yes","34-0648820","80627OH0140005","MedMutual Pediatric Dental","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140005-00","MedMutual Pediatric Dental","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150015","Pediatric Dental - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150015-00","Pediatric Dental - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150032","Pediatric Dental - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150032-00","Pediatric Dental - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150021","Dental Plan 5 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150021-00","Dental Plan 5 - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","Individual","Yes","34-0648820","80627OH0140006","MedMutual Dental 1","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140006-00","MedMutual Dental 1","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150050","Dental Plan 5 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150050-00","Dental Plan 5 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150038","Dental Plan 5 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150038-00","Dental Plan 5 - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150053","Dental Plan 5 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150053-00","Dental Plan 5 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","Individual","Yes","34-0648820","80627OH0140007","MedMutual Dental 2","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140007-00","MedMutual Dental 2","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150019","Dental Plan 4 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150019-00","Dental Plan 4 - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150049","Dental Plan 4 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150049-00","Dental Plan 4 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150022","Dental Plan 6 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150022-00","Dental Plan 6 - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150024","Dental Plan 6 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150024-00","Dental Plan 6 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150025","Dental Plan 7 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150025-00","Dental Plan 7 - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150027","Dental Plan 7 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150027-00","Dental Plan 7 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150028","Dental Plan 8 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150028-00","Dental Plan 8 - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150051","Dental Plan 8 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150051-00","Dental Plan 8 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150036","Dental Plan 4 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150036-00","Dental Plan 4 - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","Individual","Yes","34-0648820","80627OH0140008","MedMutual Dental 3","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140008-00","MedMutual Dental 3","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150052","Dental Plan 4 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150052-00","Dental Plan 4 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150039","Dental Plan 6 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150039-00","Dental Plan 6 - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150041","Dental Plan 6 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150041-00","Dental Plan 6 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150042","Dental Plan 7 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150042-00","Dental Plan 7 - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150044","Dental Plan 7 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150044-00","Dental Plan 7 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150045","Dental Plan 8 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150045-00","Dental Plan 8 - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150054","Dental Plan 8 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150054-00","Dental Plan 8 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150020","Dental Plan 4 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150020-00","Dental Plan 4 with Ortho Rider - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150023","Dental Plan 6 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150023-00","Dental Plan 6 with Ortho Rider - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150026","Dental Plan 7 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150026-00","Dental Plan 7 with Ortho Rider - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150029","Dental Plan 8 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150029-00","Dental Plan 8 with Ortho Rider - Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150037","Dental Plan 4 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150037-00","Dental Plan 4 with Ortho Rider - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150040","Dental Plan 6 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150040-00","Dental Plan 6 with Ortho Rider - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150043","Dental Plan 7 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150043-00","Dental Plan 7 with Ortho Rider - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","80627","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","34-0648820","80627OH0150046","Dental Plan 8 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150046-00","Dental Plan 8 with Ortho Rider - Non-Alliance","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","Individual","Yes","31-0685339","86728OH0260001","Delta Dental Individual PPO, EHB Certified","86728OH026",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0260001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0290001","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0290001-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","Individual","Yes","31-0685339","86728OH0260002","Delta Dental Individual PPO, EHB Certified","86728OH026",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0260002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0290002","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0290002-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","Individual","Yes","31-0685339","86728OH0340001","Delta Dental Individual PPO, EHB Certified (Exchange)","86728OH034",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0340001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_High_2017","http://www.deltadentaloh.com/OH_EHB_High_2017"
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0290005","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0290005-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","Individual","Yes","31-0685339","86728OH0340002","Delta Dental Individual PPO, EHB Certified (Exchange)","86728OH034",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0340002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_Low_2017","http://www.deltadentaloh.com/OH_EHB_Low_2017"
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0290006","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0290006-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0350001","Delta Dental Group PPO, EHB Certified (Exchange)","86728OH035",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0350001-01","Delta Dental Group PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_Group_High_2017","http://www.deltadentaloh.com/OH_EHB_Group_High_2017"
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0350002","Delta Dental Group PPO, EHB Certified (Exchange)","86728OH035",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0350002-01","Delta Dental Group PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_Group_Low_2017","http://www.deltadentaloh.com/OH_EHB_Group_Low_2017"
"2017","OH","86728","SERFF","2016-08-19 03:49:17","Individual","Yes","31-0685339","86728OH0310001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","86728OH031",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0310001-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0300001","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0300001-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","Individual","Yes","31-0685339","86728OH0310002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","86728OH031",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0310002-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0300002","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0300002-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-0685339","86728OH0300003","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0300003-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","86728","SERFF","2016-08-19 03:49:17","Individual","Yes","31-0685339","86728OH0360001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","86728OH036",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0360001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_Ped_High_2017","http://www.deltadentaloh.com/OH_Ped_High_2017"
"2017","OH","86728","SERFF","2016-08-19 03:49:17","Individual","Yes","31-0685339","86728OH0360002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","86728OH036",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0360002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_Ped_Low_2017","http://www.deltadentaloh.com/OH_Ped_Low_2017"
"2017","OH","91261","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","57-0523959","91261OH0020002","Group Dental Policy","91261OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","91261OH0020002-00","Group Dental Policy","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","97596","SERFF","2016-08-20 11:23:22","Individual","Yes","39-1263473","97596OH0580001","Humana Dental Smart Choice","97596OH058",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9872","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","97596OH0580001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857114"
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080021","Market HMO 1200 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080021-03","Market HMO 1200 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005585000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080028","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080028-00","Market HMO 1200 - Mercy","Standard Gold Off Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005702000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080028","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080028-01","Market HMO 1200 - Mercy","Standard Gold On Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005702000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080028","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080028-02","Market HMO 1200 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005703000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080028","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080028-03","Market HMO 1200 - Mercy","Limited Cost Sharing Plan Variation",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005704000000000",
"2017","OH","97596","SERFF","2016-08-20 11:23:22","Individual","Yes","39-1263473","97596OH0580001","Humana Dental Smart Choice","97596OH058",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9872","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","97596OH0580001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857114"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","Individual","Yes","31-1185262","99734OH0050005","Ohio DentaTrust PPO - Pediatric High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050005-00","Ohio DentaTrust PPO - Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixenroll.insxcloud.com/my-quote/plan-information/index","https://hixenroll.insxcloud.com/my-quote/plan-information/index"
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","Yes","34-1442712","99969OH0060003","MedMutual Dental 1","99969OH006",,"OHN007","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060003-00","MedMutual Dental 1","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99969","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","34-1442712","99969OH0050013","Market Silver 3530-2500","99969OH005",,"OHN006","OHS002","OHF008","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0050013-01","Market Silver 3530-2500","Standard Silver On Exchange Plan",,"0.718478918075562","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$2,500","$400","$0","$40","$0","$0","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001409338000000000",
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0040005","DentaSpan Dental-Family High Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040005-00","DentaSpan Dental-Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgboh.dentalcareplus.com"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0040005","DentaSpan Dental-Family High Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040005-01","DentaSpan Dental-Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgboh.dentalcareplus.com"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","Individual","Yes","31-1185262","99734OH0050005","Ohio DentaTrust PPO - Pediatric High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050005-01","Ohio DentaTrust PPO - Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixenroll.insxcloud.com/my-quote/plan-information/index","https://hixenroll.insxcloud.com/my-quote/plan-information/index"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","Individual","Yes","31-1185262","99734OH0050006","Ohio DentaTrust PPO - Pediatric Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050006-00","Ohio DentaTrust PPO - Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixenroll.insxcloud.com/my-quote/plan-information/index","https://hixenroll.insxcloud.com/my-quote/plan-information/index"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0040006","DentaSpan Dental-Family Low Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040006-00","DentaSpan Dental-Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgboh.dentalcareplus.com"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0040006","DentaSpan Dental-Family Low Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040006-01","DentaSpan Dental-Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgboh.dentalcareplus.com"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","Individual","Yes","31-1185262","99734OH0050006","Ohio DentaTrust PPO - Pediatric Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050006-01","Ohio DentaTrust PPO - Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixenroll.insxcloud.com/my-quote/plan-information/index","https://hixenroll.insxcloud.com/my-quote/plan-information/index"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0040011","DentaSpan Dental-Family High Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040011-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgboh.dentalcareplus.com"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0040012","DentaSpan Dental-Family Low Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040012-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgboh.dentalcareplus.com"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0040009","DentaSpan Dental-Child Only High Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040009-00","DentaSpan Dental-Child Only High Option-Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgsboh.dentalcareplus.com"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","Individual","Yes","31-1185262","99734OH0050007","Ohio DentaTrust PPO - Family High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050007-00","Ohio DentaTrust PPO - Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixenroll.insxcloud.com/my-quote/plan-information/index","https://hixenroll.insxcloud.com/my-quote/plan-information/index"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","Individual","Yes","31-1185262","99734OH0050007","Ohio DentaTrust PPO - Family High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050007-01","Ohio DentaTrust PPO - Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixenroll.insxcloud.com/my-quote/plan-information/index","https://hixenroll.insxcloud.com/my-quote/plan-information/index"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0040010","DentaSpan Dental-Child Only Low Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040010-00","DentaSpan Dental-Child Only Low Option-Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgsboh.dentalcareplus.com"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","Individual","Yes","31-1185262","99734OH0050008","Ohio DentaTrust PPO - Family Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050008-00","Ohio DentaTrust PPO - Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixenroll.insxcloud.com/my-quote/plan-information/index","https://hixenroll.insxcloud.com/my-quote/plan-information/index"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","Individual","Yes","31-1185262","99734OH0050008","Ohio DentaTrust PPO - Family Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050008-01","Ohio DentaTrust PPO - Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixenroll.insxcloud.com/my-quote/plan-information/index","https://hixenroll.insxcloud.com/my-quote/plan-information/index"
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0010016","HMO - Plan #16","99734OH001","7083617077","OHN002","OHS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,"","99734OH0010016-00","HMO - Plan #16","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0010017","HMO - Plan #017","99734OH001","7083617077","OHN002","OHS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,"","99734OH0010017-00","HMO - Plan #017","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0020021","PPO - Plan #017 - 900","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020021-00","PPO - Plan #017 - 900","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0020022","PPO - Plan #018 - 900","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020022-00","PPO - Plan #018 - 900","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0020023","PPO - Plan #019 - 900","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020023-00","PPO - Plan #019 - 900","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0020024","PPO - Plan #020 - 900","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020024-00","PPO - Plan #020 - 900","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0020025","PPO - Plan #017 - 600","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020025-00","PPO - Plan #017 - 600","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0020026","PPO - Plan #018 - 600","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020026-00","PPO - Plan #018 - 600","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0020027","PPO - Plan #019 - 600","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020027-00","PPO - Plan #019 - 600","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99734","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","31-1185262","99734OH0020028","PPO - Plan #020 - 600","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020028-00","PPO - Plan #020 - 600","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99969","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","Yes","34-1442712","99969OH0070002","Pediatric Dental","99969OH007",,"OHN007","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0070002-00","Pediatric Dental","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","Yes","34-1442712","99969OH0060002","MedMutual Pediatric Dental","99969OH006",,"OHN007","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060002-00","MedMutual Pediatric Dental","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080001","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-00","Market HMO 1200 - Mercy","Standard Gold Off Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005672000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","34-1442712","99969OH0050017","Market Gold 2520-1000","99969OH005",,"OHN006","OHS002","OHF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0050017-00","Market Gold 2520-1000","Standard Gold Off Exchange Plan",,"0.805150926113129","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001409337000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","34-1442712","99969OH0050017","Market Gold 2520-1000","99969OH005",,"OHN006","OHS002","OHF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0050017-01","Market Gold 2520-1000","Standard Gold On Exchange Plan",,"0.805150926113129","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001409337000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080001","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-01","Market HMO 1200 - Mercy","Standard Gold On Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005672000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080001","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-02","Market HMO 1200 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005673000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080001","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-03","Market HMO 1200 - Mercy","Limited Cost Sharing Plan Variation",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005674000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080021","Market HMO 1200 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080021-00","Market HMO 1200 - OhioHealth","Standard Gold Off Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005583000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080021","Market HMO 1200 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080021-01","Market HMO 1200 - OhioHealth","Standard Gold On Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005583000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080021","Market HMO 1200 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080021-02","Market HMO 1200 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005584000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080035","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS004","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080035-00","Market HMO 1200 - Mercy","Standard Gold Off Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005732000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080035","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS004","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080035-01","Market HMO 1200 - Mercy","Standard Gold On Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005732000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080035","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS004","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080035-02","Market HMO 1200 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005733000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080035","Market HMO 1200 - Mercy","99969OH008",,"OHN002","OHS004","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080035-03","Market HMO 1200 - Mercy","Limited Cost Sharing Plan Variation",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005734000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","34-1442712","99969OH0050013","Market Silver 3530-2500","99969OH005",,"OHN006","OHS002","OHF008","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0050013-00","Market Silver 3530-2500","Standard Silver Off Exchange Plan",,"0.718478918075562","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$2,500","$400","$0","$40","$0","$0","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001409338000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","Yes","34-1442712","99969OH0060004","MedMutual Dental 2","99969OH006",,"OHN007","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060004-00","MedMutual Dental 2","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","Yes","34-1442712","99969OH0060005","MedMutual Dental 3","99969OH006",,"OHN007","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060005-00","MedMutual Dental 3","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-00","Market HMO 1750 - Mercy","Standard Silver Off Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005675000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-01","Market HMO 1750 - Mercy","Standard Silver On Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005675000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-02","Market HMO 1750 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005676000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-03","Market HMO 1750 - Mercy","Limited Cost Sharing Plan Variation",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005677000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-04","Market HMO 1750 - Mercy","73% AV Level Silver Plan",,"0.739519774913788","No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$1,600","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005678000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-05","Market HMO 1750 - Mercy","87% AV Level Silver Plan",,"0.861778557300568","No","Yes","No","100%",,"$800","$20","$400","$200","$800","$1,200","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005679000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-06","Market HMO 1750 - Mercy","94% AV Level Silver Plan",,"0.934927046298981","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005680000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080022","Market HMO 1750 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-00","Market HMO 1750 - OhioHealth","Standard Silver Off Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005595000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080022","Market HMO 1750 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-01","Market HMO 1750 - OhioHealth","Standard Silver On Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005595000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080022","Market HMO 1750 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-02","Market HMO 1750 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005597000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080022","Market HMO 1750 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-03","Market HMO 1750 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005596000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080022","Market HMO 1750 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-04","Market HMO 1750 - OhioHealth","73% AV Level Silver Plan",,"0.739519774913788","No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$1,600","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005598000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080022","Market HMO 1750 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-05","Market HMO 1750 - OhioHealth","87% AV Level Silver Plan",,"0.861778557300568","No","Yes","No","100%",,"$800","$20","$400","$200","$800","$1,200","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005599000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080022","Market HMO 1750 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-06","Market HMO 1750 - OhioHealth","94% AV Level Silver Plan",,"0.934927046298981","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005600000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080029","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080029-00","Market HMO 1750 - Mercy","Standard Silver Off Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005705000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080029","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080029-01","Market HMO 1750 - Mercy","Standard Silver On Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005705000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080029","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080029-02","Market HMO 1750 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005706000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080029","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080029-03","Market HMO 1750 - Mercy","Limited Cost Sharing Plan Variation",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005707000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080029","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080029-04","Market HMO 1750 - Mercy","73% AV Level Silver Plan",,"0.739519774913788","No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$1,600","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005708000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080029","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080029-05","Market HMO 1750 - Mercy","87% AV Level Silver Plan",,"0.861778557300568","No","Yes","No","100%",,"$800","$20","$400","$200","$800","$1,200","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005709000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080029","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080029-06","Market HMO 1750 - Mercy","94% AV Level Silver Plan",,"0.934927046298981","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005710000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080036","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS004","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080036-00","Market HMO 1750 - Mercy","Standard Silver Off Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005735000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080036","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS004","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080036-01","Market HMO 1750 - Mercy","Standard Silver On Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005735000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080036","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS004","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080036-02","Market HMO 1750 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005736000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080036","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS004","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080036-03","Market HMO 1750 - Mercy","Limited Cost Sharing Plan Variation",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005737000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080036","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS004","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080036-04","Market HMO 1750 - Mercy","73% AV Level Silver Plan",,"0.739519774913788","No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$1,600","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005738000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080036","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS004","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080036-05","Market HMO 1750 - Mercy","87% AV Level Silver Plan",,"0.861778557300568","No","Yes","No","100%",,"$800","$20","$400","$200","$800","$1,200","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005739000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080036","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS004","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080036-06","Market HMO 1750 - Mercy","94% AV Level Silver Plan",,"0.934927046298981","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005740000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-00","Market HMO 4000 HSA - Mercy","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005681000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-01","Market HMO 4000 HSA - Mercy","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005681000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-02","Market HMO 4000 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005682000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-03","Market HMO 4000 - Mercy","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005683000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-04","Market HMO 4000 HSA - Mercy","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005684000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-05","Market HMO 4000 - Mercy","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005685000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-06","Market HMO 4000 - Mercy","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005686000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-00","Market HMO 4000 HSA - OhioHealth","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005645000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-01","Market HMO 4000 HSA - OhioHealth","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005645000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-02","Market HMO 4000 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005649000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-03","Market HMO 4000 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005650000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-04","Market HMO 4000 HSA - OhioHealth","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005646000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-05","Market HMO 4000 - OhioHealth","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005647000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-06","Market HMO 4000 - OhioHealth","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005648000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080030","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080030-00","Market HMO 4000 HSA - Mercy","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005711000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080030","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080030-01","Market HMO 4000 HSA - Mercy","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005711000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080030","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080030-02","Market HMO 4000 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005712000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080030","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080030-03","Market HMO 4000 - Mercy","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005713000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080030","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080030-04","Market HMO 4000 HSA - Mercy","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005714000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080030","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080030-05","Market HMO 4000 - Mercy","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005715000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080030","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080030-06","Market HMO 4000 - Mercy","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005716000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080037","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080037-00","Market HMO 4000 HSA - Mercy","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=0050057410000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080037","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080037-01","Market HMO 4000 HSA - Mercy","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=0050057410000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080037","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080037-02","Market HMO 4000 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=0050057420000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080037","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080037-03","Market HMO 4000 - Mercy","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=0050057430000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080037","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080037-04","Market HMO 4000 HSA - Mercy","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=0050057440000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080037","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080037-05","Market HMO 4000 - Mercy","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=0050057450000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080037","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080037-06","Market HMO 4000 - Mercy","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=0050057460000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080007","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-00","Market HMO 6400 HSA - Mercy","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005693000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080007","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-01","Market HMO 6400 HSA - Mercy","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005693000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080007","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-02","Market HMO 6400 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005694000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080007","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-03","Market HMO 6400 - Mercy","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005695000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080025","Market HMO 6400 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080025-00","Market HMO 6400 HSA - OhioHealth","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005624000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080025","Market HMO 6400 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080025-01","Market HMO 6400 HSA - OhioHealth","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005624000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080025","Market HMO 6400 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080025-02","Market HMO 6400 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005625000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080025","Market HMO 6400 HSA - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080025-03","Market HMO 6400 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005626000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080032","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080032-00","Market HMO 6400 HSA - Mercy","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005723000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080032","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080032-01","Market HMO 6400 HSA - Mercy","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005723000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080032","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080032-02","Market HMO 6400 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005724000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080032","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080032-03","Market HMO 6400 - Mercy","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005725000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080039","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080039-00","Market HMO 6400 HSA - Mercy","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005753000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080039","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080039-01","Market HMO 6400 HSA - Mercy","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005753000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080039","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080039-02","Market HMO 6400 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005754000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080039","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080039-03","Market HMO 6400 - Mercy","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005755000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080012","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS005","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080012-00","Market HMO 7150 - Mercy","Standard Bronze Off Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005696000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080012","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS005","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080012-01","Market HMO 7150 - Mercy","Standard Bronze On Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005696000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080012","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS005","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080012-02","Market HMO 7150 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005697000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080012","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS005","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080012-03","Market HMO 7150 - Mercy","Limited Cost Sharing Plan Variation",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005698000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080026","Market HMO 7150 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080026-00","Market HMO 7150 - OhioHealth","Standard Bronze Off Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005621000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080026","Market HMO 7150 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080026-01","Market HMO 7150 - OhioHealth","Standard Bronze On Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005621000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080026","Market HMO 7150 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080026-02","Market HMO 7150 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005622000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080026","Market HMO 7150 - OhioHealth","99969OH008",,"OHN005","OHS006","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080026-03","Market HMO 7150 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005623000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080033","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080033-00","Market HMO 7150 - Mercy","Standard Bronze Off Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005726000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080033","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080033-01","Market HMO 7150 - Mercy","Standard Bronze On Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005726000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080033","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080033-02","Market HMO 7150 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005727000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080033","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS003","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080033-03","Market HMO 7150 - Mercy","Limited Cost Sharing Plan Variation",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005728000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080040","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080040-00","Market HMO 7150 - Mercy","Standard Bronze Off Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005756000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080040","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080040-01","Market HMO 7150 - Mercy","Standard Bronze On Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005756000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080040","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080040-02","Market HMO 7150 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005757000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0080040","Market HMO 7150 - Mercy","99969OH008",,"OHN002","OHS004","OHF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080040-03","Market HMO 7150 - Mercy","Limited Cost Sharing Plan Variation",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005758000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100003","Market 2400","99969OH010",,"OHN006","OHS007","OHF007","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100003-00","Market 2400","Standard Silver Off Exchange Plan",,"0.688966870307922","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306395000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100003","Market 2400","99969OH010",,"OHN006","OHS007","OHF007","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100003-01","Market 2400","Standard Silver On Exchange Plan",,"0.688966870307922","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306395000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100003","Market 2400","99969OH010",,"OHN006","OHS007","OHF007","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100003-02","Market 2400","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306400000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100003","Market 2400","99969OH010",,"OHN006","OHS007","OHF007","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100003-03","Market 2400","Limited Cost Sharing Plan Variation",,"0.688966870307922","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306399000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100003","Market 2400","99969OH010",,"OHN006","OHS007","OHF007","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100003-04","Market 2400","73% AV Level Silver Plan",,"0.729467749595642","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$200","$1,800","$0","$400","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306396000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100003","Market 2400","99969OH010",,"OHN006","OHS007","OHF007","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100003-05","Market 2400","87% AV Level Silver Plan",,"0.866410851478577","Yes","Yes","No","100%",,"$400","$0","$1,400","$200","$400","$0","$700","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306397000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100003","Market 2400","99969OH010",,"OHN006","OHS007","OHF007","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100003-06","Market 2400","94% AV Level Silver Plan",,"0.939516007900238","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$0","$400","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306398000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100010","Market Young Adult Essentials","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100010-00","Market Young Adult Essentials","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306413000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100010","Market Young Adult Essentials","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100010-01","Market Young Adult Essentials","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306413000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100001","Market 1200","99969OH010",,"OHN006","OHS007","OHF001","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100001-00","Market 1200","Standard Gold Off Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306386000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100001","Market 1200","99969OH010",,"OHN006","OHS007","OHF001","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100001-01","Market 1200","Standard Gold On Exchange Plan",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306386000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100001","Market 1200","99969OH010",,"OHN006","OHS007","OHF001","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100001-02","Market 1200","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306387000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100001","Market 1200","99969OH010",,"OHN006","OHS007","OHF001","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100001-03","Market 1200","Limited Cost Sharing Plan Variation",,"0.780574321746826","No","Yes","No","100%",,"$1,200","$20","$1,200","$200","$1,200","$600","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306388000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100002","Market 1750","99969OH010",,"OHN006","OHS007","OHF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100002-00","Market 1750","Standard Silver Off Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306389000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100002","Market 1750","99969OH010",,"OHN006","OHS007","OHF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100002-01","Market 1750","Standard Silver On Exchange Plan",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306389000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100002","Market 1750","99969OH010",,"OHN006","OHS007","OHF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100002-02","Market 1750","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306394000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100002","Market 1750","99969OH010",,"OHN006","OHS007","OHF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100002-03","Market 1750","Limited Cost Sharing Plan Variation",,"0.718839228153229","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$1,800","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306393000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100002","Market 1750","99969OH010",,"OHN006","OHS007","OHF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100002-04","Market 1750","73% AV Level Silver Plan",,"0.739519774913788","No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$1,600","$800","$10","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","25.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306392000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100002","Market 1750","99969OH010",,"OHN006","OHS007","OHF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100002-05","Market 1750","87% AV Level Silver Plan",,"0.861778557300568","No","Yes","No","100%",,"$800","$20","$400","$200","$800","$1,200","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306391000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100002","Market 1750","99969OH010",,"OHN006","OHS007","OHF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100002-06","Market 1750","94% AV Level Silver Plan",,"0.934927046298981","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306390000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100004","Market 4000 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100004-00","Market 4000 HSA","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306401000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100004","Market 4000 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100004-01","Market 4000 HSA","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306401000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100004","Market 4000 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100004-02","Market 4000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306406000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100004","Market 4000 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100004-03","Market 4000","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306405000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100004","Market 4000 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100004-04","Market 4000 HSA","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306402000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100004","Market 4000 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100004-05","Market 4000","87% AV Level Silver Plan",,"0.872201919555664","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306403000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100004","Market 4000 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100004-06","Market 4000","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306404000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100007","Market 6400 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100007-00","Market 6400 HSA","Standard Bronze Off Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306410000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100007","Market 6400 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100007-01","Market 6400 HSA","Standard Bronze On Exchange Plan",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306410000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100007","Market 6400 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100007-02","Market 6400","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306412000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100007","Market 6400 HSA","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100007-03","Market 6400","Limited Cost Sharing Plan Variation",,"0.616997122764587","Yes","Yes","No","100%",,"$6,400","$0","$0","$200","$3,700","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306411000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100008","Market 7150","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100008-00","Market 7150","Standard Bronze Off Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306414000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100008","Market 7150","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100008-01","Market 7150","Standard Bronze On Exchange Plan",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306414000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100008","Market 7150","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100008-02","Market 7150","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306416000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100008","Market 7150","99969OH010",,"OHN006","OHS007","OHF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100008-03","Market 7150","Limited Cost Sharing Plan Variation",,"0.611813008785248","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$3,300","$200","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306415000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100006","Market 5000","99969OH010",,"OHN006","OHS007","OHF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100006-00","Market 5000","Standard Bronze Off Exchange Plan",,"0.617568075656891","No","Yes","No","100%",,"$5,000","$20","$900","$200","$3,700","$0","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306407000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100006","Market 5000","99969OH010",,"OHN006","OHS007","OHF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100006-01","Market 5000","Standard Bronze On Exchange Plan",,"0.617568075656891","No","Yes","No","100%",,"$5,000","$20","$900","$200","$3,700","$0","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306407000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100006","Market 5000","99969OH010",,"OHN006","OHS007","OHF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100006-02","Market 5000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306409000000000",
"2017","OH","99969","SERFF","2017-04-21 20:15:32","Individual","No","34-1442712","99969OH0100006","Market 5000","99969OH010",,"OHN006","OHS007","OHF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0100006-03","Market 5000","Limited Cost Sharing Plan Variation",,"0.617568075656891","No","Yes","No","100%",,"$5,000","$20","$900","$200","$3,700","$0","$0","$40","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=004306408000000000",
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0370004","SmartChoice Catastrophic","10091OR037",,"ORN002","ORS005","ORF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0370004-00","SmartChoice Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0370004-00.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0370004","SmartChoice Catastrophic","10091OR037",,"ORN002","ORS005","ORF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0370004-01","SmartChoice Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0370004-01.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0370005","Legacy Catastrophic","10091OR037",,"ORN003","ORS003","ORF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0370005-00","Legacy Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0370005-00.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0370005","Legacy Catastrophic","10091OR037",,"ORN003","ORS003","ORF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0370005-01","Legacy Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0370005-01.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360010","PacificSource Oregon Standard Bronze Plan SCN","10091OR036",,"ORN002","ORS005","ORF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360010-00","PacificSource Oregon Standard Bronze Plan SCN","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0360010-00.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","Yes","93-0245545","10091OR0490001","Dental Advantage 0-20-50","10091OR049",,"ORN005","ORS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Non-participating providers","No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0490001-00","Dental Advantage 0-20-50","Standard High Off Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/oregon/individual-dental-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","Yes","93-0245545","10091OR0490001","Dental Advantage 0-20-50","10091OR049",,"ORN005","ORS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Non-participating providers","No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0490001-01","Dental Advantage 0-20-50","Standard High On Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/oregon/individual-dental-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360010","PacificSource Oregon Standard Bronze Plan SCN","10091OR036",,"ORN002","ORS005","ORF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360010-01","PacificSource Oregon Standard Bronze Plan SCN","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0360010-01.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360010","PacificSource Oregon Standard Bronze Plan SCN","10091OR036",,"ORN002","ORS005","ORF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360010-02","PacificSource Oregon Standard Bronze Plan SCN","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2017/SBC/10091OR0360010-02.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360010","PacificSource Oregon Standard Bronze Plan SCN","10091OR036",,"ORN002","ORS005","ORF008","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360010-03","PacificSource Oregon Standard Bronze Plan SCN","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0360010-03.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360011","PacificSource Oregon Standard Silver Plan SCN","10091OR036",,"ORN002","ORS005","ORF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360011-00","PacificSource Oregon Standard Silver Plan SCN","Standard Silver Off Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360011-00.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360011","PacificSource Oregon Standard Silver Plan SCN","10091OR036",,"ORN002","ORS005","ORF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360011-01","PacificSource Oregon Standard Silver Plan SCN","Standard Silver On Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360011-01.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360011","PacificSource Oregon Standard Silver Plan SCN","10091OR036",,"ORN002","ORS005","ORF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360011-02","PacificSource Oregon Standard Silver Plan SCN","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360011-02.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360011","PacificSource Oregon Standard Silver Plan SCN","10091OR036",,"ORN002","ORS005","ORF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360011-03","PacificSource Oregon Standard Silver Plan SCN","Limited Cost Sharing Plan Variation",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360011-03.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360011","PacificSource Oregon Standard Silver Plan SCN","10091OR036",,"ORN002","ORS005","ORF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360011-04","PacificSource Oregon Standard Silver Plan SCN","73% AV Level Silver Plan",,"0.739740669727325","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360011-04.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360011","PacificSource Oregon Standard Silver Plan SCN","10091OR036",,"ORN002","ORS005","ORF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360011-05","PacificSource Oregon Standard Silver Plan SCN","87% AV Level Silver Plan",,"0.879485428333282","No","Yes","No","100%",,"$850","$20","$640","$150","$850","$500","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360011-05.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360011","PacificSource Oregon Standard Silver Plan SCN","10091OR036",,"ORN002","ORS005","ORF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360011-06","PacificSource Oregon Standard Silver Plan SCN","94% AV Level Silver Plan",,"0.947362661361694","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$300","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360011-06.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360012","PacificSource Oregon Standard Gold Plan SCN","10091OR036",,"ORN002","ORS005","ORF013","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360012-00","PacificSource Oregon Standard Gold Plan SCN","Standard Gold Off Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360012-00.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360012","PacificSource Oregon Standard Gold Plan SCN","10091OR036",,"ORN002","ORS005","ORF013","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360012-01","PacificSource Oregon Standard Gold Plan SCN","Standard Gold On Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360012-01.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360012","PacificSource Oregon Standard Gold Plan SCN","10091OR036",,"ORN002","ORS005","ORF013","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360012-02","PacificSource Oregon Standard Gold Plan SCN","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360012-02.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360012","PacificSource Oregon Standard Gold Plan SCN","10091OR036",,"ORN002","ORS005","ORF013","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360012-03","PacificSource Oregon Standard Gold Plan SCN","Limited Cost Sharing Plan Variation",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360012-03.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360013","PacificSource Oregon Standard Bronze Plan LHN","10091OR036",,"ORN003","ORS003","ORF008","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360013-00","PacificSource Oregon Standard Bronze Plan LHN","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0360013-00.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360013","PacificSource Oregon Standard Bronze Plan LHN","10091OR036",,"ORN003","ORS003","ORF008","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360013-01","PacificSource Oregon Standard Bronze Plan LHN","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0360013-01.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998318801435981",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020004-00","ATRIO Oregon Standard Silver Plan","Standard Silver Off Exchange Plan",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998318801435981",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020004-01","ATRIO Oregon Standard Silver Plan","Standard Silver On Exchange Plan",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360013","PacificSource Oregon Standard Bronze Plan LHN","10091OR036",,"ORN003","ORS003","ORF008","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360013-02","PacificSource Oregon Standard Bronze Plan LHN","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2017/SBC/10091OR0360013-02.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360013","PacificSource Oregon Standard Bronze Plan LHN","10091OR036",,"ORN003","ORS003","ORF008","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360013-03","PacificSource Oregon Standard Bronze Plan LHN","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2017/SBC/10091OR0360013-03.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360014","PacificSource Oregon Standard Silver Plan LHN","10091OR036",,"ORN003","ORS003","ORF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360014-00","PacificSource Oregon Standard Silver Plan LHN","Standard Silver Off Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360014-00.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360014","PacificSource Oregon Standard Silver Plan LHN","10091OR036",,"ORN003","ORS003","ORF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360014-01","PacificSource Oregon Standard Silver Plan LHN","Standard Silver On Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360014-01.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360014","PacificSource Oregon Standard Silver Plan LHN","10091OR036",,"ORN003","ORS003","ORF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360014-02","PacificSource Oregon Standard Silver Plan LHN","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360014-02.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360014","PacificSource Oregon Standard Silver Plan LHN","10091OR036",,"ORN003","ORS003","ORF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360014-03","PacificSource Oregon Standard Silver Plan LHN","Limited Cost Sharing Plan Variation",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360014-03.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360014","PacificSource Oregon Standard Silver Plan LHN","10091OR036",,"ORN003","ORS003","ORF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360014-04","PacificSource Oregon Standard Silver Plan LHN","73% AV Level Silver Plan",,"0.739740669727325","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360014-04.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360014","PacificSource Oregon Standard Silver Plan LHN","10091OR036",,"ORN003","ORS003","ORF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360014-05","PacificSource Oregon Standard Silver Plan LHN","87% AV Level Silver Plan",,"0.879485428333282","No","Yes","No","100%",,"$850","$20","$640","$150","$850","$500","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360014-05.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360014","PacificSource Oregon Standard Silver Plan LHN","10091OR036",,"ORN003","ORS003","ORF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360014-06","PacificSource Oregon Standard Silver Plan LHN","94% AV Level Silver Plan",,"0.947362661361694","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$300","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360014-06.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360015","PacificSource Oregon Standard Gold Plan LHN","10091OR036",,"ORN003","ORS003","ORF013","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360015-00","PacificSource Oregon Standard Gold Plan LHN","Standard Gold Off Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360015-00.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360015","PacificSource Oregon Standard Gold Plan LHN","10091OR036",,"ORN003","ORS003","ORF013","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360015-01","PacificSource Oregon Standard Gold Plan LHN","Standard Gold On Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360015-01.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360015","PacificSource Oregon Standard Gold Plan LHN","10091OR036",,"ORN003","ORS003","ORF013","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360015-02","PacificSource Oregon Standard Gold Plan LHN","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360015-02.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","No","93-0245545","10091OR0360015","PacificSource Oregon Standard Gold Plan LHN","10091OR036",,"ORN003","ORS003","ORF013","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2017-01-01",,"Yes","Emergency care only","Yes","Travel network and non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0360015-03","PacificSource Oregon Standard Gold Plan LHN","Limited Cost Sharing Plan Variation",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2017/SBC/10091OR0360015-03.PDF","https://pacificsource.com/oregon/individual-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","Yes","93-0245545","10091OR0470002","Kids Dental Advantage 0-20-50","10091OR047",,"ORN005","ORS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Non-participating providers","No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0470002-00","Kids Dental Advantage 0-20-50","Standard High Off Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/oregon/individual-dental-brochure-2017.PDF"
"2017","OR","10091","SERFF","2016-08-20 11:23:22","Individual","Yes","93-0245545","10091OR0470002","Kids Dental Advantage 0-20-50","10091OR047",,"ORN005","ORS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency care only","Yes","Non-participating providers","No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0470002-01","Kids Dental Advantage 0-20-50","Standard High On Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/oregon/individual-dental-brochure-2017.PDF"
"2017","OR","25486","SERFF","2016-08-17 06:03:28","Individual","Yes","93-0896677","25486OR0020001","SmartSmile","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.46","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020001-00","SmartSmile","Standard Low Off Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2017","OR","25486","SERFF","2016-08-17 06:03:28","Individual","Yes","93-0896677","25486OR0020001","SmartSmile","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.46","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020001-01","SmartSmile","Standard Low On Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2017","OR","25486","SERFF","2016-08-17 06:03:28","Individual","Yes","93-0896677","25486OR0020002","Super SmartSmile","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.37","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020002-00","Super SmartSmile","Standard Low Off Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2017","OR","25486","SERFF","2016-08-17 06:03:28","Individual","Yes","93-0896677","25486OR0020002","Super SmartSmile","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.37","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020002-01","Super SmartSmile","Standard Low On Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2017","OR","25486","SERFF","2016-08-17 06:03:28","Individual","Yes","93-0896677","25486OR0020003","SmartSmile Plus","25486OR002",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.42","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020003-00","SmartSmile Plus","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2017","OR","25486","SERFF","2016-08-17 06:03:28","Individual","Yes","93-0896677","25486OR0020003","SmartSmile Plus","25486OR002",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.42","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020003-01","SmartSmile Plus","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2017","OR","28415","SERFF","2016-08-24 05:44:16","Individual","Yes","93-0438772","28415OR0210001","Delta Dental Premier","28415OR021",,"ORN002","ORS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","28415OR0210001-00","Delta Dental Premier","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremier_2017_OR.pdf"
"2017","OR","28415","SERFF","2016-08-24 05:44:16","Individual","Yes","93-0438772","28415OR0210001","Delta Dental Premier","28415OR021",,"ORN002","ORS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","28415OR0210001-01","Delta Dental Premier","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremier_2017_OR.pdf"
"2017","OR","28415","SERFF","2016-08-24 05:44:16","Individual","Yes","93-0438772","28415OR0010001","Delta Dental PPO","28415OR001",,"ORN001","ORS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","28415OR0010001-00","Delta Dental PPO","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO_2017_OR.pdf"
"2017","OR","28415","SERFF","2016-08-24 05:44:16","Individual","Yes","93-0438772","28415OR0010001","Delta Dental PPO","28415OR001",,"ORN001","ORS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","28415OR0010001-01","Delta Dental PPO","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO_2017_OR.pdf"
"2017","OR","28415","SERFF","2016-08-24 05:44:16","Individual","Yes","93-0438772","28415OR0010002","Delta Dental Exclusive PPO","28415OR001",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","28415OR0010002-00","Delta Dental Exclusive PPO","Standard High Off Exchange Plan","86.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalExclusivePPO_2017_OR.pdf"
"2017","OR","28415","SERFF","2016-08-24 05:44:16","Individual","Yes","93-0438772","28415OR0010002","Delta Dental Exclusive PPO","28415OR001",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","28415OR0010002-01","Delta Dental Exclusive PPO","Standard High On Exchange Plan","86.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalExclusivePPO_2017_OR.pdf"
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020006","ATRIO Oregon Standard Bronze Plan","32536OR002",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997861515426567",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020006-03","ATRIO Oregon Standard Bronze Plan","Limited Cost Sharing Plan Variation",,"0.617887854576111","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020006-03-ATRIO-OREGON-STANDARD-BRONZE-PLAN-TRIBAL-L.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020008","ATRIO Gold Premium 1000","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998541279281424",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020008-00","ATRIO Gold Premium 1000","Standard Gold Off Exchange Plan",,"0.804017066955566","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020008-01-ATRIO-GOLD-PREMIUM-1000.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020008","ATRIO Gold Premium 1000","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998541279281424",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020008-01","ATRIO Gold Premium 1000","Standard Gold On Exchange Plan",,"0.804017066955566","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020008-01-ATRIO-GOLD-PREMIUM-1000.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020008","ATRIO Gold Premium 1000","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998541279281424",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020008-02","ATRIO Gold Premium 1000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020008-02-ATRIO-GOLD-PREMIUM-1000-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020008","ATRIO Gold Premium 1000","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998541279281424",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020008-03","ATRIO Gold Premium 1000","Limited Cost Sharing Plan Variation",,"0.804017066955566","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020008-03-ATRIO-GOLD-PREMIUM-1000-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2500","32536OR002",,"ORN001","ORS001","ORF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998368814207908",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020009-00","ATRIO Silver Choice 2500","Standard Silver Off Exchange Plan",,"0.718190789222717","No","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$360","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020009-01-ATRIO-SILVER-CHOICE-2500.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2500","32536OR002",,"ORN001","ORS001","ORF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998368814207908",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020009-01","ATRIO Silver Choice 2500","Standard Silver On Exchange Plan",,"0.718190789222717","No","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$360","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020009-01-ATRIO-SILVER-CHOICE-2500.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020002","ATRIO Oregon Standard Gold Plan","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998574343617712",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020002-00","ATRIO Oregon Standard Gold Plan","Standard Gold Off Exchange Plan",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020002","ATRIO Oregon Standard Gold Plan","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998574343617712",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020002-01","ATRIO Oregon Standard Gold Plan","Standard Gold On Exchange Plan",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020002","ATRIO Oregon Standard Gold Plan","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998574343617712",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020002-02","ATRIO Oregon Standard Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020002-02-ATRIO-OREGON-STANDARD-GOLD-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020002","ATRIO Oregon Standard Gold Plan","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998574343617712",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020002-03","ATRIO Oregon Standard Gold Plan","Limited Cost Sharing Plan Variation",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020002-03-ATRIO-OREGON-STANDARD-GOLD-PLAN-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998318801435981",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020004-02","ATRIO Oregon Standard Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020004-02-ATRIO-OREGON-STANDARD-SILVER-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998318801435981",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020004-03","ATRIO Oregon Standard Silver Plan","Limited Cost Sharing Plan Variation",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020004-03-ATRIO-OREGON-STANDARD-SILVER-PLAN-TRIBAL-L.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998318801435981",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020004-04","ATRIO Oregon Standard Silver Plan","73% AV Level Silver Plan",,"0.737883269786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020004-04-ATRIO-OREGON-STANDARD-SILVER-PLAN-CSR250.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998318801435981",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020004-05","ATRIO Oregon Standard Silver Plan","87% AV Level Silver Plan",,"0.878856003284454","No","Yes","No","100%",,"$850","$20","$640","$150","$850","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020004-05-ATRIO-OREGON-STANDARD-SILVER-PLAN-CSR200.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998318801435981",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020004-06","ATRIO Oregon Standard Silver Plan","94% AV Level Silver Plan",,"0.946812570095062","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020004-06-ATRIO-OREGON-STANDARD-SILVER-PLAN-CSR150.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020006","ATRIO Oregon Standard Bronze Plan","32536OR002",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997861515426567",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020006-00","ATRIO Oregon Standard Bronze Plan","Standard Bronze Off Exchange Plan",,"0.617887854576111","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020006","ATRIO Oregon Standard Bronze Plan","32536OR002",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997861515426567",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020006-01","ATRIO Oregon Standard Bronze Plan","Standard Bronze On Exchange Plan",,"0.617887854576111","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020006","ATRIO Oregon Standard Bronze Plan","32536OR002",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997861515426567",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020006-02","ATRIO Oregon Standard Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020006-02-ATRIO-OREGON-STANDARD-BRONZE-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2500","32536OR002",,"ORN001","ORS001","ORF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998368814207908",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020009-02","ATRIO Silver Choice 2500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020009-02-ATRIO-SILVER-CHOICE-2500-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2500","32536OR002",,"ORN001","ORS001","ORF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998368814207908",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020009-03","ATRIO Silver Choice 2500","Limited Cost Sharing Plan Variation",,"0.718190789222717","No","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$360","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020009-03-ATRIO-SILVER-CHOICE-2500-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2500","32536OR002",,"ORN001","ORS001","ORF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998368814207908",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020009-04","ATRIO Silver Choice 2500","73% AV Level Silver Plan",,"0.73820573091507","No","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$360","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$5,650","$5650 per person","$11300 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020009-04-ATRIO-SILVER-CHOICE-2500-CSR250.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2500","32536OR002",,"ORN001","ORS001","ORF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998368814207908",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020009-05","ATRIO Silver Choice 2500","87% AV Level Silver Plan",,"0.868521273136139","No","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$360","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020009-05-ATRIO-SILVER-CHOICE-2500-CSR200.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2500","32536OR002",,"ORN001","ORS001","ORF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998368814207908",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020009-06","ATRIO Silver Choice 2500","94% AV Level Silver Plan",,"0.940669536590576","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020009-06-ATRIO-SILVER-CHOICE-2500-CSR150.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998272629585273",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020011-00","ATRIO Silver Choice 3030","Standard Silver Off Exchange Plan",,"0.717623233795166","No","Yes","No","100%",,"$3,000","$20","$1,290","$150","$3,000","$300","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020011-01-ATRIO-SILVER-CHOICE-3030.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998272629585273",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020011-01","ATRIO Silver Choice 3030","Standard Silver On Exchange Plan",,"0.717623233795166","No","Yes","No","100%",,"$3,000","$20","$1,290","$150","$3,000","$300","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020011-01-ATRIO-SILVER-CHOICE-3030.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998272629585273",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020011-02","ATRIO Silver Choice 3030","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020011-02-ATRIO-SILVER-CHOICE-3030-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998272629585273",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020011-03","ATRIO Silver Choice 3030","Limited Cost Sharing Plan Variation",,"0.717623233795166","No","Yes","No","100%",,"$3,000","$20","$1,290","$150","$3,000","$300","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020011-03-ATRIO-SILVER-CHOICE-3030-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998272629585273",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020011-04","ATRIO Silver Choice 3030","73% AV Level Silver Plan",,"0.738713681697845","No","Yes","No","100%",,"$3,000","$20","$1,290","$150","$3,000","$300","$280","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020011-04-ATRIO-SILVER-CHOICE-3030-CSR250.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998272629585273",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020011-05","ATRIO Silver Choice 3030","87% AV Level Silver Plan",,"0.866160929203033","No","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$360","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020011-05-ATRIO-SILVER-CHOICE-3030-CSR200.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998272629585273",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020011-06","ATRIO Silver Choice 3030","94% AV Level Silver Plan",,"0.942607700824738","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020011-06-ATRIO-SILVER-CHOICE-3030-CSR150.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020012","ATRIO Bronze 6350 HSA","32536OR002",,"ORN001","ORS001","ORF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997995797025836",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020012-00","ATRIO Bronze 6350 HSA","Standard Bronze Off Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Yes",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020012-01-ATRIO-BRONZE-6350-HSA.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020012","ATRIO Bronze 6350 HSA","32536OR002",,"ORN001","ORS001","ORF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997995797025836",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020012-01","ATRIO Bronze 6350 HSA","Standard Bronze On Exchange Plan",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Yes",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020012-01-ATRIO-BRONZE-6350-HSA.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020012","ATRIO Bronze 6350 HSA","32536OR002",,"ORN001","ORS001","ORF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997995797025836",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020012-02","ATRIO Bronze 6350 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020012-02-ATRIO-BRONZE-6350-HSA-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020012","ATRIO Bronze 6350 HSA","32536OR002",,"ORN001","ORS001","ORF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997995797025836",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020012-03","ATRIO Bronze 6350 HSA","Limited Cost Sharing Plan Variation",,"0.618602871894836","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Yes",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020012-03-ATRIO-BRONZE-6350-HSA-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020013","ATRIO Bronze Saver 6850","32536OR002",,"ORN001","ORS001","ORF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997971077254808",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020013-00","ATRIO Bronze Saver 6850","Standard Bronze Off Exchange Plan",,"0.599242508411407","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020013-01-ATRIO-BRONZE-SAVER-6850.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020013","ATRIO Bronze Saver 6850","32536OR002",,"ORN001","ORS001","ORF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997971077254808",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020013-01","ATRIO Bronze Saver 6850","Standard Bronze On Exchange Plan",,"0.599242508411407","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Non-Standard-Enhanced-Plans/2017/32536OR0020013-01-ATRIO-BRONZE-SAVER-6850.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020013","ATRIO Bronze Saver 6850","32536OR002",,"ORN001","ORS001","ORF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997971077254808",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020013-02","ATRIO Bronze Saver 6850","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020013-02-ATRIO-BRONZE-SAVER-6850-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0020013","ATRIO Bronze Saver 6850","32536OR002",,"ORN001","ORS001","ORF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997971077254808",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0020013-03","ATRIO Bronze Saver 6850","Limited Cost Sharing Plan Variation",,"0.599242508411407","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0020013-03-ATRIO-BRONZE-SAVER-6850-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040001","ATRIO Gold Pioneer","32536OR004",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.99849508474776",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040001-00","ATRIO Gold Pioneer","Standard Gold Off Exchange Plan",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040001-01-ATRIO-GOLD-PIONEER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040001","ATRIO Gold Pioneer","32536OR004",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.99849508474776",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040001-01","ATRIO Gold Pioneer","Standard Gold On Exchange Plan",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040001-01-ATRIO-GOLD-PIONEER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040001","ATRIO Gold Pioneer","32536OR004",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.99849508474776",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040001-02","ATRIO Gold Pioneer","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0040001-02-ATRIO-GOLD-PIONEER-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040001","ATRIO Gold Pioneer","32536OR004",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.99849508474776",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040001-03","ATRIO Gold Pioneer","Limited Cost Sharing Plan Variation",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0040001-03-ATRIO-GOLD-PIONEER-PLAN-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998220894697643",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040002-00","ATRIO Silver Pioneer","Standard Silver Off Exchange Plan",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040002-01-ATRIO-SILVER-PIONEER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998220894697643",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040002-01","ATRIO Silver Pioneer","Standard Silver On Exchange Plan",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040002-01-ATRIO-SILVER-PIONEER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998220894697643",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040002-02","ATRIO Silver Pioneer","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0040002-02-ATRIO-SILVER-PIONEER-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998220894697643",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040002-03","ATRIO Silver Pioneer","Limited Cost Sharing Plan Variation",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0040002-03-ATRIO-SILVER-PIONEER-PLAN-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998220894697643",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040002-04","ATRIO Silver Pioneer","73% AV Level Silver Plan",,"0.737883269786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040002-04-ATRIO-SILVER-PIONEER-PLAN-CSR250.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998220894697643",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040002-05","ATRIO Silver Pioneer","87% AV Level Silver Plan",,"0.878856003284454","No","Yes","No","100%",,"$850","$20","$640","$150","$850","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040002-05-ATRIO-SILVER-PIONEER-PLAN-CSR200.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998220894697643",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040002-06","ATRIO Silver Pioneer","94% AV Level Silver Plan",,"0.946812570095062","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040002-06-ATRIO-SILVER-PIONEER-PLAN-CSR150.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040003","ATRIO Bronze Pioneer","32536OR004",,"ORN001","ORS001","ORF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997732253898799",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040003-00","ATRIO Bronze Pioneer","Standard Bronze Off Exchange Plan",,"0.587789475917816","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040003-01-ATRIO-BRONZE-PIONEER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040003","ATRIO Bronze Pioneer","32536OR004",,"ORN001","ORS001","ORF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997732253898799",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040003-01","ATRIO Bronze Pioneer","Standard Bronze On Exchange Plan",,"0.587789475917816","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/2017/32536OR0040003-01-ATRIO-BRONZE-PIONEER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040003","ATRIO Bronze Pioneer","32536OR004",,"ORN001","ORS001","ORF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997732253898799",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040003-02","ATRIO Bronze Pioneer","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0040003-02-ATRIO-BRONZE-PIONEER-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0040003","ATRIO Bronze Pioneer","32536OR004",,"ORN001","ORS001","ORF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.997732253898799",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0040003-03","ATRIO Bronze Pioneer","Limited Cost Sharing Plan Variation",,"0.587789475917816","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0040003-03-ATRIO-BRONZE-PIONEER-PLAN-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060001","ATRIO Oregon Standard Gold Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998780795568168",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060001-00","ATRIO Oregon Standard Gold Plan (Deschutes)","Standard Gold Off Exchange Plan",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060001-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060001","ATRIO Oregon Standard Gold Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998780795568168",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060001-01","ATRIO Oregon Standard Gold Plan (Deschutes)","Standard Gold On Exchange Plan",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060001-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060001","ATRIO Oregon Standard Gold Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998780795568168",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060001-02","ATRIO Oregon Standard Gold Plan (Deschutes)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0060001-02-ATRIO-OREGON-STANDARD-GOLD-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060001","ATRIO Oregon Standard Gold Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998780795568168",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060001-03","ATRIO Oregon Standard Gold Plan (Deschutes)","Limited Cost Sharing Plan Variation",,"0.786138892173767","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0060003-03-ATRIO-OREGON-STANDARD-BRONZE-PLAN-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060002","ATRIO Oregon Standard Silver Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998561879910267",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060002-00","ATRIO Oregon Standard Silver Plan (Deschutes)","Standard Silver Off Exchange Plan",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060002-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060002","ATRIO Oregon Standard Silver Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998561879910267",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060002-01","ATRIO Oregon Standard Silver Plan (Deschutes)","Standard Silver On Exchange Plan",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060002-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060002","ATRIO Oregon Standard Silver Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998561879910267",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060002-02","ATRIO Oregon Standard Silver Plan (Deschutes)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0060002-02-ATRIO-OREGON-STANDARD-SILVER-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060002","ATRIO Oregon Standard Silver Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998561879910267",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060002-03","ATRIO Oregon Standard Silver Plan (Deschutes)","Limited Cost Sharing Plan Variation",,"0.7018923163414","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0060002-03-ATRIO-OREGON-STANDARD-SILVER-PLAN-TRIBAL-LIM.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060002","ATRIO Oregon Standard Silver Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998561879910267",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060002-04","ATRIO Oregon Standard Silver Plan (Deschutes)","73% AV Level Silver Plan",,"0.737883269786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060002-04-ATRIO-OREGON-STANDARD-SILVER-PLAN-CSR250.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060002","ATRIO Oregon Standard Silver Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998561879910267",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060002-05","ATRIO Oregon Standard Silver Plan (Deschutes)","87% AV Level Silver Plan",,"0.878856003284454","No","Yes","No","100%",,"$850","$20","$640","$150","$850","$360","$190","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060002-05-ATRIO-OREGON-STANDARD-SILVER-PLAN-CSR200.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060002","ATRIO Oregon Standard Silver Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998561879910267",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060002-06","ATRIO Oregon Standard Silver Plan (Deschutes)","94% AV Level Silver Plan",,"0.946812570095062","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060002-06-ATRIO-OREGON-STANDARD-SILVER-PLAN-CSR150.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060003","ATRIO Oregon Standard Bronze Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998170671879014",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060003-00","ATRIO Oregon Standard Bronze Plan (Deschutes)","Standard Bronze Off Exchange Plan",,"0.617887854576111","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060003-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060003","ATRIO Oregon Standard Bronze Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998170671879014",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060003-01","ATRIO Oregon Standard Bronze Plan (Deschutes)","Standard Bronze On Exchange Plan",,"0.617887854576111","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/2017/32536OR0060003-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060003","ATRIO Oregon Standard Bronze Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998170671879014",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060003-02","ATRIO Oregon Standard Bronze Plan (Deschutes)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0060003-02-ATRIO-OREGON-STANDARD-BRONZE-PLAN-TRIBAL-0.pdf",
"2017","OR","32536","SERFF","2016-10-18 04:56:11","Individual","No","43-2071108","32536OR0060003","ATRIO Oregon Standard Bronze Plan (Deschutes)","32536OR006",,"ORN001","ORS002","ORF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.998170671879014",,,"2017-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/documents/Exchange/Formulary/2016-Commercial-Formulary.pdf","32536OR0060003-03","ATRIO Oregon Standard Bronze Plan (Deschutes)","Limited Cost Sharing Plan Variation",,"0.617887854576111","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,410","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","No",,,"https://www.atriohp.com/documents/Exchange/Benefit-Info/Tribal-Plans/2017/32536OR0060001-03-ATRIO-OREGON-STANDARD-GOLD-PLAN-TRIBAL-LIM.pdf",
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-00","Moda Health Oregon Standard Silver (Beacon)","Standard Silver Off Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,410","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-01","Moda Health Oregon Standard Silver (Beacon)","Standard Silver On Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,410","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-02","Moda Health Oregon Standard Silver (Beacon)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-03","Moda Health Oregon Standard Silver (Beacon)","Limited Cost Sharing Plan Variation",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,410","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-04","Moda Health Oregon Standard Silver (Beacon)","73% AV Level Silver Plan",,"0.739740669727325","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,410","$1,000","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV1_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV1_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-05","Moda Health Oregon Standard Silver (Beacon)","87% AV Level Silver Plan",,"0.879485428333282","No","Yes","No","100%",,"$850","$20","$600","$200","$850","$600","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV2_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV2_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-06","Moda Health Oregon Standard Silver (Beacon)","94% AV Level Silver Plan",,"0.947362661361694","No","Yes","No","100%",,"$100","$0","$600","$200","$100","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","25.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV3_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV3_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560003","Moda Health Oregon Standard Bronze (Beacon)","39424OR156",,"ORN001","ORS001","ORF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560003-00","Moda Health Oregon Standard Bronze (Beacon)","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$5,170","$20","$0","$200","$1,410","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560003","Moda Health Oregon Standard Bronze (Beacon)","39424OR156",,"ORN001","ORS001","ORF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560003-01","Moda Health Oregon Standard Bronze (Beacon)","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$5,170","$20","$0","$200","$1,410","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560003","Moda Health Oregon Standard Bronze (Beacon)","39424OR156",,"ORN001","ORS001","ORF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560003-02","Moda Health Oregon Standard Bronze (Beacon)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560003","Moda Health Oregon Standard Bronze (Beacon)","39424OR156",,"ORN001","ORS001","ORF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560003-03","Moda Health Oregon Standard Bronze (Beacon)","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$5,170","$20","$0","$200","$1,410","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-00","Moda Health Oregon Standard Silver (Affinity)","Standard Silver Off Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,410","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-01","Moda Health Oregon Standard Silver (Affinity)","Standard Silver On Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,410","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-02","Moda Health Oregon Standard Silver (Affinity)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-03","Moda Health Oregon Standard Silver (Affinity)","Limited Cost Sharing Plan Variation",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,410","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-04","Moda Health Oregon Standard Silver (Affinity)","73% AV Level Silver Plan",,"0.739740669727325","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,410","$1,000","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV1_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV1_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-05","Moda Health Oregon Standard Silver (Affinity)","87% AV Level Silver Plan",,"0.879485428333282","No","Yes","No","100%",,"$850","$20","$600","$200","$850","$600","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV2_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV2_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-06","Moda Health Oregon Standard Silver (Affinity)","94% AV Level Silver Plan",,"0.947362661361694","No","Yes","No","100%",,"$100","$0","$600","$200","$100","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","25.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV3_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV3_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560006","Moda Health Oregon Standard Bronze (Affinity)","39424OR156",,"ORN002","ORS002","ORF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560006-00","Moda Health Oregon Standard Bronze (Affinity)","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$5,170","$20","$0","$200","$1,410","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560006","Moda Health Oregon Standard Bronze (Affinity)","39424OR156",,"ORN002","ORS002","ORF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560006-01","Moda Health Oregon Standard Bronze (Affinity)","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$5,170","$20","$0","$200","$1,410","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560006","Moda Health Oregon Standard Bronze (Affinity)","39424OR156",,"ORN002","ORS002","ORF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560006-02","Moda Health Oregon Standard Bronze (Affinity)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560006","Moda Health Oregon Standard Bronze (Affinity)","39424OR156",,"ORN002","ORS002","ORF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9981",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560006-03","Moda Health Oregon Standard Bronze (Affinity)","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$5,170","$20","$0","$200","$1,410","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560001","Moda Health Oregon Standard Gold (Beacon)","39424OR156",,"ORN001","ORS001","ORF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560001-00","Moda Health Oregon Standard Gold (Beacon)","Standard Gold Off Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560001","Moda Health Oregon Standard Gold (Beacon)","39424OR156",,"ORN001","ORS001","ORF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560001-01","Moda Health Oregon Standard Gold (Beacon)","Standard Gold On Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560001","Moda Health Oregon Standard Gold (Beacon)","39424OR156",,"ORN001","ORS001","ORF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560001-02","Moda Health Oregon Standard Gold (Beacon)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560001","Moda Health Oregon Standard Gold (Beacon)","39424OR156",,"ORN001","ORS001","ORF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560001-03","Moda Health Oregon Standard Gold (Beacon)","Limited Cost Sharing Plan Variation",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560004","Moda Health Oregon Standard Gold (Affinity)","39424OR156",,"ORN002","ORS002","ORF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560004-00","Moda Health Oregon Standard Gold (Affinity)","Standard Gold Off Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560004","Moda Health Oregon Standard Gold (Affinity)","39424OR156",,"ORN002","ORS002","ORF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560004-01","Moda Health Oregon Standard Gold (Affinity)","Standard Gold On Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560004","Moda Health Oregon Standard Gold (Affinity)","39424OR156",,"ORN002","ORS002","ORF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560004-02","Moda Health Oregon Standard Gold (Affinity)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1560004","Moda Health Oregon Standard Gold (Affinity)","39424OR156",,"ORN002","ORS002","ORF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560004-03","Moda Health Oregon Standard Gold (Affinity)","Limited Cost Sharing Plan Variation",,"0.788648962974548","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580001","Moda Health Beacon Be Protected","39424OR158",,"ORN001","ORS001","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580001-00","Moda Health Beacon Be Protected","Standard Gold Off Exchange Plan",,"0.801834285259247","Yes","Yes","No","100%",,"$1,000","$20","$900","$200","$1,000","$600","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580001","Moda Health Beacon Be Protected","39424OR158",,"ORN001","ORS001","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580001-01","Moda Health Beacon Be Protected","Standard Gold On Exchange Plan",,"0.801834285259247","Yes","Yes","No","100%",,"$1,000","$20","$900","$200","$1,000","$600","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580001","Moda Health Beacon Be Protected","39424OR158",,"ORN001","ORS001","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580001-02","Moda Health Beacon Be Protected","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580001","Moda Health Beacon Be Protected","39424OR158",,"ORN001","ORS001","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580001-03","Moda Health Beacon Be Protected","Limited Cost Sharing Plan Variation",,"0.801834285259247","Yes","Yes","No","100%",,"$1,000","$20","$900","$200","$1,000","$600","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared","39424OR158",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-00","Moda Health Beacon Be Prepared","Standard Silver Off Exchange Plan",,"0.713824391365051","Yes","Yes","No","100%",,"$2,250","$20","$1,500","$200","$1,410","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared","39424OR158",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-01","Moda Health Beacon Be Prepared","Standard Silver On Exchange Plan",,"0.713824391365051","Yes","Yes","No","100%",,"$2,250","$20","$1,500","$200","$1,410","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared","39424OR158",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-02","Moda Health Beacon Be Prepared","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared","39424OR158",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-03","Moda Health Beacon Be Prepared","Limited Cost Sharing Plan Variation",,"0.713824391365051","Yes","Yes","No","100%",,"$2,250","$20","$1,500","$200","$1,410","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared","39424OR158",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-04","Moda Health Beacon Be Prepared","73% AV Level Silver Plan",,"0.735724866390228","Yes","Yes","No","100%",,"$2,250","$20","$1,500","$200","$1,410","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV1_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV1_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared","39424OR158",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-05","Moda Health Beacon Be Prepared","87% AV Level Silver Plan",,"0.874471485614777","Yes","Yes","No","100%",,"$750","$0","$800","$200","$750","$700","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV2_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV2_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared","39424OR158",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-06","Moda Health Beacon Be Prepared","94% AV Level Silver Plan",,"0.947782754898071","Yes","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV3_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV3_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1460001","Moda Health Beacon Be Integrated","39424OR146",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460001-00","Moda Health Beacon Be Integrated","Standard Gold Off Exchange Plan",,"0.79876708984375","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeIntegrated_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeIntegrated_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1460001","Moda Health Beacon Be Integrated","39424OR146",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460001-01","Moda Health Beacon Be Integrated","Standard Gold On Exchange Plan",,"0.79876708984375","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeIntegrated_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeIntegrated_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1460001","Moda Health Beacon Be Integrated","39424OR146",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460001-02","Moda Health Beacon Be Integrated","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeIntegrated_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeIntegrated_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1460001","Moda Health Beacon Be Integrated","39424OR146",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2017-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460001-03","Moda Health Beacon Be Integrated","Limited Cost Sharing Plan Variation",,"0.79876708984375","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeIntegrated_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeIntegrated_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1590001","Moda Health Beacon Be Steady","39424OR159",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2017-01-01",,"No",,"No",,"Yes",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1590001-00","Moda Health Beacon Be Steady","Standard Silver Off Exchange Plan",,"0.716387689113617","Yes","Yes","No","100%",,"$3,650","$20","$1,100","$200","$1,410","$800","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","30.00%",,,,,"$7,300","$7300 per person","$14600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1590001","Moda Health Beacon Be Steady","39424OR159",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2017-01-01",,"No",,"No",,"Yes",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1590001-01","Moda Health Beacon Be Steady","Standard Silver On Exchange Plan",,"0.716387689113617","Yes","Yes","No","100%",,"$3,650","$20","$1,100","$200","$1,410","$800","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","30.00%",,,,,"$7,300","$7300 per person","$14600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1590001","Moda Health Beacon Be Steady","39424OR159",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2017-01-01",,"No",,"No",,"Yes",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1590001-02","Moda Health Beacon Be Steady","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV0_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV0_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1590001","Moda Health Beacon Be Steady","39424OR159",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2017-01-01",,"No",,"No",,"Yes",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1590001-03","Moda Health Beacon Be Steady","Limited Cost Sharing Plan Variation",,"0.716387689113617","Yes","Yes","No","100%",,"$3,650","$20","$1,100","$200","$1,410","$800","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","30.00%",,,,,"$7,300","$7300 per person","$14600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1590001","Moda Health Beacon Be Steady","39424OR159",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2017-01-01",,"No",,"No",,"Yes",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1590001-04","Moda Health Beacon Be Steady","73% AV Level Silver Plan",,"0.739356458187103","Yes","Yes","No","100%",,"$3,650","$20","$1,100","$200","$1,410","$800","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","30.00%",,,,,"$7,300","$7300 per person","$14600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV1_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV1_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1590001","Moda Health Beacon Be Steady","39424OR159",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2017-01-01",,"No",,"No",,"Yes",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1590001-05","Moda Health Beacon Be Steady","87% AV Level Silver Plan",,"0.874252080917358","Yes","Yes","No","100%",,"$750","$0","$800","$200","$750","$500","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$7,300","$7300 per person","$14600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV2_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV2_2017_OR.pdf"
"2017","OR","39424","SERFF","2017-01-24 20:15:29","Individual","No","93-0989307","39424OR1590001","Moda Health Beacon Be Steady","39424OR159",,"ORN001","ORS001","ORF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2017-01-01",,"No",,"No",,"Yes",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1590001-06","Moda Health Beacon Be Steady","94% AV Level Silver Plan",,"0.938868463039398","Yes","Yes","No","100%",,"$100","$0","$400","$200","$250","$90","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"$7,300","$7300 per person","$14600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV3_SBC_2017_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV3_2017_OR.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850006","Balance 2500 Silver","56707OR085",,"ORN001","ORS002","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-00","Balance 2500 Silver","Standard Silver Off Exchange Plan",,"0.706751227378845","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/direct/2017 OR IND Balance 2500 Silver00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850006","Balance 2500 Silver","56707OR085",,"ORN001","ORS002","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-01","Balance 2500 Silver","Standard Silver On Exchange Plan",,"0.706751227378845","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Balance 2500 Silver01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850006","Balance 2500 Silver","56707OR085",,"ORN001","ORS002","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-02","Balance 2500 Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Balance 2500 Silver02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850006","Balance 2500 Silver","56707OR085",,"ORN001","ORS002","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-03","Balance 2500 Silver","Limited Cost Sharing Plan Variation",,"0.706751227378845","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Balance 2500 Silver03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850006","Balance 2500 Silver","56707OR085",,"ORN001","ORS002","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-04","Balance 2500 Silver","73% AV Level Silver Plan",,"0.737053513526917","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"$21,200","$21200 per person","$42400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Balance 2500 Silver04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850006","Balance 2500 Silver","56707OR085",,"ORN001","ORS002","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-05","Balance 2500 Silver","87% AV Level Silver Plan",,"0.877152562141418","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$460","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Balance 2500 Silver05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850006","Balance 2500 Silver","56707OR085",,"ORN001","ORS002","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-06","Balance 2500 Silver","94% AV Level Silver Plan",,"0.946624219417572","Yes","Yes","No","100%",,"$100","$20","$360","$150","$100","$450","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Balance 2500 Silver06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850008","Balance 7150 Bronze","56707OR085",,"ORN001","ORS002","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850008-00","Balance 7150 Bronze","Standard Bronze Off Exchange Plan","61.92%","0.62182742357254","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Balance 7150 Bronze01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850008","Balance 7150 Bronze","56707OR085",,"ORN001","ORS002","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850008-01","Balance 7150 Bronze","Standard Bronze On Exchange Plan","61.92%","0.62182742357254","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Balance 7150 Bronze01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850008","Balance 7150 Bronze","56707OR085",,"ORN001","ORS002","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850008-02","Balance 7150 Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Balance 7150 Bronze02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0850008","Balance 7150 Bronze","56707OR085",,"ORN001","ORS002","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850008-03","Balance 7150 Bronze","Limited Cost Sharing Plan Variation","61.92%","0.62182742357254","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Balance 7150 Bronze03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900009","Choice 2500 Silver","56707OR090",,"ORN002","ORS003","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9936",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-00","Choice 2500 Silver","Standard Silver Off Exchange Plan",,"0.706751227378845","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/direct/2017 OR IND Choice 2500 Silver00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900009","Choice 2500 Silver","56707OR090",,"ORN002","ORS003","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9936",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-01","Choice 2500 Silver","Standard Silver On Exchange Plan",,"0.706751227378845","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Choice 2500 Silver01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900009","Choice 2500 Silver","56707OR090",,"ORN002","ORS003","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9936",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-02","Choice 2500 Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Choice 2500 Silver02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900009","Choice 2500 Silver","56707OR090",,"ORN002","ORS003","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9936",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-03","Choice 2500 Silver","Limited Cost Sharing Plan Variation",,"0.706751227378845","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Choice 2500 Silver03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900009","Choice 2500 Silver","56707OR090",,"ORN002","ORS003","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9936",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-04","Choice 2500 Silver","73% AV Level Silver Plan",,"0.737053513526917","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"$21,200","$21200 per person","$42400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Choice 2500 Silver04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900009","Choice 2500 Silver","56707OR090",,"ORN002","ORS003","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9936",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-05","Choice 2500 Silver","87% AV Level Silver Plan",,"0.877152562141418","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$460","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Choice 2500 Silver05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900009","Choice 2500 Silver","56707OR090",,"ORN002","ORS003","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9936",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-06","Choice 2500 Silver","94% AV Level Silver Plan",,"0.946624219417572","Yes","Yes","No","100%",,"$100","$20","$360","$150","$100","$450","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Choice 2500 Silver06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900011","Choice 7150 Bronze","56707OR090",,"ORN002","ORS003","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900011-00","Choice 7150 Bronze","Standard Bronze Off Exchange Plan","61.92%","0.62182742357254","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Choice 7150 Bronze01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900011","Choice 7150 Bronze","56707OR090",,"ORN002","ORS003","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900011-01","Choice 7150 Bronze","Standard Bronze On Exchange Plan","61.92%","0.62182742357254","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Choice 7150 Bronze01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900011","Choice 7150 Bronze","56707OR090",,"ORN002","ORS003","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900011-02","Choice 7150 Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Choice 7150 Bronze02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0900011","Choice 7150 Bronze","56707OR090",,"ORN002","ORS003","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900011-03","Choice 7150 Bronze","Limited Cost Sharing Plan Variation","61.92%","0.62182742357254","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Choice 7150 Bronze03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910009","Connect 2500 Silver","56707OR091",,"ORN003","ORS004","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-00","Connect 2500 Silver","Standard Silver Off Exchange Plan",,"0.706751227378845","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/direct/2017 OR IND Connect 2500 Silver00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910009","Connect 2500 Silver","56707OR091",,"ORN003","ORS004","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-01","Connect 2500 Silver","Standard Silver On Exchange Plan",,"0.706751227378845","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Connect 2500 Silver01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910009","Connect 2500 Silver","56707OR091",,"ORN003","ORS004","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-02","Connect 2500 Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Connect 2500 Silver02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910009","Connect 2500 Silver","56707OR091",,"ORN003","ORS004","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-03","Connect 2500 Silver","Limited Cost Sharing Plan Variation",,"0.706751227378845","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Connect 2500 Silver03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910009","Connect 2500 Silver","56707OR091",,"ORN003","ORS004","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-04","Connect 2500 Silver","73% AV Level Silver Plan",,"0.737053513526917","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$580","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"$21,200","$21200 per person","$42400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Connect 2500 Silver04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910009","Connect 2500 Silver","56707OR091",,"ORN003","ORS004","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-05","Connect 2500 Silver","87% AV Level Silver Plan",,"0.877152562141418","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$460","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Connect 2500 Silver05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910009","Connect 2500 Silver","56707OR091",,"ORN003","ORS004","ORF001","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9969",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-06","Connect 2500 Silver","94% AV Level Silver Plan",,"0.946624219417572","Yes","Yes","No","100%",,"$100","$20","$360","$150","$100","$450","$70","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Connect 2500 Silver06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910011","Connect 7150 Bronze","56707OR091",,"ORN003","ORS004","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910011-00","Connect 7150 Bronze","Standard Bronze Off Exchange Plan","61.92%","0.63032865524292","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/direct/2017 OR IND Connect 7150 Bronze00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910011","Connect 7150 Bronze","56707OR091",,"ORN003","ORS004","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910011-01","Connect 7150 Bronze","Standard Bronze On Exchange Plan","61.92%","0.63032865524292","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Connect 7150 Bronze01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910011","Connect 7150 Bronze","56707OR091",,"ORN003","ORS004","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910011-02","Connect 7150 Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Connect 7150 Bronze02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0910011","Connect 7150 Bronze","56707OR091",,"ORN003","ORS004","ORF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2017-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910011-03","Connect 7150 Bronze","Limited Cost Sharing Plan Variation","61.92%","0.63032865524292","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Connect 7150 Bronze03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990004","Providence Oregon Standard Gold Plan Area G","56707OR099",,"ORN001","ORS006","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990004-01","Providence Oregon Standard Gold Plan Area G","Standard Gold On Exchange Plan",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Gold Plan Area G01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990004","Providence Oregon Standard Gold Plan Area G","56707OR099",,"ORN001","ORS006","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990004-02","Providence Oregon Standard Gold Plan Area G","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Gold Plan Area G02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0890005","HSA 6000 Bronze","56707OR089",,"ORN001","ORS002","ORF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0890005-00","HSA 6000 Bronze","Standard Bronze Off Exchange Plan",,"0.614537060260773","Yes","Yes","No","100%",,"$6,000","$0","$260","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/direct/2017 OR IND HSA Qualified 6000 Bronze00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0890005","HSA 6000 Bronze","56707OR089",,"ORN001","ORS002","ORF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0890005-01","HSA 6000 Bronze","Standard Bronze On Exchange Plan",,"0.614537060260773","Yes","Yes","No","100%",,"$6,000","$0","$260","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND HSA Qualified 6000 Bronze01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0890005","HSA 6000 Bronze","56707OR089",,"ORN001","ORS002","ORF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0890005-02","HSA 6000 Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND HSA Qualified 6000 Bronze02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0890005","HSA 6000 Bronze","56707OR089",,"ORN001","ORS002","ORF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0890005-03","HSA 6000 Bronze","Limited Cost Sharing Plan Variation",,"0.614537060260773","Yes","Yes","No","100%",,"$6,000","$0","$260","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND HSA Qualified 6000 Bronze03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990002","Providence Oregon Standard Gold Plan","56707OR099",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990002-00","Providence Oregon Standard Gold Plan","Standard Gold Off Exchange Plan",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/direct/2017 OR IND Providence Oregon Standard Gold Plan00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990002","Providence Oregon Standard Gold Plan","56707OR099",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990002-01","Providence Oregon Standard Gold Plan","Standard Gold On Exchange Plan",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Providence Oregon Standard Gold Plan01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990002","Providence Oregon Standard Gold Plan","56707OR099",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990002-02","Providence Oregon Standard Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Providence Oregon Standard Gold Plan02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990002","Providence Oregon Standard Gold Plan","56707OR099",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990002-03","Providence Oregon Standard Gold Plan","Limited Cost Sharing Plan Variation",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Providence Oregon Standard Gold Plan03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-00","Providence Oregon Standard Silver Plan","Standard Silver Off Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/direct/2017 OR IND Providence Oregon Standard Silver Plan00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-01","Providence Oregon Standard Silver Plan","Standard Silver On Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Providence Oregon Standard Silver Plan01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-02","Providence Oregon Standard Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Providence Oregon Standard Silver Plan02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-03","Providence Oregon Standard Silver Plan","Limited Cost Sharing Plan Variation",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Providence Oregon Standard Silver Plan03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-04","Providence Oregon Standard Silver Plan","73% AV Level Silver Plan",,"0.729355037212372","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"$21,200","$21200 per person","$42400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Providence Oregon Standard Silver Plan04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-05","Providence Oregon Standard Silver Plan","87% AV Level Silver Plan",,"0.863629102706909","No","Yes","No","100%",,"$750","$20","$650","$150","$750","$510","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Providence Oregon Standard Silver Plan05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-06","Providence Oregon Standard Silver Plan","94% AV Level Silver Plan",,"0.936406314373016","No","Yes","No","100%",,"$150","$10","$360","$150","$150","$300","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","5.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Providence Oregon Standard Silver Plan06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000002","Providence Oregon Standard Bronze Plan","56707OR100",,"ORN001","ORS001","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000002-00","Providence Oregon Standard Bronze Plan","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/direct/2017 OR IND Providence Oregon Standard Bronze Plan00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000002","Providence Oregon Standard Bronze Plan","56707OR100",,"ORN001","ORS001","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000002-01","Providence Oregon Standard Bronze Plan","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/ffm/2017 OR IND Providence Oregon Standard Bronze Plan01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000002","Providence Oregon Standard Bronze Plan","56707OR100",,"ORN001","ORS001","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000002-02","Providence Oregon Standard Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Providence Oregon Standard Bronze Plan02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000002","Providence Oregon Standard Bronze Plan","56707OR100",,"ORN001","ORS001","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000002-03","Providence Oregon Standard Bronze Plan","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/tribal/2017  OR IND Providence Oregon Standard Bronze Plan03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990003","Providence Oregon Standard Gold Plan Area D","56707OR099",,"ORN001","ORS005","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990003-00","Providence Oregon Standard Gold Plan Area D","Standard Gold Off Exchange Plan",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Gold Plan Area D00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990003","Providence Oregon Standard Gold Plan Area D","56707OR099",,"ORN001","ORS005","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990003-01","Providence Oregon Standard Gold Plan Area D","Standard Gold On Exchange Plan",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Gold Plan Area D01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990003","Providence Oregon Standard Gold Plan Area D","56707OR099",,"ORN001","ORS005","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990003-02","Providence Oregon Standard Gold Plan Area D","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Gold Plan Area D02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990003","Providence Oregon Standard Gold Plan Area D","56707OR099",,"ORN001","ORS005","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990003-03","Providence Oregon Standard Gold Plan Area D","Limited Cost Sharing Plan Variation",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Gold Plan Area D03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990004","Providence Oregon Standard Gold Plan Area G","56707OR099",,"ORN001","ORS006","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990004-00","Providence Oregon Standard Gold Plan Area G","Standard Gold Off Exchange Plan",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Gold Plan Area G00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0990004","Providence Oregon Standard Gold Plan Area G","56707OR099",,"ORN001","ORS006","ORF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990004-03","Providence Oregon Standard Gold Plan Area G","Limited Cost Sharing Plan Variation",,"0.787944436073303","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Gold Plan Area G03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870003","Providence Oregon Standard Silver Plan Area D","56707OR087",,"ORN001","ORS005","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870003-00","Providence Oregon Standard Silver Plan Area D","Standard Silver Off Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area D00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870003","Providence Oregon Standard Silver Plan Area D","56707OR087",,"ORN001","ORS005","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870003-01","Providence Oregon Standard Silver Plan Area D","Standard Silver On Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area D01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870003","Providence Oregon Standard Silver Plan Area D","56707OR087",,"ORN001","ORS005","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870003-02","Providence Oregon Standard Silver Plan Area D","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area D02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870003","Providence Oregon Standard Silver Plan Area D","56707OR087",,"ORN001","ORS005","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870003-03","Providence Oregon Standard Silver Plan Area D","Limited Cost Sharing Plan Variation",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area D03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870003","Providence Oregon Standard Silver Plan Area D","56707OR087",,"ORN001","ORS005","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870003-04","Providence Oregon Standard Silver Plan Area D","73% AV Level Silver Plan",,"0.729355037212372","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"$21,200","$21200 per person","$42400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area D04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870003","Providence Oregon Standard Silver Plan Area D","56707OR087",,"ORN001","ORS005","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870003-05","Providence Oregon Standard Silver Plan Area D","87% AV Level Silver Plan",,"0.863629102706909","No","Yes","No","100%",,"$750","$20","$650","$150","$750","$510","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area D05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870003","Providence Oregon Standard Silver Plan Area D","56707OR087",,"ORN001","ORS005","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870003-06","Providence Oregon Standard Silver Plan Area D","94% AV Level Silver Plan",,"0.936406314373016","No","Yes","No","100%",,"$150","$10","$360","$150","$150","$300","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","5.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area D06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870004","Providence Oregon Standard Silver Plan Area G","56707OR087",,"ORN001","ORS006","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870004-00","Providence Oregon Standard Silver Plan Area G","Standard Silver Off Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area G00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870004","Providence Oregon Standard Silver Plan Area G","56707OR087",,"ORN001","ORS006","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870004-01","Providence Oregon Standard Silver Plan Area G","Standard Silver On Exchange Plan",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area G01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870004","Providence Oregon Standard Silver Plan Area G","56707OR087",,"ORN001","ORS006","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870004-02","Providence Oregon Standard Silver Plan Area G","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area G02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870004","Providence Oregon Standard Silver Plan Area G","56707OR087",,"ORN001","ORS006","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870004-03","Providence Oregon Standard Silver Plan Area G","Limited Cost Sharing Plan Variation",,"0.704381167888641","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area G03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870004","Providence Oregon Standard Silver Plan Area G","56707OR087",,"ORN001","ORS006","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870004-04","Providence Oregon Standard Silver Plan Area G","73% AV Level Silver Plan",,"0.729355037212372","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"$21,200","$21200 per person","$42400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area G04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870004","Providence Oregon Standard Silver Plan Area G","56707OR087",,"ORN001","ORS006","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870004-05","Providence Oregon Standard Silver Plan Area G","87% AV Level Silver Plan",,"0.863629102706909","No","Yes","No","100%",,"$750","$20","$650","$150","$750","$510","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$9,400","$9400 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area G05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR0870004","Providence Oregon Standard Silver Plan Area G","56707OR087",,"ORN001","ORS006","ORF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870004-06","Providence Oregon Standard Silver Plan Area G","94% AV Level Silver Plan",,"0.936406314373016","No","Yes","No","100%",,"$150","$10","$360","$150","$150","$300","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","5.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Silver Plan Area G06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000003","Providence Oregon Standard Bronze Plan Area D","56707OR100",,"ORN001","ORS005","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000003-00","Providence Oregon Standard Bronze Plan Area D","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Bronze Plan Area D00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000003","Providence Oregon Standard Bronze Plan Area D","56707OR100",,"ORN001","ORS005","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000003-01","Providence Oregon Standard Bronze Plan Area D","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Bronze Plan Area D01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000003","Providence Oregon Standard Bronze Plan Area D","56707OR100",,"ORN001","ORS005","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000003-02","Providence Oregon Standard Bronze Plan Area D","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Bronze Plan Area D02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000003","Providence Oregon Standard Bronze Plan Area D","56707OR100",,"ORN001","ORS005","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000003-03","Providence Oregon Standard Bronze Plan Area D","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Bronze Plan Area D03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000004","Providence Oregon Standard Bronze Plan Area G","56707OR100",,"ORN001","ORS006","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000004-00","Providence Oregon Standard Bronze Plan Area G","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Bronze Plan Area G00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000004","Providence Oregon Standard Bronze Plan Area G","56707OR100",,"ORN001","ORS006","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000004-01","Providence Oregon Standard Bronze Plan Area G","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Bronze Plan Area G01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000004","Providence Oregon Standard Bronze Plan Area G","56707OR100",,"ORN001","ORS006","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000004-02","Providence Oregon Standard Bronze Plan Area G","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Bronze Plan Area G02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","56707","SERFF","2016-09-28 04:33:02","Individual","No","93-0863097","56707OR1000004","Providence Oregon Standard Bronze Plan Area G","56707OR100",,"ORN001","ORS006","ORF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"2017-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000004-03","Providence Oregon Standard Bronze Plan Area G","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/sbc/area/2017 OR IND Providence Oregon Standard Bronze Plan Area G03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2017/plan overview.pdf"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310003","Silver Essential 4000 RealValue","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997844183692628",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310003-03","Silver Essential 4000 RealValue","Limited Cost Sharing Plan Variation",,"0.682912290096283","Yes","Yes","No","100%",,"$4,000","$10","$330","$150","$3,440","$390","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverEssential4000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/SilverEssential4000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310003","Silver Essential 4000 RealValue","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997844183692628",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310003-04","Silver Essential 4000 RealValue","73% AV Level Silver Plan",,"0.731571793556213","Yes","Yes","No","100%",,"$2,700","$10","$460","$150","$2,700","$390","$180","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,700","$12700 per person","$25400 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverEssential4000RealValueOregon73EN","https://bridgespanhealth.com/policy/2017/OR/SilverEssential4000RealValueOregon73"
"2017","OR","60013","SERFF","2016-08-26 03:12:28","Individual","Yes","93-1171647","60013OR0020002","Willamette Dental ProCare Oregon Plan 1","60013OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"0.777","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","The enrollee may seek treatment for a dental emergency from a non-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No","http://www.willamettedental.com/pco-member","","60013OR0020002-00","Willamette Dental ProCare Oregon Plan 1","Standard Low Off Exchange Plan","68.45%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://willamettedental.gelfuzion.net/_Literature_232689/2017_ProCare_Oregon_Plan_1_Benefit_Summary","http://www.willamettedental.com/pco-member"
"2017","OR","60013","SERFF","2016-08-26 03:12:28","Individual","Yes","93-1171647","60013OR0020002","Willamette Dental ProCare Oregon Plan 1","60013OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"0.777","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","The enrollee may seek treatment for a dental emergency from a non-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No","http://www.willamettedental.com/pco-member","","60013OR0020002-01","Willamette Dental ProCare Oregon Plan 1","Standard Low On Exchange Plan","68.45%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://willamettedental.gelfuzion.net/_Literature_232689/2017_ProCare_Oregon_Plan_1_Benefit_Summary","http://www.willamettedental.com/pco-member"
"2017","OR","60013","SERFF","2016-08-26 03:12:28","Individual","Yes","93-1171647","60013OR0020003","Willamette Dental ProCare Oregon Plan 2","60013OR002",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"0.803","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","The enrollee may seek treatment for a dental emergency from a non-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No","http://www.willamettedental.com/pco-member","","60013OR0020003-00","Willamette Dental ProCare Oregon Plan 2","Standard High Off Exchange Plan","84.51%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://willamettedental.gelfuzion.net/_Literature_232690/2017_ProCare_Oregon_Plan_2_Benefit_Summary","http://www.willamettedental.com/pco-member"
"2017","OR","60013","SERFF","2016-08-26 03:12:28","Individual","Yes","93-1171647","60013OR0020003","Willamette Dental ProCare Oregon Plan 2","60013OR002",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"0.803","Estimated Rate","2017-01-01","2017-12-31","No",,"Yes","The enrollee may seek treatment for a dental emergency from a non-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No","http://www.willamettedental.com/pco-member","","60013OR0020003-01","Willamette Dental ProCare Oregon Plan 2","Standard High On Exchange Plan","84.51%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://willamettedental.gelfuzion.net/_Literature_232690/2017_ProCare_Oregon_Plan_2_Benefit_Summary","http://www.willamettedental.com/pco-member"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010001","BridgeSpan Standard Gold Plan RealValue","63474OR001",,"ORN001","ORS002","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998359983944251",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010001-00","BridgeSpan Standard Gold Plan RealValue","Standard Gold Off Exchange Plan",,"0.789064109325409","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$420","$1,330","$0","$40","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardGoldPlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardGoldRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010001","BridgeSpan Standard Gold Plan RealValue","63474OR001",,"ORN001","ORS002","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998359983944251",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010001-01","BridgeSpan Standard Gold Plan RealValue","Standard Gold On Exchange Plan",,"0.789064109325409","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$420","$1,330","$0","$40","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardGoldPlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardGoldRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010001","BridgeSpan Standard Gold Plan RealValue","63474OR001",,"ORN001","ORS002","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998359983944251",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010001-02","BridgeSpan Standard Gold Plan RealValue","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardGoldPlanRealValueOregon-300EN","https://bridgespanhealth.com/policy/2017/OR/StandardGoldRealValueOregon-300"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010001","BridgeSpan Standard Gold Plan RealValue","63474OR001",,"ORN001","ORS002","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998359983944251",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010001-03","BridgeSpan Standard Gold Plan RealValue","Limited Cost Sharing Plan Variation",,"0.789064109325409","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$420","$1,330","$0","$40","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardGoldPlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardGoldRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010002","BridgeSpan Standard Silver Plan RealValue","63474OR001",,"ORN001","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9980048044119",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010002-00","BridgeSpan Standard Silver Plan RealValue","Standard Silver Off Exchange Plan",,"0.704546928405762","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$2,010","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardSilverPlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardSilverRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010002","BridgeSpan Standard Silver Plan RealValue","63474OR001",,"ORN001","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9980048044119",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010002-01","BridgeSpan Standard Silver Plan RealValue","Standard Silver On Exchange Plan",,"0.704546928405762","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$2,010","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardSilverPlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardSilverRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010002","BridgeSpan Standard Silver Plan RealValue","63474OR001",,"ORN001","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9980048044119",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010002-02","BridgeSpan Standard Silver Plan RealValue","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardSilverPlanRealValueOregon-300EN","https://bridgespanhealth.com/policy/2017/OR/StandardSilverRealValueOregon-300"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010002","BridgeSpan Standard Silver Plan RealValue","63474OR001",,"ORN001","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9980048044119",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010002-03","BridgeSpan Standard Silver Plan RealValue","Limited Cost Sharing Plan Variation",,"0.704546928405762","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$2,010","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardSilverPlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardSilverRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010002","BridgeSpan Standard Silver Plan RealValue","63474OR001",,"ORN001","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9980048044119",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010002-04","BridgeSpan Standard Silver Plan RealValue","73% AV Level Silver Plan",,"0.739693880081177","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$2,010","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardSilverPlanRealValueOregon73EN","https://bridgespanhealth.com/policy/2017/OR/StandardSilverRealValueOregon73"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010002","BridgeSpan Standard Silver Plan RealValue","63474OR001",,"ORN001","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9980048044119",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010002-05","BridgeSpan Standard Silver Plan RealValue","87% AV Level Silver Plan",,"0.879423975944519","No","Yes","No","100%",,"$850","$20","$340","$150","$420","$1,180","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardSilverPlanRealValueOregon87EN","https://bridgespanhealth.com/policy/2017/OR/StandardSilverRealValueOregon87"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010002","BridgeSpan Standard Silver Plan RealValue","63474OR001",,"ORN001","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9980048044119",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010002-06","BridgeSpan Standard Silver Plan RealValue","94% AV Level Silver Plan",,"0.947328448295593","No","Yes","No","100%",,"$100","$10","$720","$150","$100","$670","$30","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardSilverPlanRealValueOregon94EN","https://bridgespanhealth.com/policy/2017/OR/StandardSilverRealValueOregon94"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010003","BridgeSpan Standard Bronze Plan RealValue","63474OR001",,"ORN001","ORS002","ORF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997554532423844",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010003-00","BridgeSpan Standard Bronze Plan RealValue","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$1,320","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$17,450","$17450 per person","$34900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardBronzePlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardBronzeRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010003","BridgeSpan Standard Bronze Plan RealValue","63474OR001",,"ORN001","ORS002","ORF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997554532423844",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010003-01","BridgeSpan Standard Bronze Plan RealValue","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$1,320","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$17,450","$17450 per person","$34900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardBronzePlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardBronzeRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010003","BridgeSpan Standard Bronze Plan RealValue","63474OR001",,"ORN001","ORS002","ORF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997554532423844",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010003-02","BridgeSpan Standard Bronze Plan RealValue","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardBronzePlanRealValueOregon-300EN","https://bridgespanhealth.com/policy/2017/OR/StandardBronzeRealValueOregon-300"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0010003","BridgeSpan Standard Bronze Plan RealValue","63474OR001",,"ORN001","ORS002","ORF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997554532423844",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0010003-03","BridgeSpan Standard Bronze Plan RealValue","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$1,320","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$17,450","$17450 per person","$34900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/StandardBronzePlanRealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/StandardBronzeRealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310001","Silver HDHP 3000 RealValue","63474OR031",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997751714763733",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310001-00","Silver HDHP 3000 RealValue","Standard Silver Off Exchange Plan",,"0.68314254283905","Yes","Yes","No","100%",,"$3,000","$0","$430","$150","$3,000","$0","$230","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$10,000","per person not applicable","$20000 per group","$13,000","per person not applicable","$26000 per group","Yes",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverHDHP3000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/SilverHDHP3000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310001","Silver HDHP 3000 RealValue","63474OR031",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997751714763733",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310001-01","Silver HDHP 3000 RealValue","Standard Silver On Exchange Plan",,"0.68314254283905","Yes","Yes","No","100%",,"$3,000","$0","$430","$150","$3,000","$0","$230","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$10,000","per person not applicable","$20000 per group","$13,000","per person not applicable","$26000 per group","Yes",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverHDHP3000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/SilverHDHP3000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310001","Silver HDHP 3000 RealValue","63474OR031",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997751714763733",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310001-02","Silver HDHP 3000 RealValue","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverHDHP3000RealValueOregon-300EN","https://bridgespanhealth.com/policy/2017/OR/SilverHDHP3000RealValueOregon-300"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310001","Silver HDHP 3000 RealValue","63474OR031",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997751714763733",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310001-03","Silver HDHP 3000 RealValue","Limited Cost Sharing Plan Variation",,"0.68314254283905","Yes","Yes","No","100%",,"$3,000","$0","$430","$150","$3,000","$0","$230","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$10,000","per person not applicable","$20000 per group","$13,000","per person not applicable","$26000 per group","Yes",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverHDHP3000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/SilverHDHP3000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310001","Silver HDHP 3000 RealValue","63474OR031",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997751714763733",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310001-04","Silver HDHP 3000 RealValue","73% AV Level Silver Plan",,"0.726198017597198","Yes","Yes","No","100%",,"$2,200","$0","$510","$150","$2,200","$0","$310","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","10.00%",,,,,"$10,000","per person not applicable","$20000 per group","$12,200","per person not applicable","$24400 per group","Yes",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverHDHP3000RealValueOregon73EN","https://bridgespanhealth.com/policy/2017/OR/SilverHDHP3000RealValueOregon73"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310001","Silver HDHP 3000 RealValue","63474OR031",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997751714763733",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310001-05","Silver HDHP 3000 RealValue","87% AV Level Silver Plan",,"0.86393666267395","Yes","Yes","No","100%",,"$700","$0","$660","$150","$700","$0","$460","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2350 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","per person not applicable","$1400 per group","10.00%",,,,,"$10,000","per person not applicable","$20000 per group","$10,700","per person not applicable","$21400 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverHDHP3000RealValueOregon87EN","https://bridgespanhealth.com/policy/2017/OR/SilverHDHP3000RealValueOregon87"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310001","Silver HDHP 3000 RealValue","63474OR031",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997751714763733",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310001-06","Silver HDHP 3000 RealValue","94% AV Level Silver Plan",,"0.936012387275696","Yes","Yes","No","100%",,"$100","$0","$720","$150","$100","$0","$520","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","10.00%",,,,,"$10,000","per person not applicable","$20000 per group","$10,100","per person not applicable","$20200 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverHDHP3000RealValueOregon94EN","https://bridgespanhealth.com/policy/2017/OR/SilverHDHP3000RealValueOregon94"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310002","Bronze HDHP 6000 RealValue","63474OR031",,"ORN001","ORS001","ORF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997302864839221",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310002-00","Bronze HDHP 6000 RealValue","Standard Bronze Off Exchange Plan",,"0.614648878574371","Yes","Yes","No","100%",,"$6,000","$0","$130","$150","$5,310","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10.00%",,,,,"$12,000","per person not applicable","$24000 per group","$18,000","per person not applicable","$36000 per group","Yes",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeHDHP6000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeHDHP6000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310002","Bronze HDHP 6000 RealValue","63474OR031",,"ORN001","ORS001","ORF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997302864839221",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310002-01","Bronze HDHP 6000 RealValue","Standard Bronze On Exchange Plan",,"0.614648878574371","Yes","Yes","No","100%",,"$6,000","$0","$130","$150","$5,310","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10.00%",,,,,"$12,000","per person not applicable","$24000 per group","$18,000","per person not applicable","$36000 per group","Yes",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeHDHP6000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeHDHP6000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310002","Bronze HDHP 6000 RealValue","63474OR031",,"ORN001","ORS001","ORF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997302864839221",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310002-02","Bronze HDHP 6000 RealValue","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeHDHP6000RealValueOregon-300EN","https://bridgespanhealth.com/policy/2017/OR/BronzeHDHP6000RealValueOregon-300"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310002","Bronze HDHP 6000 RealValue","63474OR031",,"ORN001","ORS001","ORF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997302864839221",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310002-03","Bronze HDHP 6000 RealValue","Limited Cost Sharing Plan Variation",,"0.614648878574371","Yes","Yes","No","100%",,"$6,000","$0","$130","$150","$5,310","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7150 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10.00%",,,,,"$12,000","per person not applicable","$24000 per group","$18,000","per person not applicable","$36000 per group","Yes",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeHDHP6000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeHDHP6000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310003","Silver Essential 4000 RealValue","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997844183692628",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310003-00","Silver Essential 4000 RealValue","Standard Silver Off Exchange Plan",,"0.682912290096283","Yes","Yes","No","100%",,"$4,000","$10","$330","$150","$3,440","$390","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverEssential4000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/SilverEssential4000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310003","Silver Essential 4000 RealValue","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997844183692628",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310003-01","Silver Essential 4000 RealValue","Standard Silver On Exchange Plan",,"0.682912290096283","Yes","Yes","No","100%",,"$4,000","$10","$330","$150","$3,440","$390","$0","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverEssential4000RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/SilverEssential4000RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310003","Silver Essential 4000 RealValue","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997844183692628",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310003-02","Silver Essential 4000 RealValue","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverEssential4000RealValueOregon-300EN","https://bridgespanhealth.com/policy/2017/OR/SilverEssential4000RealValueOregon-300"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310003","Silver Essential 4000 RealValue","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997844183692628",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310003-05","Silver Essential 4000 RealValue","87% AV Level Silver Plan",,"0.86441433429718","Yes","Yes","No","100%",,"$800","$10","$650","$150","$800","$390","$630","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,800","$10800 per person","$21600 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverEssential4000RealValueOregon87EN","https://bridgespanhealth.com/policy/2017/OR/SilverEssential4000RealValueOregon87"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310003","Silver Essential 4000 RealValue","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997844183692628",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310003-06","Silver Essential 4000 RealValue","94% AV Level Silver Plan",,"0.934296429157257","Yes","Yes","No","100%",,"$100","$10","$720","$150","$100","$390","$770","$40","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,100","$10100 per person","$20200 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/SilverEssential4000RealValueOregon94EN","https://bridgespanhealth.com/policy/2017/OR/SilverEssential4000RealValueOregon94"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310004","Bronze Essential 7150 RealValue","63474OR031",,"ORN001","ORS001","ORF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997597542068548",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310004-00","Bronze Essential 7150 RealValue","Standard Bronze Off Exchange Plan",,"0.617050468921661","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$880","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeEssential7150RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeEssential7150RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310004","Bronze Essential 7150 RealValue","63474OR031",,"ORN001","ORS001","ORF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997597542068548",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310004-01","Bronze Essential 7150 RealValue","Standard Bronze On Exchange Plan",,"0.617050468921661","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$880","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeEssential7150RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeEssential7150RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310004","Bronze Essential 7150 RealValue","63474OR031",,"ORN001","ORS001","ORF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997597542068548",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310004-02","Bronze Essential 7150 RealValue","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeEssential7150RealValueOregon-300EN","https://bridgespanhealth.com/policy/2017/OR/BronzeEssential7150RealValueOregon-300"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0310004","Bronze Essential 7150 RealValue","63474OR031",,"ORN001","ORS001","ORF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997597542068548",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0310004-03","Bronze Essential 7150 RealValue","Limited Cost Sharing Plan Variation",,"0.617050468921661","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$880","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeEssential7150RealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeEssential7150RealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0590001","Bronze Essential 7150 EPO RealValue","63474OR059",,"ORN001","ORS001","ORF007","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997581213432992",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0590001-00","Bronze Essential 7150 EPO RealValue","Standard Bronze Off Exchange Plan",,"0.617050468921661","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$880","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$28600 per person","$42900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeEssential7150EPORealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeEssential7150EPORealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0590001","Bronze Essential 7150 EPO RealValue","63474OR059",,"ORN001","ORS001","ORF007","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997581213432992",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0590001-01","Bronze Essential 7150 EPO RealValue","Standard Bronze On Exchange Plan",,"0.617050468921661","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$880","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$28600 per person","$42900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeEssential7150EPORealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeEssential7150EPORealValueOregon"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0590001","Bronze Essential 7150 EPO RealValue","63474OR059",,"ORN001","ORS001","ORF007","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997581213432992",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0590001-02","Bronze Essential 7150 EPO RealValue","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeEssential7150EPORealValueOregon-300EN","https://bridgespanhealth.com/policy/2017/OR/BronzeEssential7150EPORealValueOregon-300"
"2017","OR","63474","SERFF","2016-08-24 05:44:16","Individual","No","87-0388069","63474OR0590001","Bronze Essential 7150 EPO RealValue","63474OR059",,"ORN001","ORS001","ORF007","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997581213432992",,,"2017-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://bridgespanhealth.com/formulary/2017/6tierEssential","63474OR0590001-03","Bronze Essential 7150 EPO RealValue","Limited Cost Sharing Plan Variation",,"0.617050468921661","Yes","Yes","No","100%",,"$7,150","$20","$0","$150","$3,440","$880","$0","$40","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$21,450","$28600 per person","$42900 per group","No",,,"https://bridgespanhealth.com/SBC/2017/OR/BronzeEssential7150EPORealValueOregonEN","https://bridgespanhealth.com/policy/2017/OR/BronzeEssential7150EPORealValueOregon"
"2017","OR","68420","SERFF","2016-08-19 03:49:17","Individual","Yes","75-1233841","68420OR0010006","Dentegra Dental PPO Family Basic Plan","68420OR001",,"ORN001","ORS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010006-00","Dentegra Dental PPO Family Basic Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010006-17"
"2017","OR","68420","SERFF","2016-08-19 03:49:17","Individual","Yes","75-1233841","68420OR0010006","Dentegra Dental PPO Family Basic Plan","68420OR001",,"ORN001","ORS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010006-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010006-17"
"2017","OR","68420","SERFF","2016-08-19 03:49:17","Individual","Yes","75-1233841","68420OR0010004","Dentegra Dental PPO Family Preferred Plan","68420OR001",,"ORN001","ORS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010004-00","Dentegra Dental PPO Family Preferred Plan","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010004-17"
"2017","OR","68420","SERFF","2016-08-19 03:49:17","Individual","Yes","75-1233841","68420OR0010004","Dentegra Dental PPO Family Preferred Plan","68420OR001",,"ORN001","ORS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010004-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010004-17"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","Yes","93-0798039","71287OR0590001","KP OR Dental 100","71287OR059",,"ORN002","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590001-00","KP OR Dental 100","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9785",,,"2017-01-01","2017-12-31","Yes","Yes","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420001-00","KP OR Gold 0/20","Standard Gold Off Exchange Plan",,"0.813419938087463","Yes","Yes","No","100%",,"$0","$20","$2,200","$200","$0","$800","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Gold_0_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9785",,,"2017-01-01","2017-12-31","Yes","Yes","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420001-01","KP OR Gold 0/20","Standard Gold On Exchange Plan",,"0.813419938087463","Yes","Yes","No","100%",,"$0","$20","$2,200","$200","$0","$800","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Gold_0_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","Yes","93-0798039","71287OR0590001","KP OR Dental 100","71287OR059",,"ORN002","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590001-01","KP OR Dental 100","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9785",,,"2017-01-01","2017-12-31","Yes","Yes","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420001-02","KP OR Gold 0/20","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_with_Eye_Exam_HMO.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9785",,,"2017-01-01","2017-12-31","Yes","Yes","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420001-03","KP OR Gold 0/20","Limited Cost Sharing Plan Variation",,"0.813419938087463","Yes","Yes","No","100%",,"$0","$20","$2,200","$200","$0","$800","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Gold_0_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420002","Kaiser Permanete Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420002-00","Kaiser Permanete Oregon Standard Gold Plan","Standard Gold Off Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,300","$20","$600","$200","$218","$800","$200","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Standard_Gold_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","Yes","93-0798039","71287OR0590002","KP OR Dental 80H","71287OR059",,"ORN002","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590002-00","KP OR Dental 80H","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","Yes","93-0798039","71287OR0590002","KP OR Dental 80H","71287OR059",,"ORN002","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590002-01","KP OR Dental 80H","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420002","Kaiser Permanete Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420002-01","Kaiser Permanete Oregon Standard Gold Plan","Standard Gold On Exchange Plan",,"0.788648962974548","No","Yes","No","100%",,"$1,300","$20","$600","$200","$218","$800","$200","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Standard_Gold_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420012-01","KP OR Silver 3000/30","Standard Silver On Exchange Plan",,"0.696813821792603","Yes","Yes","No","100%",,"$4,250","$20","$1,300","$200","$311","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_3000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420012-02","KP OR Silver 3000/30","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_without_Eye_Exam_DHMO.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420012-03","KP OR Silver 3000/30","Limited Cost Sharing Plan Variation",,"0.696813821792603","Yes","Yes","No","100%",,"$4,250","$20","$1,300","$200","$311","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_3000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","54-1808292","15614PA0030004","Select Plan Premium","15614PA003","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0030004-01","Select Plan Premium","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHSMGFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020004","Elite PPO Basic","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020004-01","Elite PPO Basic","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLINDFAMEHB.PDF"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420002","Kaiser Permanete Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420002-02","Kaiser Permanete Oregon Standard Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_with_Eye_Exam_DHMO.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420002","Kaiser Permanete Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.998",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420002-03","Kaiser Permanete Oregon Standard Gold Plan","Limited Cost Sharing Plan Variation",,"0.788648962974548","No","Yes","No","100%",,"$1,300","$20","$600","$200","$218","$800","$200","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Standard_Gold_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-00","Kaiser Permanente Oregon Standard Silver Plan","Standard Silver Off Exchange Plan",,"0.70441746711731","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$469","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Standard_Silver_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","Yes","93-0798039","71287OR0590003","KP OR Dental 80L","71287OR059",,"ORN002","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"No","$0.00","No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590003-00","KP OR Dental 80L","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","Yes","93-0798039","71287OR0590003","KP OR Dental 80L","71287OR059",,"ORN002","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"No","$0.00","No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590003-01","KP OR Dental 80L","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-01","Kaiser Permanente Oregon Standard Silver Plan","Standard Silver On Exchange Plan",,"0.70441746711731","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$469","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Standard_Silver_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-02","Kaiser Permanente Oregon Standard Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_Standard_0_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-03","Kaiser Permanente Oregon Standard Silver Plan","Limited Cost Sharing Plan Variation",,"0.70441746711731","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$469","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Standard_Silver_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-04","Kaiser Permanente Oregon Standard Silver Plan","73% AV Level Silver Plan",,"0.739698708057404","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$469","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/Kaiser_OR_Standard_Silver_2500_35_CSR_73.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-05","Kaiser Permanente Oregon Standard Silver Plan","87% AV Level Silver Plan",,"0.879433751106262","No","Yes","No","100%",,"$850","$0","$600","$200","$218","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/Kaiser_OR_Standard_Silver_2500_35_CSR_87.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-06","Kaiser Permanente Oregon Standard Silver Plan","94% AV Level Silver Plan",,"0.947382390499115","No","Yes","No","100%",,"$100","$10","$700","$200","$100","$400","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/Kaiser_OR_Standard_Silver_2500_35_CSR_94.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420004","Kaiser Permanente Oregon Standard Bronze Plan","71287OR042",,"ORN001","ORS001","ORF026","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420004-00","Kaiser Permanente Oregon Standard Bronze Plan","Standard Bronze Off Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$20","$0","$200","$311","$2,500","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Standard_Bronze_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420004","Kaiser Permanente Oregon Standard Bronze Plan","71287OR042",,"ORN001","ORS001","ORF026","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420004-01","Kaiser Permanente Oregon Standard Bronze Plan","Standard Bronze On Exchange Plan",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$20","$0","$200","$311","$2,500","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Standard_Bronze_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420004","Kaiser Permanente Oregon Standard Bronze Plan","71287OR042",,"ORN001","ORS001","ORF026","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420004-02","Kaiser Permanente Oregon Standard Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_Standard_0_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420004","Kaiser Permanente Oregon Standard Bronze Plan","71287OR042",,"ORN001","ORS001","ORF026","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9979",,,"2017-01-01","2017-12-31","Yes","Emergency Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420004-03","Kaiser Permanente Oregon Standard Bronze Plan","Limited Cost Sharing Plan Variation",,"0.619666457176209","Yes","Yes","No","100%",,"$7,150","$20","$0","$200","$311","$2,500","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Standard_Bronze_Plan.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420005-00","KP OR Gold 1000/20","Standard Gold Off Exchange Plan",,"0.791344881057739","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$200","$1,008","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Gold_1000_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420005-01","KP OR Gold 1000/20","Standard Gold On Exchange Plan",,"0.791344881057739","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$200","$1,008","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Gold_1000_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420005-02","KP OR Gold 1000/20","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_with_Eye_Exam_DHMO.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420005-03","KP OR Gold 1000/20","Limited Cost Sharing Plan Variation",,"0.791344881057739","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$200","$1,008","$600","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Gold_1000_20.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-00","KP OR Silver 2000/30","Standard Silver Off Exchange Plan",,"0.714159965515137","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$311","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Silver_2000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-01","KP OR Silver 2000/30","Standard Silver On Exchange Plan",,"0.714159965515137","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$311","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_2000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-02","KP OR Silver 2000/30","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_without_Eye_Exam_DHMO.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-03","KP OR Silver 2000/30","Limited Cost Sharing Plan Variation",,"0.714159965515137","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$311","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_2000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-04","KP OR Silver 2000/30","73% AV Level Silver Plan",,"0.737890720367432","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$311","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_1750_30_73_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-05","KP OR Silver 2000/30","87% AV Level Silver Plan",,"0.869862735271454","Yes","Yes","No","100%",,"$0","$20","$2,200","$200","$0","$1,000","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_0_15_87_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9784",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-06","KP OR Silver 2000/30","94% AV Level Silver Plan",,"0.934485554695129","Yes","Yes","No","100%",,"$0","$10","$700","$200","$0","$400","$30","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_0_5_94_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420012-00","KP OR Silver 3000/30","Standard Silver Off Exchange Plan",,"0.696813821792603","Yes","Yes","No","100%",,"$4,250","$20","$1,300","$200","$311","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Silver_3000_30.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420012-04","KP OR Silver 3000/30","73% AV Level Silver Plan",,"0.733691871166229","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$311","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_2000_30_73_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420012-05","KP OR Silver 3000/30","87% AV Level Silver Plan",,"0.860413134098053","Yes","Yes","No","100%",,"$500","$20","$2,000","$200","$137","$1,000","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_500_15_87_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2017-01-01","2017-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420012-06","KP OR Silver 3000/30","94% AV Level Silver Plan",,"0.933699727058411","Yes","Yes","No","100%",,"$100","$10","$700","$200","$100","$400","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Silver_100_5_94_CSR.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 5000/50","71287OR042",,"ORN001","ORS001","ORF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420014-00","KP OR Bronze 5000/50","Standard Bronze Off Exchange Plan",,"0.618887543678284","Yes","Yes","No","100%",,"$5,000","$20","$900","$200","$983","$1,500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Bronze_5000_50.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 5000/50","71287OR042",,"ORN001","ORS001","ORF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420014-01","KP OR Bronze 5000/50","Standard Bronze On Exchange Plan",,"0.618887543678284","Yes","Yes","No","100%",,"$5,000","$20","$900","$200","$983","$1,500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Bronze_5000_50.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 5000/50","71287OR042",,"ORN001","ORS001","ORF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420014-02","KP OR Bronze 5000/50","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_without_Eye_Exam_DHMO.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 5000/50","71287OR042",,"ORN001","ORS001","ORF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420014-03","KP OR Bronze 5000/50","Limited Cost Sharing Plan Variation",,"0.618887543678284","Yes","Yes","No","100%",,"$5,000","$20","$900","$200","$983","$1,500","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Bronze_5000_50.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6500/50","71287OR042",,"ORN001","ORS001","ORF007","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420015-00","KP OR Bronze 6500/50","Standard Bronze Off Exchange Plan",,"0.609852433204651","Yes","Yes","No","100%",,"$6,500","$0","$400","$200","$311","$800","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Bronze_6500_50.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6500/50","71287OR042",,"ORN001","ORS001","ORF007","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420015-01","KP OR Bronze 6500/50","Standard Bronze On Exchange Plan",,"0.609852433204651","Yes","Yes","No","100%",,"$6,500","$0","$400","$200","$311","$800","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Bronze_6500_50.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6500/50","71287OR042",,"ORN001","ORS001","ORF007","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420015-02","KP OR Bronze 6500/50","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/OR_AI_AN_without_Eye_Exam_DHMO.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6500/50","71287OR042",,"ORN001","ORS001","ORF007","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420015-03","KP OR Bronze 6500/50","Limited Cost Sharing Plan Variation",,"0.609852433204651","Yes","Yes","No","100%",,"$6,500","$0","$400","$200","$311","$800","$0","$80","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Bronze_6500_50.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420010","KP OR Catastrophic 7150/0","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420010-00","KP OR Catastrophic 7150/0","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$500","$0","$200","$1,166","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-OFF-Exchange/KP_OR_Catastrophic_7150_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","OR","71287","SERFF","2017-03-23 15:56:55","Individual","No","93-0798039","71287OR0420010","KP OR Catastrophic 7150/0","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://service.healthplan.com/index","http://www.kp.org/orformulary","71287OR0420010-01","KP OR Catastrophic 7150/0","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$500","$0","$200","$1,166","$0","$0","$80","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2017-ON-Exchange/KP_OR_Catastrophic_7150_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/or2017planbrochure.pdf"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020005","Elite PPO Basic Kids","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020005-00","Elite PPO Basic Kids","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","54-1808292","15614PA0040004","Choice PPO Basic","15614PA004","7962405180","PAN002","PAS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040004-00","Choice PPO Basic","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLSMGFAMEHB.PDF"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,950/$35 – Premium Network","16322PA004",,"PAN003","PAS003","PAF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040024-02","UPMC Advantage Bronze $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZL_PPO_RX1D06_DOVC_0117_1217_16322PA004002402.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002402"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060054","UPMC Small Business Advantage Gold PPO $1,000 $20/$45 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060054-00","UPMC Small Business Advantage Gold PPO $1,000 $20/$45 - Premium Network","Standard Gold Off Exchange Plan",,"0.8181312084198","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB6_PPO_RX1F12_EB02_0117_1217_16322PA006005400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006005400"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060054","UPMC Small Business Advantage Gold PPO $1,000 $20/$45 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060054-01","UPMC Small Business Advantage Gold PPO $1,000 $20/$45 - Premium Network","Standard Gold On Exchange Plan",,"0.8181312084198","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP43_PPO_RX1F12_EB02_0117_1217_16322PA006005401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006005401"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,950/$35 – Premium Network","16322PA004",,"PAN003","PAS003","PAF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040024-03","UPMC Advantage Bronze $6,950/$35 - Premium Network","Limited Cost Sharing Plan Variation","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLR_PPO_RX1F41_DOVC_0117_1217_16322PA004002403.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002403"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060075","UPMC Small Business Advantage Gold PPO $1,500 $10/$40 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060075-00","UPMC Small Business Advantage Gold PPO $1,500 $10/$40 - Premium Network","Standard Gold Off Exchange Plan",,"0.806377351284027","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB9_PPO_RX1F12_EB02_0117_1217_16322PA006007500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007500"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","54-1808292","15614PA0040004","Choice PPO Basic","15614PA004","7962405180","PAN002","PAS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040004-01","Choice PPO Basic","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLSMGFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020005","Elite PPO Basic Kids","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020005-01","Elite PPO Basic Kids","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020003","Elite PPO Premium Kids","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020003-00","Elite PPO Premium Kids","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","54-1808292","15614PA0040005","Choice PPO Premium","15614PA004","7962405180","PAN002","PAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040005-00","Choice PPO Premium","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHSMGFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","54-1808292","15614PA0040005","Choice PPO Premium","15614PA004","7962405180","PAN002","PAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040005-01","Choice PPO Premium","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHSMGFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020003","Elite PPO Premium Kids","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020003-01","Elite PPO Premium Kids","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0010003","Select Plan Basic Kids","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010003-00","Select Plan Basic Kids","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBLINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0010003","Select Plan Basic Kids","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010003-01","Select Plan Basic Kids","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBLINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0010005","Select Plan Premium Kids","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010005-00","Select Plan Premium Kids","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBHINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","54-1808292","15614PA0060002","Elite ePPO","15614PA006","7962405180","PAN003","PAS003",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0060002-00","Elite ePPO","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHSMGFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","54-1808292","15614PA0060002","Elite ePPO","15614PA006","7962405180","PAN003","PAS003",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0060002-01","Elite ePPO","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHSMGFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0010005","Select Plan Premium Kids","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010005-01","Select Plan Premium Kids","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBHINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020004","Elite PPO Basic","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020004-00","Elite PPO Basic","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBLINDFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","54-1808292","15614PA0030004","Select Plan Premium","15614PA003","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0030004-00","Select Plan Premium","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHSMGFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020006","Elite PPO Premium","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020006-00","Elite PPO Premium","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHINDFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020006","Elite PPO Premium","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020006-01","Elite PPO Premium","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17SBHINDFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0010004","Select Plan Basic","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010004-00","Select Plan Basic","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBLINDFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0010004","Select Plan Basic","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010004-01","Select Plan Basic","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBLINDFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0010006","Select Plan Premium","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010006-00","Select Plan Premium","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBHINDFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0010006","Select Plan Premium","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010006-01","Select Plan Premium","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17DBHINDFAMEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0050001","Elite ePPO","15614PA005","7962405180","PAN003","PAS003",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0050001-00","Elite ePPO","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17EPLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17EPLINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0050001","Elite ePPO","15614PA005","7962405180","PAN003","PAS003",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0050001-01","Elite ePPO","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17EPLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17EPLINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0050002","Elite ePPO","15614PA005","7962405180","PAN003","PAS003",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0050002-00","Elite ePPO","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17EPHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17EPHINDPEDEHB.PDF"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0050002","Elite ePPO","15614PA005","7962405180","PAN003","PAS003",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0050002-01","Elite ePPO","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17EPHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA17EPHINDPEDEHB.PDF"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040025-00","UPMC Advantage Silver HSA $2,600/20% - Premium Network","Standard Silver Off Exchange Plan","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NASP1_PPO_RX1F39_DOVC_0117_1217_16322PA004002500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002500"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060076","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","16322PA006",,"PAN005","PAS003","PAF001","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060076-00","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","Standard Bronze Off Exchange Plan","61.98%","0.623678267002106","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,100","$800","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPC1_PPO_RX1F47_EB02_0117_1217_16322PA006007600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007600"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060076","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","16322PA006",,"PAN005","PAS003","PAF001","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060076-01","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","Standard Bronze On Exchange Plan","61.98%","0.623678267002106","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,100","$800","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP47_PPO_RX1F47_EB02_0117_1217_16322PA006007601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007601"
"2017","PA","15614","SERFF","2016-08-20 11:23:22","Individual","Yes","54-1808292","15614PA0020007","PPO Elite Plus","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020007-00","PPO Elite Plus","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040026","UPMC Advantage Catastrophic $7,150/$0 - Premium Network","16322PA004",,"PAN003","PAS003","PAF004","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040026-00","UPMC Advantage Catastrophic $7,150/$0 - Premium Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP34_PPO_RX1D05_DCVC_0117_1217_16322PA004002600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002600"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060073","UPMC Small Business Advantage Silver PPO $3,000 $20/$50 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060073-00","UPMC Small Business Advantage Silver PPO $3,000 $20/$50 - Premium Network","Standard Silver Off Exchange Plan",,"0.719026148319244","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB7_PPO_RX1F12_EB02_0117_1217_16322PA006007300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007300"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060073","UPMC Small Business Advantage Silver PPO $3,000 $20/$50 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060073-01","UPMC Small Business Advantage Silver PPO $3,000 $20/$50 - Premium Network","Standard Silver On Exchange Plan",,"0.719026148319244","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP44_PPO_RX1F12_EB02_0117_1217_16322PA006007301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007301"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040026","UPMC Advantage Catastrophic $7,150/$0 - Premium Network","16322PA004",,"PAN003","PAS003","PAF004","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040026-01","UPMC Advantage Catastrophic $7,150/$0 - Premium Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP60_PPO_RX1D05_DCVC_0117_1217_16322PA004002601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002601"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050111","UPMC Advantage Catastrophic $7,150/$0 - Partner Network","16322PA005",,"PAN001","PAS001","PAF004","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050111-00","UPMC Advantage Catastrophic $7,150/$0 - Partner Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE42_EPO_RX1D05_DCVC_0117_1217_16322PA005011100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011100"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070016","UPMC Small Business Advantage Silver EPO $3,000 $20/$50 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070016-00","UPMC Small Business Advantage Silver EPO $3,000 $20/$50 - Premium Network","Standard Silver Off Exchange Plan",,"0.719026148319244","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP44_EPO_RX1F12_EB02_0117_1217_16322PA007001600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007001600"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070016","UPMC Small Business Advantage Silver EPO $3,000 $20/$50 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070016-01","UPMC Small Business Advantage Silver EPO $3,000 $20/$50 - Premium Network","Standard Silver On Exchange Plan",,"0.719026148319244","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP20_EPO_RX1F12_EB02_0117_1217_16322PA007001601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007001601"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050111","UPMC Advantage Catastrophic $7,150/$0 - Partner Network","16322PA005",,"PAN001","PAS001","PAF004","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050111-01","UPMC Advantage Catastrophic $7,150/$0 - Partner Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA2_EPO_RX1D05_DCVC_0117_1217_16322PA005011101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011101"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050112","UPMC Advantage Catastrophic $7,150/$0 – Select Network","16322PA005",,"PAN002","PAS002","PAF004","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050112-00","UPMC Advantage Catastrophic $7,150/$0 – Select Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE43_EPO_RX1D05_DCVC_0117_1217_16322PA005011200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011200"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050112","UPMC Advantage Catastrophic $7,150/$0 – Select Network","16322PA005",,"PAN002","PAS002","PAF004","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050112-01","UPMC Advantage Catastrophic $7,150/$0 – Select Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA3_EPO_RX1D05_DCVC_0117_1217_16322PA005011201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011201"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,950/$35 – Premium Network","16322PA004",,"PAN003","PAS003","PAF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040024-00","UPMC Advantage Bronze $6,950/$35 – Premium Network","Standard Bronze Off Exchange Plan","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP33_PPO_RX1F33_DOVC_0117_1217_16322PA004002400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002400"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060051","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060051-00","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","Standard Gold Off Exchange Plan",,"0.80351984500885","No","Yes","No","100%",,"$2,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB4_PPO_RX1F12_EB02_0117_1217_16322PA006005100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006005100"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060051","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060051-01","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","Standard Gold On Exchange Plan",,"0.80351984500885","No","Yes","No","100%",,"$2,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP41_PPO_RX1F12_EB02_0117_1217_16322PA006005101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006005101"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,950/$35 – Premium Network","16322PA004",,"PAN003","PAS003","PAF005","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040024-01","UPMC Advantage Bronze $6,950/$35 - Premium Network","Standard Bronze On Exchange Plan","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP57_PPO_RX1F33_DOVC_0117_1217_16322PA004002401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002401"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,950/$35 – Partner Network","16322PA005",,"PAN001","PAS001","PAF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050100-00","UPMC Advantage Bronze $6,950/$35 – Partner Network","Standard Bronze Off Exchange Plan","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE35_EPO_RX1F33_DOVC_0117_1217_16322PA005010000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010000"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,950/$35 – Partner Network","16322PA005",,"PAN001","PAS001","PAF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050100-01","UPMC Advantage Bronze $6,950/$35 - Partner Network","Standard Bronze On Exchange Plan","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE81_EPO_RX1F33_DOVC_0117_1217_16322PA005010001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010001"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060075","UPMC Small Business Advantage Gold PPO $1,500 $10/$40 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060075-01","UPMC Small Business Advantage Gold PPO $1,500 $10/$40 - Premium Network","Standard Gold On Exchange Plan",,"0.806377351284027","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP46_PPO_RX1F12_EB02_0117_1217_16322PA006007501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007501"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070014","UPMC Small Business Advantage Gold EPO $1,500 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070014-00","UPMC Small Business Advantage Gold EPO $1,500 $10/$40 - Premium Network","Standard Gold Off Exchange Plan",,"0.806377351284027","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP43_EPO_RX1F12_EB02_0117_1217_16322PA007001400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007001400"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,950/$35 – Partner Network","16322PA005",,"PAN001","PAS001","PAF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050100-02","UPMC Advantage Bronze $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZM_EPO_RX1D06_DOVC_0117_1217_16322PA005010002.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010002"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,950/$35 – Partner Network","16322PA005",,"PAN001","PAS001","PAF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050100-03","UPMC Advantage Bronze $6,950/$35 - Partner Network","Limited Cost Sharing Plan Variation","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELQ_EPO_RX1F41_DOVC_0117_1217_16322PA005010003.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010003"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070014","UPMC Small Business Advantage Gold EPO $1,500 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070014-01","UPMC Small Business Advantage Gold EPO $1,500 $10/$40 - Premium Network","Standard Gold On Exchange Plan",,"0.806377351284027","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP19_EPO_RX1F12_EB02_0117_1217_16322PA007001401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007001401"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070025","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070025-00","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","Standard Gold Off Exchange Plan",,"0.80351984500885","No","Yes","No","100%",,"$2,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP45_EPO_RX1F12_EB02_0117_1217_16322PA007002500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007002500"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,950/$35 – Select Network","16322PA005",,"PAN002","PAS002","PAF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050101-00","UPMC Advantage Bronze $6,950/$35 – Select Network","Standard Bronze Off Exchange Plan","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE36_EPO_RX1F33_DOVC_0117_1217_16322PA005010100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010100"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,950/$35 – Select Network","16322PA005",,"PAN002","PAS002","PAF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050101-01","UPMC Advantage Bronze $6,950/$35 - Select Network","Standard Bronze On Exchange Plan","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE82_EPO_RX1F33_DOVC_0117_1217_16322PA005010101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010101"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070025","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070025-01","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","Standard Gold On Exchange Plan",,"0.80351984500885","No","Yes","No","100%",,"$2,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP21_EPO_RX1F12_EB02_0117_1217_16322PA007002501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007002501"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,950/$35 – Select Network","16322PA005",,"PAN002","PAS002","PAF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050101-02","UPMC Advantage Bronze $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZN_EPO_RX1D06_DOVC_0117_1217_16322PA005010102.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010102"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070026","UPMC Small Business Advantage Gold EPO $1,000 $20/$45 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070026-00","UPMC Small Business Advantage Gold EPO $1,000 $20/$45 - Premium Network","Standard Gold Off Exchange Plan",,"0.8181312084198","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP46_EPO_RX1F12_EB02_0117_1217_16322PA007002600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007002600"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070026","UPMC Small Business Advantage Gold EPO $1,000 $20/$45 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070026-01","UPMC Small Business Advantage Gold EPO $1,000 $20/$45 - Premium Network","Standard Gold On Exchange Plan",,"0.8181312084198","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP22_EPO_RX1F12_EB02_0117_1217_16322PA007002601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007002601"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,950/$35 – Select Network","16322PA005",,"PAN002","PAS002","PAF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050101-03","UPMC Advantage Bronze $6,950/$35 - Select Network","Limited Cost Sharing Plan Variation","61.44%","0.625855147838593","Yes","Yes","No","100%",,"$7,000","$20","$0","$200","$3,300","$900","$40","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELR_EPO_RX1F41_DOVC_0117_1217_16322PA005010103.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010103"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040025-01","UPMC Advantage Silver HSA $2,600/20% - Premium Network","Standard Silver On Exchange Plan","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP1_PPO_RX1F39_DOVC_0117_1217_16322PA004002501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002501"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040025-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZM_PPO_RX1D06_DOVC_0117_1217_16322PA004002502.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002502"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070027","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070027-00","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","Standard Bronze Off Exchange Plan","61.98%","0.623678267002106","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,100","$800","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP47_EPO_RX1F47_EB02_0117_1217_16322PA007002700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007002700"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070027","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070027-01","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","Standard Bronze On Exchange Plan","61.98%","0.623678267002106","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,100","$800","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP23_EPO_RX1F47_EB02_0117_1217_16322PA007002701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007002701"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040025-03","UPMC Advantage Silver HSA $2,600/20% - Premium Network","Limited Cost Sharing Plan Variation","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP2_PPO_RX1F43_DOVC_0117_1217_16322PA004002503.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002503"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040025-04","UPMC Advantage Silver HSA $2,600/20% - Premium Network","73% AV Level Silver Plan","73.85%","0.738450825214386","Yes","Yes","No","100%",,"$2,600","$0","$800","$200","$2,600","$600","$200","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP3_PPO_RX1F39_DOVC_0117_1217_16322PA004002504.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002504"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040025-05","UPMC Advantage Silver $650/20% - Premium Network","87% AV Level Silver Plan","87.08%","0.870816349983215","Yes","Yes","No","100%",,"$700","$10","$1,300","$200","$700","$300","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%",,,,,"$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP58_PPO_RX1F36_DOVC_0117_1217_16322PA004002505.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002505"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040025-06","UPMC Advantage Silver $100/20% - Premium Network","94% AV Level Silver Plan","93.71%","0.937101364135742","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$200","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP59_PPO_RX1F37_DOVC_0117_1217_16322PA004002506.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002506"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050105-00","UPMC Advantage Silver HSA $2,600/20% - Partner Network","Standard Silver Off Exchange Plan","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NASE1_EPO_RX1F39_DOVC_0117_1217_16322PA005010500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010500"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050105-01","UPMC Advantage Silver HSA $2,600/20% - Partner Network","Standard Silver On Exchange Plan","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE1_EPO_RX1F39_DOVC_0117_1217_16322PA005010501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010501"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050105-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZR_EPO_RX1D06_DOVC_0117_1217_16322PA005010502.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010502"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050105-03","UPMC Advantage Silver HSA $2,600/20% - Partner Network","Limited Cost Sharing Plan Variation","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE2_EPO_RX1F43_DOVC_0117_1217_16322PA005010503.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010503"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050105-04","UPMC Advantage Silver HSA $2,600/20% - Partner Network","73% AV Level Silver Plan","73.85%","0.738450825214386","Yes","Yes","No","100%",,"$2,600","$0","$800","$200","$2,600","$600","$200","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE3_EPO_RX1F39_DOVC_0117_1217_16322PA005010504.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010504"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050105-05","UPMC Advantage Silver $650/20% - Partner Network","87% AV Level Silver Plan","87.08%","0.870816349983215","Yes","Yes","No","100%",,"$700","$10","$1,300","$200","$700","$300","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE95_EPO_RX1F36_DOVC_0117_1217_16322PA005010505.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010505"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050105-06","UPMC Advantage Silver $100/20% - Partner Network","94% AV Level Silver Plan","93.71%","0.937101364135742","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$200","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE96_EPO_RX1F37_DOVC_0117_1217_16322PA005010506.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010506"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050108-00","UPMC Advantage Silver HSA $2,600/20% - Select Network","Standard Silver Off Exchange Plan","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NASE2_EPO_RX1F39_DOVC_0117_1217_16322PA005010800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010800"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050108-01","UPMC Advantage Silver HSA $2,600/20% - Select Network","Standard Silver On Exchange Plan","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE4_EPO_RX1F39_DOVC_0117_1217_16322PA005010801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010801"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050108-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZU_EPO_RX1D06_DOVC_0117_1217_16322PA005010802.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010802"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050103-05","UPMC Advantage Silver $500/$15 - Partner Network","87% AV Level Silver Plan",,"0.878859639167786","No","Yes","No","100%",,"$500","$300","$1,200","$200","$500","$600","$400","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE89_EPO_RX1F36_DOVC_0117_1217_16322PA005010305.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010305"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050103-06","UPMC Advantage Silver $75/$5 - Partner Network","94% AV Level Silver Plan",,"0.941720604896545","No","Yes","No","100%",,"$80","$200","$700","$200","$80","$400","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE90_EPO_RX1F37_DOVC_0117_1217_16322PA005010306.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010306"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040008-00","UPMC Advantage Silver $3,250/$10 - Premium Network","Standard Silver Off Exchange Plan",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP30_PPO_RX1F38_DOVC_0117_1217_16322PA004000800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000800"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060045","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN005","PAS003","PAF003","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060045-00","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","Standard Platinum Off Exchange Plan","88.54%","0.828145444393158","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$500","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","10.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NIP40_PPO_RX1G69_EB02_0117_1217_16322PA006004500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004500"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050108-03","UPMC Advantage Silver HSA $2,600/20% - Select Network","Limited Cost Sharing Plan Variation","71.83%","0.718315064907074","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$900","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE5_EPO_RX1F43_DOVC_0117_1217_16322PA005010803.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010803"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050108-04","UPMC Advantage Silver HSA $2,600/20% - Select Network","73% AV Level Silver Plan","73.85%","0.738450825214386","Yes","Yes","No","100%",,"$2,600","$0","$800","$200","$2,600","$600","$200","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE6_EPO_RX1F39_DOVC_0117_1217_16322PA005010804.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010804"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050108-05","UPMC Advantage Silver $650/20% - Select Network","87% AV Level Silver Plan","87.08%","0.870816349983215","Yes","Yes","No","100%",,"$700","$10","$1,300","$200","$700","$300","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE99_EPO_RX1F36_DOVC_0117_1217_16322PA005010805.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010805"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050108-06","UPMC Advantage Silver $100/20% - Select Network","94% AV Level Silver Plan","93.71%","0.937101364135742","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$200","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA1_EPO_RX1F37_DOVC_0117_1217_16322PA005010806.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010806"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060053","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060053-00","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","Standard Platinum Off Exchange Plan",,"0.914910912513733","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB5_PPO_RX1F12_EB02_0117_1217_16322PA006005300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006005300"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040007-00","UPMC Advantage Silver $1,750/$30 - Premium Network","Standard Silver Off Exchange Plan",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP29_PPO_RX1F38_DOVC_0117_1217_16322PA004000700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000700"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040007-01","UPMC Advantage Silver $1,750/$30 - Premium Network","Standard Silver On Exchange Plan",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP47_PPO_RX1F38_DOVC_0117_1217_16322PA004000701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000701"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060053","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060053-01","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","Standard Platinum On Exchange Plan",,"0.914910912513733","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP42_PPO_RX1F12_EB02_0117_1217_16322PA006005301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006005301"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040007-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZH_PPO_RX1D06_DOVC_0117_1217_16322PA004000702.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000702"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060074","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060074-00","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan",,"0.895824432373047","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB8_PPO_RX1F12_EB02_0117_1217_16322PA006007400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007400"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060074","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS003","PAF002","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060074-01","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","Standard Platinum On Exchange Plan",,"0.895824432373047","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP45_PPO_RX1F12_EB02_0117_1217_16322PA006007401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007401"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040007-03","UPMC Advantage Silver $1,750/$30 - Premium Network","Limited Cost Sharing Plan Variation",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLN_PPO_RX1F44_DOVC_0117_1217_16322PA004000703.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000703"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040007-04","UPMC Advantage Silver $1,750/$30 - Premium Network","73% AV Level Silver Plan",,"0.735689520835876","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP48_PPO_RX1F38_DOVC_0117_1217_16322PA004000704.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000704"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070012","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070012-00","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","Standard Platinum Off Exchange Plan",,"0.914910912513733","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP41_EPO_RX1F12_EB02_0117_1217_16322PA007001200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007001200"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070012","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070012-01","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","Standard Platinum On Exchange Plan",,"0.914910912513733","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP17_EPO_RX1F12_EB02_0117_1217_16322PA007001201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007001201"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040007-05","UPMC Advantage Silver $500/$15 - Premium Network","87% AV Level Silver Plan",,"0.878859639167786","No","Yes","No","100%",,"$500","$300","$1,200","$200","$500","$600","$400","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP49_PPO_RX1F36_DOVC_0117_1217_16322PA004000705.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000705"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040007-06","UPMC Advantage Silver $75/$5 - Premium Network","94% AV Level Silver Plan",,"0.941720604896545","No","Yes","No","100%",,"$80","$200","$700","$200","$80","$400","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20.00%",,,,,"$150","$150 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP50_PPO_RX1F37_DOVC_0117_1217_16322PA004000706.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000706"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070013","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070013-00","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan",,"0.895824432373047","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP42_EPO_RX1F12_EB02_0117_1217_16322PA007001300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007001300"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0070013","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF002","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0070013-01","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","Standard Platinum On Exchange Plan",,"0.895824432373047","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP18_EPO_RX1F12_EB02_0117_1217_16322PA007001301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA007001301"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050030-00","UPMC Advantage Silver $1,750/$30 - Select Network","Standard Silver Off Exchange Plan",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE31_EPO_RX1F38_DOVC_0117_1217_16322PA005003000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003000"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050030-01","UPMC Advantage Silver $1,750/$30 - Select Network","Standard Silver On Exchange Plan",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE71_EPO_RX1F38_DOVC_0117_1217_16322PA005003001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003001"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050030-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZI_EPO_RX1D06_DOVC_0117_1217_16322PA005003002.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003002"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050030-03","UPMC Advantage Silver $1,750/$30 - Select Network","Limited Cost Sharing Plan Variation",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELM_EPO_RX1F44_DOVC_0117_1217_16322PA005003003.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003003"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050030-04","UPMC Advantage Silver $1,750/$30 - Select Network","73% AV Level Silver Plan",,"0.735689520835876","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE72_EPO_RX1F38_DOVC_0117_1217_16322PA005003004.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003004"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050030-05","UPMC Advantage Silver $500/$15 - Select Network","87% AV Level Silver Plan",,"0.878859639167786","No","Yes","No","100%",,"$500","$300","$1,200","$200","$500","$600","$400","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE73_EPO_RX1F36_DOVC_0117_1217_16322PA005003005.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003005"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050030-06","UPMC Advantage Silver $75/$5 - Select Network","94% AV Level Silver Plan",,"0.941720604896545","No","Yes","No","100%",,"$80","$200","$700","$200","$80","$400","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE74_EPO_RX1F37_DOVC_0117_1217_16322PA005003006.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003006"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050103-00","UPMC Advantage Silver $1,750/$30 - Partner Network","Standard Silver Off Exchange Plan",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE38_EPO_RX1F38_DOVC_0117_1217_16322PA005010300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010300"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050103-01","UPMC Advantage Silver $1,750/$30 - Partner Network","Standard Silver On Exchange Plan",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE87_EPO_RX1F38_DOVC_0117_1217_16322PA005010301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010301"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050103-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZP_EPO_RX1D06_DOVC_0117_1217_16322PA005010302.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010302"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050103-03","UPMC Advantage Silver $1,750/$30 - Partner Network","Limited Cost Sharing Plan Variation",,"0.714972317218781","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELT_EPO_RX1F44_DOVC_0117_1217_16322PA005010303.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010303"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060042","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","16322PA006",,"PAN005","PAS003","PAF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060042-01","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","Standard Gold On Exchange Plan",,"0.786525309085846","Yes","Yes","No","100%",,"$2,000","$20","$0","$200","$2,000","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP14_PPO_RX1F13_EB02_0117_1217_16322PA006004201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004201"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040006-04","UPMC Advantage Silver $0/$50 - Premium Network","73% AV Level Silver Plan",,"0.739585161209106","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP44_PPO_RX1F35_DOVC_0117_1217_16322PA004000604.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000604"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060043","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN005","PAS003","PAF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060043-00","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","Standard Gold Off Exchange Plan",,"0.798928678035736","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$800","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","10.00%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP48_PPO_RX1F13_EB02_0117_1217_16322PA006004300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004300"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060043","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN005","PAS003","PAF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060043-01","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","Standard Gold On Exchange Plan",,"0.798928678035736","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$800","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","10.00%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP15_PPO_RX1F13_EB02_0117_1217_16322PA006004301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004301"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050103-04","UPMC Advantage Silver $1,750/$30 - Partner Network","73% AV Level Silver Plan",,"0.735689520835876","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE88_EPO_RX1F38_DOVC_0117_1217_16322PA005010304.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010304"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060045","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN005","PAS003","PAF003","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060045-01","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","Standard Platinum On Exchange Plan","88.54%","0.828145444393158","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$500","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","10.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XIP07_PPO_RX1G69_EB02_0117_1217_16322PA006004501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004501"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040008-01","UPMC Advantage Silver $3,250/$10 - Premium Network","Standard Silver On Exchange Plan",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP51_PPO_RX1F38_DOVC_0117_1217_16322PA004000801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000801"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040008-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZI_PPO_RX1D06_DOVC_0117_1217_16322PA004000802.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000802"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060046","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN005","PAS003","PAF003","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060046-00","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","Standard Gold Off Exchange Plan","80.39%","0.745309174060822","Yes","Yes","No","100%",,"$2,500","$20","$500","$200","$2,500","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NIP41_PPO_RX1G69_EB02_0117_1217_16322PA006004600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004600"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060046","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN005","PAS003","PAF003","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060046-01","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","Standard Gold On Exchange Plan","80.39%","0.745309174060822","Yes","Yes","No","100%",,"$2,500","$20","$500","$200","$2,500","$700","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XIP08_PPO_RX1G69_EB02_0117_1217_16322PA006004601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004601"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040008-03","UPMC Advantage Silver $3,250/$10 - Premium Network","Limited Cost Sharing Plan Variation",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLO_PPO_RX1F44_DOVC_0117_1217_16322PA004000803.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000803"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040008-04","UPMC Advantage Silver $3,250/$10 - Premium Network","73% AV Level Silver Plan",,"0.736267328262329","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP52_PPO_RX1F38_DOVC_0117_1217_16322PA004000804.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000804"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040008-05","UPMC Advantage Silver $1,000/$5 - Premium Network","87% AV Level Silver Plan",,"0.878772258758545","No","Yes","No","100%",,"$1,000","$300","$0","$200","$1,000","$500","$100","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP53_PPO_RX1F36_DOVC_0117_1217_16322PA004000805.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000805"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040008-06","UPMC Advantage Silver $100/$5 - Premium Network","94% AV Level Silver Plan",,"0.949859976768494","No","Yes","No","100%",,"$100","$200","$0","$200","$100","$400","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0.00%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP54_PPO_RX1F37_DOVC_0117_1217_16322PA004000806.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000806"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050031-00","UPMC Advantage Silver $3,250/$10 - Select Network","Standard Silver Off Exchange Plan",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE32_EPO_RX1F38_DOVC_0117_1217_16322PA005003100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003100"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050031-01","UPMC Advantage Silver $3,250/$10 - Select Network","Standard Silver On Exchange Plan",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE75_EPO_RX1F38_DOVC_0117_1217_16322PA005003101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003101"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050031-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZJ_EPO_RX1D06_DOVC_0117_1217_16322PA005003102.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003102"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050031-03","UPMC Advantage Silver $3,250/$10 - Select Network","Limited Cost Sharing Plan Variation",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELN_EPO_RX1F44_DOVC_0117_1217_16322PA005003103.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003103"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050031-04","UPMC Advantage Silver $3,250/$10 - Select Network","73% AV Level Silver Plan",,"0.736267328262329","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE76_EPO_RX1F38_DOVC_0117_1217_16322PA005003104.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003104"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050031-05","UPMC Advantage Silver $1,000/$5 - Select Network","87% AV Level Silver Plan",,"0.878772258758545","No","Yes","No","100%",,"$1,000","$300","$0","$200","$1,000","$500","$100","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE77_EPO_RX1F36_DOVC_0117_1217_16322PA005003105.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003105"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050031-06","UPMC Advantage Silver $100/$5 - Select Network","94% AV Level Silver Plan",,"0.949859976768494","No","Yes","No","100%",,"$100","$200","$0","$200","$100","$400","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE78_EPO_RX1F37_DOVC_0117_1217_16322PA005003106.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003106"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050104-00","UPMC Advantage Silver $3,250/$10 - Partner Network","Standard Silver Off Exchange Plan",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE39_EPO_RX1F38_DOVC_0117_1217_16322PA005010400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010400"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050104-01","UPMC Advantage Silver $3,250/$10 - Partner Network","Standard Silver On Exchange Plan",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE91_EPO_RX1F38_DOVC_0117_1217_16322PA005010401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010401"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050104-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZQ_EPO_RX1D06_DOVC_0117_1217_16322PA005010402.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010402"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050104-03","UPMC Advantage Silver $3,250/$10 - Partner Network","Limited Cost Sharing Plan Variation",,"0.715272903442383","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELU_EPO_RX1F44_DOVC_0117_1217_16322PA005010403.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010403"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050104-04","UPMC Advantage Silver $3,250/$10 - Partner Network","73% AV Level Silver Plan",,"0.736267328262329","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE92_EPO_RX1F38_DOVC_0117_1217_16322PA005010404.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010404"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050104-05","UPMC Advantage Silver $1,000/$5 - Partner Network","87% AV Level Silver Plan",,"0.878772258758545","No","Yes","No","100%",,"$1,000","$300","$0","$200","$1,000","$500","$100","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE93_EPO_RX1F36_DOVC_0117_1217_16322PA005010405.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010405"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050104-06","UPMC Advantage Silver $100/$5 - Partner Network","94% AV Level Silver Plan",,"0.949859976768494","No","Yes","No","100%",,"$100","$200","$0","$200","$100","$400","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE94_EPO_RX1F37_DOVC_0117_1217_16322PA005010406.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010406"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060041","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","16322PA006",,"PAN005","PAS003","PAF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060041-00","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","Standard Silver Off Exchange Plan",,"0.708603620529175","Yes","Yes","No","100%",,"$3,300","$20","$0","$200","$3,300","$800","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP46_PPO_RX1F47_EB02_0117_1217_16322PA006004100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004100"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040006-00","UPMC Advantage Silver $0/$50 - Premium Network","Standard Silver Off Exchange Plan",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP28_PPO_RX1F35_DOVC_0117_1217_16322PA004000600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000600"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040006-01","UPMC Advantage Silver $0/$50 - Premium Network","Standard Silver On Exchange Plan",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP43_PPO_RX1F35_DOVC_0117_1217_16322PA004000601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000601"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060041","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","16322PA006",,"PAN005","PAS003","PAF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060041-01","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","Standard Silver On Exchange Plan",,"0.708603620529175","Yes","Yes","No","100%",,"$3,300","$20","$0","$200","$3,300","$800","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP13_PPO_RX1F47_EB02_0117_1217_16322PA006004101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004101"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060042","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","16322PA006",,"PAN005","PAS003","PAF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060042-00","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","Standard Gold Off Exchange Plan",,"0.786525309085846","Yes","Yes","No","100%",,"$2,000","$20","$0","$200","$2,000","$800","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP47_PPO_RX1F13_EB02_0117_1217_16322PA006004200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004200"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040006-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZG_PPO_RX1D06_DOVC_0117_1217_16322PA004000602.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000602"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040006-03","UPMC Advantage Silver $0/$50 - Premium Network","Limited Cost Sharing Plan Variation",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLM_PPO_RX1F42_DOVC_0117_1217_16322PA004000603.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000603"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040006-05","UPMC Advantage Silver $0/$25 - Premium Network","87% AV Level Silver Plan",,"0.879458606243134","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$700","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP45_PPO_RX1F36_DOVC_0117_1217_16322PA004000605.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000605"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040006-06","UPMC Advantage Silver $0/$10 - Premium Network","94% AV Level Silver Plan",,"0.9417884349823","No","Yes","No","100%",,"$0","$800","$0","$200","$0","$400","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP46_PPO_RX1F37_DOVC_0117_1217_16322PA004000606.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004000606"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050029-00","UPMC Advantage Silver $0/$50 - Select Network","Standard Silver Off Exchange Plan",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE30_EPO_RX1F35_DOVC_0117_1217_16322PA005002900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005002900"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $750/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050106-02","UPMC Advantage Gold $0/$0 - Partner Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZS_EPO_RX1D06_DOVC_0117_1217_16322PA005010602.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010602"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $750/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050106-03","UPMC Advantage Gold $750/$10 - Partner Network","Limited Cost Sharing Plan Variation",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELV_EPO_RX1F44_DOVC_0117_1217_16322PA005010603.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010603"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060077","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN007","PAS005","PAF002","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060077-00","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan",,"0.899569988250732","No","Yes","Yes","90%","10%","$300","$400","$0","$200","$300","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA9_PPO_RX1F12_EB02_0117_1217_16322PA006007700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007700"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050029-01","UPMC Advantage Silver $0/$50 - Select Network","Standard Silver On Exchange Plan",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE67_EPO_RX1F35_DOVC_0117_1217_16322PA005002901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005002901"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050029-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZH_EPO_RX1D06_DOVC_0117_1217_16322PA005002902.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005002902"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050029-03","UPMC Advantage Silver $0/$50 - Select Network","Limited Cost Sharing Plan Variation",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELL_EPO_RX1F42_DOVC_0117_1217_16322PA005002903.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005002903"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050029-04","UPMC Advantage Silver $0/$50 - Select Network","73% AV Level Silver Plan",,"0.739585161209106","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE68_EPO_RX1F35_DOVC_0117_1217_16322PA005002904.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005002904"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050029-05","UPMC Advantage Silver $0/$25 - Select Network","87% AV Level Silver Plan",,"0.879458606243134","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$700","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE69_EPO_RX1F36_DOVC_0117_1217_16322PA005002905.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005002905"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050029-06","UPMC Advantage Silver $0/$10 - Select Network","94% AV Level Silver Plan",,"0.9417884349823","No","Yes","No","100%",,"$0","$800","$0","$200","$0","$400","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE70_EPO_RX1F37_DOVC_0117_1217_16322PA005002906.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005002906"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050102-00","UPMC Advantage Silver $0/$50 - Partner Network","Standard Silver Off Exchange Plan",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE37_EPO_RX1F35_DOVC_0117_1217_16322PA005010200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010200"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050102-01","UPMC Advantage Silver $0/$50 - Partner Network","Standard Silver On Exchange Plan",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE83_EPO_RX1F35_DOVC_0117_1217_16322PA005010201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010201"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050102-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZO_EPO_RX1D06_DOVC_0117_1217_16322PA005010202.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010202"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050102-03","UPMC Advantage Silver $0/$50 - Partner Network","Limited Cost Sharing Plan Variation",,"0.719508528709412","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELS_EPO_RX1F42_DOVC_0117_1217_16322PA005010203.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010203"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050102-04","UPMC Advantage Silver $0/$50 - Partner Network","73% AV Level Silver Plan",,"0.739585161209106","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE84_EPO_RX1F35_DOVC_0117_1217_16322PA005010204.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010204"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050102-05","UPMC Advantage Silver $0/$25 - Partner Network","87% AV Level Silver Plan",,"0.879458606243134","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$700","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE85_EPO_RX1F36_DOVC_0117_1217_16322PA005010205.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010205"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050102-06","UPMC Advantage Silver $0/$10 - Partner Network","94% AV Level Silver Plan",,"0.9417884349823","No","Yes","No","100%",,"$0","$800","$0","$200","$0","$400","$600","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE86_EPO_RX1F37_DOVC_0117_1217_16322PA005010206.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010206"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060047","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS004","PAF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060047-00","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan",,"0.90025794506073","No","Yes","Yes","90%","10%","$300","$400","$0","$200","$300","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA5_PPO_RX1F12_EB02_0117_1217_16322PA006004700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004700"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $750/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040010-00","UPMC Advantage Gold $750/$10 - Premium Network","Standard Gold Off Exchange Plan",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP31_PPO_RX1F38_DOVC_0117_1217_16322PA004001000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004001000"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $750/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040010-01","UPMC Advantage Gold $750/$10 - Premium Network","Standard Gold On Exchange Plan",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP55_PPO_RX1F38_DOVC_0117_1217_16322PA004001001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004001001"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060047","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS004","PAF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060047-01","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum On Exchange Plan",,"0.90025794506073","No","Yes","Yes","90%","10%","$300","$400","$0","$200","$300","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP33_PPO_RX1F12_EB02_0117_1217_16322PA006004701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004701"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $750/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040010-02","UPMC Advantage Gold $0/$0 - Premium Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZJ_PPO_RX1D06_DOVC_0117_1217_16322PA004001002.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004001002"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060048","UPMC Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS004","PAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060048-00","UPMC Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network","Standard Gold Off Exchange Plan",,"0.815860509872437","No","Yes","Yes","90%","10%","$1,300","$400","$0","$200","$1,300","$1,100","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$2,500","$2500 per person","$5000 per group","35.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA6_PPO_RX1F12_EB02_0117_1217_16322PA006004800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004800"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060048","UPMC Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS004","PAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060048-01","UPMC Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network","Standard Gold On Exchange Plan",,"0.815860509872437","No","Yes","Yes","90%","10%","$1,300","$400","$0","$200","$1,300","$1,100","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$2,500","$2500 per person","$5000 per group","35.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP34_PPO_RX1F12_EB02_0117_1217_16322PA006004801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004801"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $750/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040010-03","UPMC Advantage Gold $750/$10 - Premium Network","Limited Cost Sharing Plan Variation",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLP_PPO_RX1F44_DOVC_0117_1217_16322PA004001003.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004001003"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $750/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050033-00","UPMC Advantage Gold $750/$10 - Select Network","Standard Gold Off Exchange Plan",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE33_EPO_RX1F38_DOVC_0117_1217_16322PA005003300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003300"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060049","UPMC Inside Advantage Silver PPO $3,000 $25/$55 - Premium Network","16322PA006",,"PAN006","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060049-00","UPMC Inside Advantage Silver PPO $3,000 $25/$55 - Premium Network","Standard Silver Off Exchange Plan",,"0.718157470226288","No","Yes","Yes","90%","10%","$3,000","$500","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%","$6,600","$6600 per person","$13200 per group","35.00%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA7_PPO_RX1F12_EB02_0117_1217_16322PA006004900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004900"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060049","UPMC Inside Advantage Silver PPO $3,000 $25/$55 - Premium Network","16322PA006",,"PAN006","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060049-01","UPMC Inside Advantage Silver PPO $3,000 $25/$55 - Premium Network","Standard Silver On Exchange Plan",,"0.718157470226288","No","Yes","Yes","90%","10%","$3,000","$500","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%","$6,600","$6600 per person","$13200 per group","35.00%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP35_PPO_RX1F12_EB02_0117_1217_16322PA006004901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006004901"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $750/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050033-01","UPMC Advantage Gold $750/$10 - Select Network","Standard Gold On Exchange Plan",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE79_EPO_RX1F38_DOVC_0117_1217_16322PA005003301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003301"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $750/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050033-02","UPMC Advantage Gold $0/$0 - Select Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZK_EPO_RX1D06_DOVC_0117_1217_16322PA005003302.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003302"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060050","UPMC Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060050-00","UPMC Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network","Standard Silver Off Exchange Plan",,"0.711225628852844","No","Yes","Yes","90%","10%","$5,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%","$6,350","$6350 per person","$12700 per group","35.00%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA8_PPO_RX1F12_EB02_0117_1217_16322PA006005000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006005000"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060050","UPMC Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060050-01","UPMC Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network","Standard Silver On Exchange Plan",,"0.711225628852844","No","Yes","Yes","90%","10%","$5,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%","$6,350","$6350 per person","$12700 per group","35.00%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP36_PPO_RX1F12_EB02_0117_1217_16322PA006005001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006005001"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $750/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050033-03","UPMC Advantage Gold $750/$10 - Select Network","Limited Cost Sharing Plan Variation",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELO_EPO_RX1F44_DOVC_0117_1217_16322PA005003303.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003303"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $750/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050106-00","UPMC Advantage Gold $750/$10 - Partner Network","Standard Gold Off Exchange Plan",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE40_EPO_RX1F38_DOVC_0117_1217_16322PA005010600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010600"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $750/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050106-01","UPMC Advantage Gold $750/$10 - Partner Network","Standard Gold On Exchange Plan",,"0.816883563995361","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE97_EPO_RX1F38_DOVC_0117_1217_16322PA005010601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010601"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040012-00","UPMC Advantage Platinum $250/$20 - Premium Network","Standard Platinum Off Exchange Plan",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP32_PPO_RX1F40_DOVC_0117_1217_16322PA004001200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004001200"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040012-01","UPMC Advantage Platinum $250/$20 - Premium Network","Standard Platinum On Exchange Plan",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP56_PPO_RX1F40_DOVC_0117_1217_16322PA004001201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004001201"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060077","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN007","PAS005","PAF002","New","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060077-01","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum On Exchange Plan",,"0.899569988250732","No","Yes","Yes","90%","10%","$300","$400","$0","$200","$300","$600","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP37_PPO_RX1F12_EB02_0117_1217_16322PA006007701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007701"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060078","UPMC MyCare Advantage Gold PPO $1,250 $20/$40 - Premium Network","16322PA006",,"PAN007","PAS005","PAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060078-00","UPMC MyCare Advantage Gold PPO $1,250 $20/$40 - Premium Network","Standard Gold Off Exchange Plan",,"0.812895655632019","No","Yes","Yes","90%","10%","$1,300","$400","$0","$200","$1,300","$1,100","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$2,500","$2500 per person","$5000 per group","35.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB1_PPO_RX1F12_EB02_0117_1217_16322PA006007800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007800"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040012-02","UPMC Advantage Platinum $0/$0 - Premium Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZK_PPO_RX1D06_DOVC_0117_1217_16322PA004001202.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004001202"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040012-03","UPMC Advantage Platinum $250/$20 - Premium Network","Limited Cost Sharing Plan Variation",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLQ_PPO_RX1F45_DOVC_0117_1217_16322PA004001203.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004001203"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060078","UPMC MyCare Advantage Gold PPO $1,250 $20/$40 - Premium Network","16322PA006",,"PAN007","PAS005","PAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060078-01","UPMC MyCare Advantage Gold PPO $1,250 $20/$40 - Premium Network","Standard Gold On Exchange Plan",,"0.812895655632019","No","Yes","Yes","90%","10%","$1,300","$400","$0","$200","$1,300","$1,100","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$2,500","$2500 per person","$5000 per group","35.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP38_PPO_RX1F12_EB02_0117_1217_16322PA006007801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007801"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060079","UPMC MyCare Advantage Silver PPO $3,000 $25/$55 - Premium Network","16322PA006",,"PAN007","PAS005","PAF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060079-00","UPMC MyCare Advantage Silver PPO $3,000 $25/$55 - Premium Network","Standard Silver Off Exchange Plan",,"0.71640682220459","No","Yes","Yes","90%","10%","$3,000","$500","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%","$6,600","$6600 per person","$13200 per group","35.00%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB2_PPO_RX1F12_EB02_0117_1217_16322PA006007900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007900"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010030","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010030-03","Geisinger Marketplace HMO 30/60/3500","Limited Cost Sharing Plan Variation","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003003.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010030","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010030-04","Geisinger Marketplace HMO 30/60/3500","73% AV Level Silver Plan","73.70%","0.736293792724609","No","Yes","No","100%",,"$3,900","$0","$0","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003004.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010030","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010030-05","Geisinger Marketplace HMO 30/60/3500","87% AV Level Silver Plan","87.69%","0.885314047336578","No","Yes","No","100%",,"$1,200","$6","$0","$30","$353","$307","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003005.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050035-00","UPMC Advantage Platinum $250/$20 - Select Network","Standard Platinum Off Exchange Plan",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE34_EPO_RX1F40_DOVC_0117_1217_16322PA005003500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003500"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050035-01","UPMC Advantage Platinum $250/$20 - Select Network","Standard Platinum On Exchange Plan",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE80_EPO_RX1F40_DOVC_0117_1217_16322PA005003501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003501"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060079","UPMC MyCare Advantage Silver PPO $3,000 $25/$55 - Premium Network","16322PA006",,"PAN007","PAS005","PAF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060079-01","UPMC MyCare Advantage Silver PPO $3,000 $25/$55 - Premium Network","Standard Silver On Exchange Plan",,"0.71640682220459","No","Yes","Yes","90%","10%","$3,000","$500","$0","$200","$1,300","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%","$6,600","$6600 per person","$13200 per group","35.00%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP39_PPO_RX1F12_EB02_0117_1217_16322PA006007901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006007901"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060080","UPMC MyCare Advantage Silver PPO $5,000 $20/$40 - Premium Network","16322PA006",,"PAN007","PAS005","PAF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060080-00","UPMC MyCare Advantage Silver PPO $5,000 $20/$40 - Premium Network","Standard Silver Off Exchange Plan",,"0.708552598953247","No","Yes","Yes","90%","10%","$5,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%","$6,350","$6350 per person","$12700 per group","35.00%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB3_PPO_RX1F12_EB02_0117_1217_16322PA006008000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006008000"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050035-02","UPMC Advantage Platinum $0/$0 - Select Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZL_EPO_RX1D06_DOVC_0117_1217_16322PA005003502.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003502"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050035-03","UPMC Advantage Platinum $250/$20 - Select Network","Limited Cost Sharing Plan Variation",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELP_EPO_RX1F45_DOVC_0117_1217_16322PA005003503.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005003503"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","46-2824626","16322PA0060080","UPMC MyCare Advantage Silver PPO $5,000 $20/$40 - Premium Network","16322PA006",,"PAN007","PAS005","PAF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0060080-01","UPMC MyCare Advantage Silver PPO $5,000 $20/$40 - Premium Network","Standard Silver On Exchange Plan",,"0.708552598953247","No","Yes","Yes","90%","10%","$5,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%","$6,350","$6350 per person","$12700 per group","35.00%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP40_PPO_RX1F12_EB02_0117_1217_16322PA006008001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_16322PA006008001"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050107-00","UPMC Advantage Platinum $250/$20 - Partner Network","Standard Platinum Off Exchange Plan",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE41_EPO_RX1F40_DOVC_0117_1217_16322PA005010700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010700"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050107-01","UPMC Advantage Platinum $250/$20 - Partner Network","Standard Platinum On Exchange Plan",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE98_EPO_RX1F40_DOVC_0117_1217_16322PA005010701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010701"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050107-02","UPMC Advantage Platinum $0/$0 - Partner Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZT_EPO_RX1D06_DOVC_0117_1217_16322PA005010702.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010702"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050107-03","UPMC Advantage Platinum $250/$20 - Partner Network","Limited Cost Sharing Plan Variation",,"0.908619165420532","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELW_EPO_RX1F45_DOVC_0117_1217_16322PA005010703.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005010703"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040027-00","UPMC Advantage Silver $3,500/$30 - Premium Network","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP35_PPO_RX1G88_DOVC_0117_1217_16322PA004002700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002700"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040027-01","UPMC Advantage Silver $3,500/$30 - Premium Network","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP61_PPO_RX1G88_DOVC_0117_1217_16322PA004002701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002701"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040027-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZN_PPO_RX1D06_DOVC_0117_1217_16322PA004002702.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002702"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040027-03","UPMC Advantage Silver $3,500/$30 - Premium Network","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLS_PPO_RX1G93_DOVC_0117_1217_16322PA004002703.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002703"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040027-04","UPMC Advantage Silver $3,000/$30 - Premium Network","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$1,400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP62_PPO_RX1G89_DOVC_0117_1217_16322PA004002704.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002704"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040027-05","UPMC Advantage Silver $700/$10 - Premium Network","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$200","$700","$600","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP63_PPO_RX1G90_DOVC_0117_1217_16322PA004002705.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002705"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","New","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0040027-06","UPMC Advantage Silver $250/$5 - Premium Network","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$400","$200","$300","$200","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP64_PPO_RX1G91_DOVC_0117_1217_16322PA004002706.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA004002706"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050113-00","UPMC Advantage Silver $3,500/$30 - Select Network","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE44_EPO_RX1G88_DOVC_0117_1217_16322PA005011300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011300"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050113-01","UPMC Advantage Silver $3,500/$30 - Select Network","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA4_EPO_RX1G88_DOVC_0117_1217_16322PA005011301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011301"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050113-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZV_EPO_RX1D06_DOVC_0117_1217_16322PA005011302.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011302"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050113-03","UPMC Advantage Silver $3,500/$30 - Select Network","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELX_EPO_RX1G93_DOVC_0117_1217_16322PA005011303.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011303"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050113-04","UPMC Advantage Silver $3,000/$30 - Select Network","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$1,400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA5_EPO_RX1G89_DOVC_0117_1217_16322PA005011304.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011304"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050113-05","UPMC Advantage Silver $700/$10 - Select Network","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$200","$700","$600","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA6_EPO_RX1G90_DOVC_0117_1217_16322PA005011305.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011305"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050113-06","UPMC Advantage Silver $250/$5 - Select Network","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$400","$200","$300","$200","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA7_EPO_RX1G91_DOVC_0117_1217_16322PA005011306.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011306"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050114-00","UPMC Advantage Silver $3,500/$30 - Partner Network","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE45_EPO_RX1G88_DOVC_0117_1217_16322PA005011400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011400"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0040062","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS003","PAF002","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040062-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,440","$0","$0","$30","$5,016","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA004006200.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF007","Existing","PPO","Platinum","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070001-03","Personal Choice PPO Platinum","Limited Cost Sharing Plan Variation","88.09%",,"No","Yes","No","100%",,"$0","$730","$0","$150","$0","$1,480","$0","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppoplatinumLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF009","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070004-01","Personal Choice PPO Bronze","Standard Bronze On Exchange Plan","61.78%",,"Yes","Yes","No","100%",,"$5,500","$20","$1,040","$150","$3,270","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronze2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150007","Personal Choice PPO Gold HSA-25 $2,400/100%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Gold","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150007-01","Personal Choice PPO Gold HSA-25 $2,400/100%","Standard Gold On Exchange Plan",,"0.818801462650299","Yes","Yes","No","100%",,"$2,400","$10","$0","$150","$2,400","$810","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$4800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOGoldHSA_25_2400_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF009","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070004-02","Personal Choice PPO Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronzeZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700007","my Community Blue Flex PPO 2100S","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700007-04","my Community Blue Flex PPO 2100S","73% AV Level Silver Plan",,"0.736799001693726","No","Yes","Yes","85%","15%","$2,100","$1,300","$0","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","10.00%","$3,150","$3150 per person","$6300 per group","40.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111553873/I_2111553873_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050114-01","UPMC Advantage Silver $3,500/$30 - Partner Network","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA8_EPO_RX1G88_DOVC_0117_1217_16322PA005011401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011401"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050114-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZW_EPO_RX1D06_DOVC_0117_1217_16322PA005011402.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011402"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050114-03","UPMC Advantage Silver $3,500/$30 - Partner Network","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$800","$200","$1,400","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELY_EPO_RX1G93_DOVC_0117_1217_16322PA005011403.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011403"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050114-04","UPMC Advantage Silver $3,000/$30 - Partner Network","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$1,400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA9_EPO_RX1G89_DOVC_0117_1217_16322PA005011404.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011404"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050114-05","UPMC Advantage Silver $700/$10 - Partner Network","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$200","$700","$600","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB1_EPO_RX1G90_DOVC_0117_1217_16322PA005011405.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011405"
"2017","PA","16322","SERFF","2017-01-24 20:15:29","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","16322PA0050114-06","UPMC Advantage Silver $250/$5 - Partner Network","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$400","$200","$300","$200","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB2_EPO_RX1G91_DOVC_0117_1217_16322PA005011406.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_IND_16322PA005011406"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010006","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010006-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001000600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010006","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010006-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001000601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010006","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010006-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001000602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010006","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010006-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001000603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010016","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS003","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010016-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001001600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010016","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS003","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010016-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001001601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010016","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS003","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010016-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001001602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010016","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS003","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010016-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001001603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010018","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS004","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010018-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001001800.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010018","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS004","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010018-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001001801.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010018","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS004","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010018-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001001802.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010018","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS004","PAF006","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010018-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001001803.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010034","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS002","PAF006","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010034-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003400.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010034","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS002","PAF006","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010034-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003401.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010034","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS002","PAF006","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010034-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003402.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010034","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS002","PAF006","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010034-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.39%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$353","$342","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003403.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010030","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010030-00","Geisinger Marketplace HMO 30/60/3500","Standard Silver Off Exchange Plan","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003000.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010030","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010030-01","Geisinger Marketplace HMO 30/60/3500","Standard Silver On Exchange Plan","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003001.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010030","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010030-02","Geisinger Marketplace HMO 30/60/3500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003002.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010030","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010030-06","Geisinger Marketplace HMO 30/60/3500","94% AV Level Silver Plan","94.66%","0.947447419166565","No","Yes","No","100%",,"$600","$6","$0","$30","$353","$15","$0","$79","$0","$0","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003006.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010031","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010031-00","Geisinger Marketplace HMO 30/60/3500","Standard Silver Off Exchange Plan","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003100.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010031","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010031-01","Geisinger Marketplace HMO 30/60/3500","Standard Silver On Exchange Plan","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003101.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0160001","Personal Choice Catastrophic","31609PA016",,"PAN001","PAS001","PAF012","Existing","EPO","Catastrophic","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0160001-01","Personal Choice Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$3,270","$200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppocatastrophic2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150001","Personal Choice PPO Platinum Preferred $10/$20/$150","31609PA015",,"PAN001","PAS001","PAF001","Existing","PPO","Platinum","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150001-01","Personal Choice PPO Platinum Preferred $10/$20/$150","Standard Platinum On Exchange Plan","89.82%",,"No","Yes","No","100%",,"$0","$460","$0","$150","$0","$1,460","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOPlatinumPreferred_10_20_150_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150002","Personal Choice PPO Platinum Preferred $20/$40/$150","31609PA015",,"PAN001","PAS001","PAF002","Existing","PPO","Platinum","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150002-01","Personal Choice PPO Platinum Preferred $20/$40/$150","Standard Platinum On Exchange Plan","88.56%",,"No","Yes","No","100%",,"$0","$470","$0","$150","$0","$1,610","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOPlatinumPreferred_20_40_150_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0160002","Personal Choice Bronze Basic","31609PA016",,"PAN001","PAS001","PAF012","Existing","EPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0160002-01","Personal Choice Bronze Basic","Standard Bronze On Exchange Plan","61.89%",,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$3,270","$160","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronzebasic2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0160002","Personal Choice Bronze Basic","31609PA016",,"PAN001","PAS001","PAF012","Existing","EPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0160002-02","Personal Choice Bronze Basic","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronzebasicZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010031","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010031-02","Geisinger Marketplace HMO 30/60/3500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003102.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010031","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010031-03","Geisinger Marketplace HMO 30/60/3500","Limited Cost Sharing Plan Variation","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003103.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010031","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010031-04","Geisinger Marketplace HMO 30/60/3500","73% AV Level Silver Plan","73.70%","0.736293792724609","No","Yes","No","100%",,"$3,900","$0","$0","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003104.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010031","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010031-05","Geisinger Marketplace HMO 30/60/3500","87% AV Level Silver Plan","87.69%","0.885314047336578","No","Yes","No","100%",,"$1,200","$6","$0","$30","$353","$307","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003105.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010031","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010031-06","Geisinger Marketplace HMO 30/60/3500","94% AV Level Silver Plan","94.66%","0.947447419166565","No","Yes","No","100%",,"$600","$6","$0","$30","$353","$15","$0","$79","$0","$0","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003106.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010032","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010032-00","Geisinger Marketplace HMO 30/60/3500","Standard Silver Off Exchange Plan","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003200.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010032","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010032-01","Geisinger Marketplace HMO 30/60/3500","Standard Silver On Exchange Plan","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003201.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010032","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010032-02","Geisinger Marketplace HMO 30/60/3500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003202.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010032","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010032-03","Geisinger Marketplace HMO 30/60/3500","Limited Cost Sharing Plan Variation","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003203.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010032","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010032-04","Geisinger Marketplace HMO 30/60/3500","73% AV Level Silver Plan","73.70%","0.736293792724609","No","Yes","No","100%",,"$3,900","$0","$0","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003204.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010032","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010032-05","Geisinger Marketplace HMO 30/60/3500","87% AV Level Silver Plan","87.69%","0.885314047336578","No","Yes","No","100%",,"$1,200","$6","$0","$30","$353","$307","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003205.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010032","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010032-06","Geisinger Marketplace HMO 30/60/3500","94% AV Level Silver Plan","94.66%","0.947447419166565","No","Yes","No","100%",,"$600","$6","$0","$30","$353","$15","$0","$79","$0","$0","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003206.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010033","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010033-00","Geisinger Marketplace HMO 30/60/3500","Standard Silver Off Exchange Plan","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010033","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010033-01","Geisinger Marketplace HMO 30/60/3500","Standard Silver On Exchange Plan","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010033","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010033-02","Geisinger Marketplace HMO 30/60/3500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003302.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010033","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010033-03","Geisinger Marketplace HMO 30/60/3500","Limited Cost Sharing Plan Variation","71.50%","0.719832897186279","No","Yes","No","100%",,"$4,450","$0","$574","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003303.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010033","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010033-04","Geisinger Marketplace HMO 30/60/3500","73% AV Level Silver Plan","73.70%","0.736293792724609","No","Yes","No","100%",,"$3,900","$0","$0","$30","$603","$402","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003304.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010033","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010033-05","Geisinger Marketplace HMO 30/60/3500","87% AV Level Silver Plan","87.69%","0.885314047336578","No","Yes","No","100%",,"$1,200","$6","$0","$30","$353","$307","$0","$79","$0","$0","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003305.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0010033","Geisinger Marketplace HMO 30/60/3500","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010033-06","Geisinger Marketplace HMO 30/60/3500","94% AV Level Silver Plan","94.66%","0.947447419166565","No","Yes","No","100%",,"$600","$6","$0","$30","$353","$15","$0","$79","$0","$0","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA001003306.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0040019","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS001","PAF002","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040019-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,440","$0","$0","$30","$5,016","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA004001900.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0040019","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS001","PAF002","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040019-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,440","$0","$0","$30","$5,016","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA004001901.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0040053","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS002","PAF002","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040053-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,440","$0","$0","$30","$5,016","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA004005300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0040053","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS002","PAF002","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040053-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,440","$0","$0","$30","$5,016","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA004005301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0040062","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS003","PAF002","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040062-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,440","$0","$0","$30","$5,016","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA004006201.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0040069","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS004","PAF002","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040069-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,440","$0","$0","$30","$5,016","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA004006900.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","22444","SERFF","2016-09-28 04:33:02","Individual","No","23-2311553","22444PA0040069","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS004","PAF002","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2017-01-01","2017-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040069-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,440","$0","$0","$30","$5,016","$0","$0","$79","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2017/22444PA004006901.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2017/AllPlansBrochureIndividual.pdf"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0160002","Personal Choice Bronze Basic","31609PA016",,"PAN001","PAS001","PAF012","Existing","EPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0160002-03","Personal Choice Bronze Basic","Limited Cost Sharing Plan Variation","61.89%",,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$3,270","$160","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronzebasicLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150003","Personal Choice PPO Gold Preferred $35/$70/$600","31609PA015",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150003-01","Personal Choice PPO Gold Preferred $35/$70/$600","Standard Gold On Exchange Plan","81.42%",,"No","Yes","No","100%",,"$0","$1,390","$0","$150","$0","$1,850","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOGoldPreferred_35_70_600_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF008","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070002-01","Personal Choice PPO Gold","Standard Gold On Exchange Plan","80.87%",,"No","Yes","No","100%",,"$0","$1,700","$0","$150","$0","$500","$810","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppogold2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF008","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070002-02","Personal Choice PPO Gold","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppogoldZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF008","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070002-03","Personal Choice PPO Gold","Limited Cost Sharing Plan Variation","80.87%",,"No","Yes","No","100%",,"$0","$1,700","$0","$150","$0","$500","$810","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppogoldLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","32561","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","32561PA0200001","Guardian Essentials for Families and Individuals","32561PA020",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","32561PA0200001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","PA","32561","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","32561PA0090003","Guardian Pediatric Advantage","32561PA009",,"PAN001","PAS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","32561PA0090003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","PA","32561","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","32561PA0200001","Guardian Essentials for Families and Individuals","32561PA020",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","32561PA0200001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","PA","32561","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","32561PA0100003","Guardian Pediatric Essentials","32561PA010",,"PAN001","PAS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","32561PA0100003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","PA","32561","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","32561PA0210001","Guardian Select for Families and Individuals","32561PA021",,"PAN002","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","32561PA0210001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","PA","32561","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","32561PA0210001","Guardian Select for Families and Individuals","32561PA021",,"PAN002","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","32561PA0210001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150004","Personal Choice PPO Gold Classic $1,000/$15/$30/80%","31609PA015",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150004-01","Personal Choice PPO Gold Classic $1,000/$15/$30/80%","Standard Gold On Exchange Plan","78.60%",,"No","Yes","No","100%",,"$1,000","$30","$890","$150","$160","$1,530","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOGoldClassic_1000_15_30_80_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF011","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9912",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-01","Personal Choice PPO Silver","Standard Silver On Exchange Plan","69.52%",,"Yes","Yes","No","100%",,"$2,500","$90","$810","$150","$2,190","$460","$0","$80","$0","$0","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/pposilver2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF011","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9912",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-02","Personal Choice PPO Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/pposilverZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF011","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9912",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-03","Personal Choice PPO Silver","Limited Cost Sharing Plan Variation","69.52%",,"Yes","Yes","No","100%",,"$2,500","$90","$810","$150","$2,190","$460","$0","$80","$0","$0","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/pposilverLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF011","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9912",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-04","Personal Choice PPO Silver","73% AV Level Silver Plan","73.23%",,"Yes","Yes","No","100%",,"$2,500","$80","$540","$150","$2,190","$370","$0","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/pposilver73CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF011","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9912",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-05","Personal Choice PPO Silver","87% AV Level Silver Plan","87.44%",,"Yes","Yes","No","100%",,"$0","$40","$480","$150","$750","$150","$400","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/pposilver87CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF011","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9912",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-06","Personal Choice PPO Silver","94% AV Level Silver Plan","93.93%",,"Yes","Yes","No","100%",,"$0","$20","$480","$150","$0","$100","$420","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/pposilver94CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150005","Personal Choice PPO Silver Classic $2,500/$30/$60/80%","31609PA015",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150005-01","Personal Choice PPO Silver Classic $2,500/$30/$60/80%","Standard Silver On Exchange Plan","70.44%",,"No","Yes","No","100%",,"$2,500","$40","$540","$150","$160","$330","$1,010","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOSilverClassic_2500_30_60_80_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF012","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070006-01","Personal Choice PPO Bronze Reserve","Standard Bronze On Exchange Plan",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$3,680","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronzereserve2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF012","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070006-02","Personal Choice PPO Bronze Reserve","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronzereserveZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF012","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070006-03","Personal Choice PPO Bronze Reserve","Limited Cost Sharing Plan Variation",,"0.613812267780304","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$3,680","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronzereserveLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF007","Existing","PPO","Platinum","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070001-01","Personal Choice PPO Platinum","Standard Platinum On Exchange Plan","88.09%",,"No","Yes","No","100%",,"$0","$730","$0","$150","$0","$1,480","$0","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppoplatinum2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150006","Personal Choice PPO Platinum HSA-50 $1,600/100%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Platinum","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150006-01","Personal Choice PPO Platinum HSA-50 $1,600/100%","Standard Platinum On Exchange Plan",,"0.888483226299286","Yes","Yes","No","100%",,"$1,600","$10","$0","$150","$1,600","$1,220","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$800.00","https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOPlatinumHSA_50_1600_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF007","Existing","PPO","Platinum","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070001-02","Personal Choice PPO Platinum","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppoplatinumZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF009","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070004-03","Personal Choice PPO Bronze","Limited Cost Sharing Plan Variation","61.78%",,"Yes","Yes","No","100%",,"$5,500","$20","$1,040","$150","$3,270","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/ppobronzeLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150008","Personal Choice PPO Gold HSA-0 $1,900/100%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Gold","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150008-01","Personal Choice PPO Gold HSA-0 $1,900/100%","Standard Gold On Exchange Plan",,"0.781102418899536","Yes","Yes","No","100%",,"$1,900","$10","$0","$150","$1,900","$1,010","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOGoldHSA_0_1900_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150009","Personal Choice PPO Gold HSA-50 $2,650/70%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Gold","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150009-01","Personal Choice PPO Gold HSA-50 $2,650/70%","Standard Gold On Exchange Plan",,"0.798461675643921","Yes","Yes","No","100%",,"$2,650","$10","$1,440","$150","$2,650","$630","$30","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","per person not applicable","$5300 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$1,325.00","https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOGoldHSA_50_2650_70_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150011","Personal Choice PPO Silver HSA-0 $2,700/90%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150011-01","Personal Choice PPO Silver HSA-0 $2,700/90%","Standard Silver On Exchange Plan",,"0.697226166725159","Yes","Yes","No","100%",,"$2,700","$10","$480","$150","$2,700","$630","$10","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","per person not applicable","$5400 per group","10.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOSilverHSA_0_2700_90_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150012","Personal Choice PPO Bronze HSA-0 $5,200/50%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150012-01","Personal Choice PPO Bronze HSA-0 $5,200/50%","Standard Bronze On Exchange Plan",,"0.61982250213623","Yes","Yes","No","100%",,"$5,200","$10","$1,040","$150","$3,680","$0","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","per person not applicable","$10400 per group","50.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOBronzeHSA_0_5200_50_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150013","Personal Choice PPO Bronze HSA-0 $6,550/100%","31609PA015",,"PAN001","PAS001","PAF006","Existing","PPO","Bronze","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150013-01","Personal Choice PPO Bronze HSA-0 $6,550/100%","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$3,680","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOBronzeHSA_0_6550_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150022","Personal Choice PPO Gold Classic $2,000/$40/$80/100%","31609PA015",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150022-01","Personal Choice PPO Gold Classic $2,000/$40/$80/100%","Standard Gold On Exchange Plan","78.29%",,"No","Yes","No","100%",,"$2,000","$190","$0","$150","$160","$1,730","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOGoldClassic_2000_40_80_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150024","Personal Choice PPO Silver Secure $3,000/$30/$60/$600","31609PA015",,"PAN001","PAS001","PAF014","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150024-01","Personal Choice PPO Silver Secure $3,000/$30/$60/$600","Standard Silver On Exchange Plan","69.84%",,"No","Yes","No","100%",,"$3,000","$1,240","$0","$150","$160","$1,750","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOSilverSecure_3000_30_60_600_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150023","Personal Choice PPO Silver Classic $3,300/$40/$80/100%","31609PA015",,"PAN001","PAS001","PAF014","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150023-01","Personal Choice PPO Silver Classic $3,300/$40/$80/100%","Standard Silver On Exchange Plan","69.94%",,"No","Yes","No","100%",,"$3,300","$170","$0","$150","$160","$1,830","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","0.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOSilverClassic_3300_40_80_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150046","Personal Choice PPO Silver HSA-0 $3,200/100%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150046-01","Personal Choice PPO Silver HSA-0 $3,200/100%","Standard Silver On Exchange Plan",,"0.703069984912872","Yes","Yes","No","100%",,"$3,200","$10","$0","$150","$3,200","$320","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","per person not applicable","$6400 per group","0.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOSilverHSA_0_3200_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150010","Personal Choice PPO Silver HSA-0 $2,100/70%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150010-01","Personal Choice PPO Silver HSA-0 $2,100/70%","Standard Silver On Exchange Plan",,"0.68325400352478","Yes","Yes","No","100%",,"$2,100","$10","$1,700","$150","$2,100","$860","$100","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","per person not applicable","$4200 per group","30.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOSilverHSA_0_2100_70_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150014","Personal Choice PPO Platinum HRA-50 $1,850/100%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Platinum","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150014-01","Personal Choice PPO Platinum HRA-50 $1,850/100%","Standard Platinum On Exchange Plan",,"0.882396280765533","Yes","Yes","No","100%",,"$1,850","$10","$0","$150","$1,850","$1,040","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","Yes","$925.00","https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOPlatinumHRA_50_1850_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","31609","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","23-2184623","31609PA0150015","Personal Choice PPO Gold HRA-25 $2,900/100%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Gold","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids,  Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes",,"http://www.ibx.com/ffm/formulary4s","31609PA0150015-01","Personal Choice PPO Gold HRA-25 $2,900/100%","Standard Gold On Exchange Plan",,"0.803281009197235","Yes","Yes","No","100%",,"$2,900","$10","$0","$150","$2,900","$470","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","Yes","$725.00","https://www.ibx.com/pdfs/custom/shop/2017/PersonalChoicePPOGoldHRA_25_2900_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","32561","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","32561PA0220001","Guardian Basics for Families and Individuals","32561PA022",,"PAN002","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","32561PA0220001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","PA","32561","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","32561PA0220001","Guardian Basics for Families and Individuals","32561PA022",,"PAN002","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","32561PA0220001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700005","my Community Blue Flex PPO 1700GQ","33709PA070",,"PAN001","PAS007","PAF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700005-00","my Community Blue Flex PPO 1700GQ","Standard Gold Off Exchange Plan",,"0.78779125213623","Yes","Yes","Yes","85%","15%","$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700005","my Community Blue Flex PPO 1700GQ","33709PA070",,"PAN001","PAS007","PAF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700005-01","my Community Blue Flex PPO 1700GQ","Standard Gold On Exchange Plan",,"0.78779125213623","Yes","Yes","Yes","85%","15%","$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110142202/I_2110142202_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690005","my Connect Blue EPO 1000G, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690005-01","my Connect Blue EPO 1000G, a Community Blue Flex Plan","Standard Gold On Exchange Plan","78.58%","0","No","Yes","Yes","83%","17%","$1,000","$400","$0","$0","$1,000","$400","$60","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110143768/I_2110143768_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690005","my Connect Blue EPO 1000G, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690005-02","my Connect Blue EPO 1000G, a Community Blue Flex Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","83%","17%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110144325/I_2110144325_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690005","my Connect Blue EPO 1000G, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690005-03","my Connect Blue EPO 1000G, a Community Blue Flex Plan","Limited Cost Sharing Plan Variation","78.58%","0","No","Yes","Yes","83%","17%","$1,000","$400","$0","$0","$1,000","$400","$60","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110144511/I_2110144511_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF018","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040005-03","Keystone HMO Gold Proactive","Limited Cost Sharing Plan Variation","79.11%",,"No","Yes","Yes","45%","55%","$0","$880","$0","$150","$0","$500","$1,010","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmogoldproactiveLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100005","Keystone HMO Silver Classic $2,500/$25/$50/70%","33871PA010",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100005-01","Keystone HMO Silver Classic $2,500/$25/$50/70%","Standard Silver On Exchange Plan","70.75%",,"No","Yes","No","100%",,"$2,500","$160","$810","$150","$160","$290","$1,010","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOSilverClassic_2500_25_50_70_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700005","my Community Blue Flex PPO 1700GQ","33709PA070",,"PAN001","PAS007","PAF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700005-02","my Community Blue Flex PPO 1700GQ","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110142699/I_2110142699_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700005","my Community Blue Flex PPO 1700GQ","33709PA070",,"PAN001","PAS007","PAF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700005-03","my Community Blue Flex PPO 1700GQ","Limited Cost Sharing Plan Variation",,"0.78779125213623","Yes","Yes","Yes","85%","15%","$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110142839/I_2110142839_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700007","my Community Blue Flex PPO 2100S","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700007-00","my Community Blue Flex PPO 2100S","Standard Silver Off Exchange Plan",,"0.68811047077179","No","Yes","Yes","85%","15%","$2,100","$1,300","$0","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","$6,900","$6900 per person","$13800 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","10.00%","$4,500","$4500 per person","$9000 per group","40.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700007","my Community Blue Flex PPO 2100S","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700007-01","my Community Blue Flex PPO 2100S","Standard Silver On Exchange Plan",,"0.68811047077179","No","Yes","Yes","85%","15%","$2,100","$1,300","$0","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","$6,900","$6900 per person","$13800 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","10.00%","$4,500","$4500 per person","$9000 per group","40.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111551296/I_2111551296_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700007","my Community Blue Flex PPO 2100S","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700007-02","my Community Blue Flex PPO 2100S","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111553519/I_2111553519_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700007","my Community Blue Flex PPO 2100S","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700007-03","my Community Blue Flex PPO 2100S","Limited Cost Sharing Plan Variation",,"0.68811047077179","No","Yes","Yes","85%","15%","$2,100","$1,300","$0","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","$6,900","$6900 per person","$13800 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","10.00%","$4,500","$4500 per person","$9000 per group","40.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111553013/I_2111553013_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700007","my Community Blue Flex PPO 2100S","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700007-05","my Community Blue Flex PPO 2100S","87% AV Level Silver Plan",,"0.865057528018951","No","Yes","Yes","85%","15%","$600","$1,200","$0","$0","$600","$600","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%","$900","$900 per person","$1800 per group","40.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111554391/I_2111554391_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700007","my Community Blue Flex PPO 2100S","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700007-06","my Community Blue Flex PPO 2100S","94% AV Level Silver Plan",,"0.937309205532074","No","Yes","Yes","85%","15%","$250","$100","$0","$0","$250","$400","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$375","$375 per person","$750 per group","40.00%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111555044/I_2111555044_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690002","my Connect Blue EPO 2500S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690002-04","my Connect Blue EPO 2500S, a Community Blue Flex Plan","73% AV Level Silver Plan","72.25%","0","No","Yes","Yes","83%","17%","$2,500","$700","$0","$0","$1,600","$700","$0","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%","$4,000","$4000 per person","$8000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111518915/I_2111518915_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690002","my Connect Blue EPO 2500S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690002-05","my Connect Blue EPO 2500S, a Community Blue Flex Plan","87% AV Level Silver Plan","86.12%","0","No","Yes","Yes","83%","17%","$600","$300","$0","$0","$600","$500","$100","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111519303/I_2111519303_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690002","my Connect Blue EPO 2500S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690002-06","my Connect Blue EPO 2500S, a Community Blue Flex Plan","94% AV Level Silver Plan","93.14%","0","No","Yes","Yes","83%","17%","$200","$200","$0","$0","$200","$400","$100","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","$450","$450 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","10.00%","$340","$340 per person","$680 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111521257/I_2111521257_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-05","Keystone HMO Silver","87% AV Level Silver Plan","86.38%",,"Yes","Yes","No","100%",,"$1,000","$50","$710","$150","$1,000","$100","$240","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilver87CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100036","Keystone HMO Silver Classic $4,250/$40/$80/100%","33871PA010",,"PAN001","PAS001","PAF005","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100036-01","Keystone HMO Silver Classic $4,250/$40/$80/100%","Standard Silver On Exchange Plan","68.78%",,"No","Yes","No","100%",,"$4,250","$170","$0","$150","$160","$1,830","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOSilverClassic_4250_40_80_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100006","Keystone HMO Silver Classic $2,750/$30/$60/50%","33871PA010",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Not Applicable","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100006-01","Keystone HMO Silver Classic $2,750/$30/$60/50%","Standard Silver On Exchange Plan",,"0.703495800495148","No","Yes","No","100%",,"$2,750","$160","$1,360","$150","$160","$330","$1,010","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOSilverClassic_2750_30_60_50_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700006","my Community Blue Flex PPO 2800SQE","33709PA070",,"PAN001","PAS007","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700006-00","my Community Blue Flex PPO 2800SQE","Standard Silver Off Exchange Plan","68.10%","0.681012868881226","Yes","Yes","Yes","85%","15%","$2,800","$0","$900","$0","$2,800","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700006","my Community Blue Flex PPO 2800SQE","33709PA070",,"PAN001","PAS007","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700006-01","my Community Blue Flex PPO 2800SQE","Standard Silver On Exchange Plan","68.10%","0.681012868881226","Yes","Yes","Yes","85%","15%","$2,800","$0","$900","$0","$2,800","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111540457/I_2111540457_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700006","my Community Blue Flex PPO 2800SQE","33709PA070",,"PAN001","PAS007","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700006-02","my Community Blue Flex PPO 2800SQE","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111541120/I_2111541120_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700006","my Community Blue Flex PPO 2800SQE","33709PA070",,"PAN001","PAS007","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700006-03","my Community Blue Flex PPO 2800SQE","Limited Cost Sharing Plan Variation","68.10%","0.681012868881226","Yes","Yes","Yes","85%","15%","$2,800","$0","$900","$0","$2,800","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111540886/I_2111540886_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700006","my Community Blue Flex PPO 2800SQE","33709PA070",,"PAN001","PAS007","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700006-04","my Community Blue Flex PPO 2800SQE","73% AV Level Silver Plan","72.17%","0.703559339046478","Yes","Yes","Yes","85%","15%","$2,800","$0","$900","$0","$2,800","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111544493/I_2111544493_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700006","my Community Blue Flex PPO 2800SQE","33709PA070",,"PAN001","PAS007","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700006-05","my Community Blue Flex PPO 2800SQE","87% AV Level Silver Plan","86.03%","0.859853029251099","Yes","Yes","Yes","85%","15%","$800","$0","$1,300","$0","$800","$0","$900","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%","$800","$800 per person","$1600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111549005/I_2111549005_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700006","my Community Blue Flex PPO 2800SQE","33709PA070",,"PAN001","PAS007","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700006-06","my Community Blue Flex PPO 2800SQE","94% AV Level Silver Plan","93.57%","0.935741722583771","Yes","Yes","Yes","85%","15%","$300","$0","$600","$0","$300","$0","$600","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20.00%","$300","$300 per person","$600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2444549901/I_2444549901_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700008","my Community Blue Flex PPO 6800B","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700008-00","my Community Blue Flex PPO 6800B","Standard Bronze Off Exchange Plan","60.91%","0.623426675796509","No","Yes","Yes","85%","15%","$6,600","$400","$0","$0","$1,600","$1,100","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","30.00%","$6,800","$6800 per person","$13600 per group","60.00%","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700008","my Community Blue Flex PPO 6800B","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700008-01","my Community Blue Flex PPO 6800B","Standard Bronze On Exchange Plan","60.91%","0.623426675796509","No","Yes","Yes","85%","15%","$6,600","$400","$0","$0","$1,600","$1,100","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","30.00%","$6,800","$6800 per person","$13600 per group","60.00%","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109682399/I_2109682399_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700008","my Community Blue Flex PPO 6800B","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700008-02","my Community Blue Flex PPO 6800B","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111005857/I_2111005857_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0700008","my Community Blue Flex PPO 6800B","33709PA070",,"PAN001","PAS007","PAF001","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0700008-03","my Community Blue Flex PPO 6800B","Limited Cost Sharing Plan Variation","60.91%","0.623426675796509","No","Yes","Yes","85%","15%","$6,600","$400","$0","$0","$1,600","$1,100","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","30.00%","$6,800","$6800 per person","$13600 per group","60.00%","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111005869/I_2111005869_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690001","my Connect Blue EPO 1750S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690001-00","my Connect Blue EPO 1750S, a Community Blue Flex Plan","Standard Silver Off Exchange Plan","68.33%","0","No","Yes","Yes","83%","17%","$1,750","$1,500","$0","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%","$4,500","$4500 per person","$9000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690001","my Connect Blue EPO 1750S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690001-01","my Connect Blue EPO 1750S, a Community Blue Flex Plan","Standard Silver On Exchange Plan","68.33%","0","No","Yes","Yes","83%","17%","$1,750","$1,500","$0","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%","$4,500","$4500 per person","$9000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111492039/I_2111492039_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690001","my Connect Blue EPO 1750S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690001-02","my Connect Blue EPO 1750S, a Community Blue Flex Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","83%","17%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111499166/I_2111499166_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690001","my Connect Blue EPO 1750S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690001-03","my Connect Blue EPO 1750S, a Community Blue Flex Plan","Limited Cost Sharing Plan Variation","68.33%","0","No","Yes","Yes","83%","17%","$1,750","$1,500","$0","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%","$4,500","$4500 per person","$9000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111498134/I_2111498134_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690001","my Connect Blue EPO 1750S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690001-04","my Connect Blue EPO 1750S, a Community Blue Flex Plan","73% AV Level Silver Plan","72.74%","0","No","Yes","Yes","83%","17%","$1,750","$1,500","$0","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%","$4,500","$4500 per person","$9000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111499731/I_2111499731_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690001","my Connect Blue EPO 1750S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690001-05","my Connect Blue EPO 1750S, a Community Blue Flex Plan","87% AV Level Silver Plan","86.30%","0","No","Yes","Yes","83%","17%","$700","$600","$0","$0","$700","$600","$90","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","10.00%","$1,050","$1050 per person","$2100 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111501174/I_2111501174_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690001","my Connect Blue EPO 1750S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690001-06","my Connect Blue EPO 1750S, a Community Blue Flex Plan","94% AV Level Silver Plan","93.15%","0","No","Yes","Yes","83%","17%","$250","$300","$0","$0","$250","$400","$100","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$375","$375 per person","$750 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111501667/I_2111501667_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690002","my Connect Blue EPO 2500S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690002-00","my Connect Blue EPO 2500S, a Community Blue Flex Plan","Standard Silver Off Exchange Plan","68.26%","0","No","Yes","Yes","83%","17%","$2,500","$700","$0","$0","$1,600","$700","$0","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%","$4,000","$4000 per person","$8000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690002","my Connect Blue EPO 2500S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690002-01","my Connect Blue EPO 2500S, a Community Blue Flex Plan","Standard Silver On Exchange Plan","68.26%","0","No","Yes","Yes","83%","17%","$2,500","$700","$0","$0","$1,600","$700","$0","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%","$4,000","$4000 per person","$8000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111502247/I_2111502247_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690002","my Connect Blue EPO 2500S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690002-02","my Connect Blue EPO 2500S, a Community Blue Flex Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","83%","17%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111511348/I_2111511348_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690002","my Connect Blue EPO 2500S, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690002-03","my Connect Blue EPO 2500S, a Community Blue Flex Plan","Limited Cost Sharing Plan Variation","68.26%","0","No","Yes","Yes","83%","17%","$2,500","$700","$0","$0","$1,600","$700","$0","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%","$4,000","$4000 per person","$8000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112627868/I_2112627868_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690003","my Connect Blue EPO 250G, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690003-00","my Connect Blue EPO 250G, a Community Blue Flex Plan","Standard Gold Off Exchange Plan","78.52%","0","No","Yes","Yes","83%","17%","$250","$600","$0","$0","$250","$500","$100","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$750","$750 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690003","my Connect Blue EPO 250G, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690003-01","my Connect Blue EPO 250G, a Community Blue Flex Plan","Standard Gold On Exchange Plan","78.52%","0","No","Yes","Yes","83%","17%","$250","$600","$0","$0","$250","$500","$100","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$750","$750 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111235145/I_2111235145_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690003","my Connect Blue EPO 250G, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690003-02","my Connect Blue EPO 250G, a Community Blue Flex Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","83%","17%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111235154/I_2111235154_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690003","my Connect Blue EPO 250G, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690003-03","my Connect Blue EPO 250G, a Community Blue Flex Plan","Limited Cost Sharing Plan Variation","78.52%","0","No","Yes","Yes","83%","17%","$250","$600","$0","$0","$250","$500","$100","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$750","$750 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111235160/I_2111235160_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690004","my Connect Blue EPO 6500B, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690004-00","my Connect Blue EPO 6500B, a Community Blue Flex Plan","Standard Bronze Off Exchange Plan","61.94%","0.621654212474823","No","Yes","Yes","83%","17%","$0","$1,700","$0","$0","$1,600","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690004","my Connect Blue EPO 6500B, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690004-01","my Connect Blue EPO 6500B, a Community Blue Flex Plan","Standard Bronze On Exchange Plan","61.94%","0.621654212474823","No","Yes","Yes","83%","17%","$0","$1,700","$0","$0","$1,600","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109657701/I_2109657701_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690004","my Connect Blue EPO 6500B, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690004-02","my Connect Blue EPO 6500B, a Community Blue Flex Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","83%","17%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110056583/I_2110056583_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690004","my Connect Blue EPO 6500B, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690004-03","my Connect Blue EPO 6500B, a Community Blue Flex Plan","Limited Cost Sharing Plan Variation","61.94%","0.621654212474823","No","Yes","Yes","83%","17%","$0","$1,700","$0","$0","$1,600","$1,000","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110056653/I_2110056653_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0690005","my Connect Blue EPO 1000G, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS008","PAF001","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0690005-00","my Connect Blue EPO 1000G, a Community Blue Flex Plan","Standard Gold Off Exchange Plan","78.58%","0","No","Yes","Yes","83%","17%","$1,000","$400","$0","$0","$1,000","$400","$60","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0380004","Major Events Blue PPO 7150, a Community Blue Plan","33709PA038",,"PAN001","PAS010","PAF005","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes",,"https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","33709PA0380004-00","Major Events Blue PPO 7150, a Community Blue Plan","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,,
"2017","PA","33709","SERFF","2017-01-23 20:15:25","Individual","No","23-1294723","33709PA0380004","Major Events Blue PPO 7150, a Community Blue Plan","33709PA038",,"PAN001","PAS010","PAF005","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes",,"https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","33709PA0380004-01","Major Events Blue PPO 7150, a Community Blue Plan","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111106456/I_2111106456_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040002-01","Keystone HMO Gold","Standard Gold On Exchange Plan","81.23%",,"No","Yes","No","100%",,"$0","$1,700","$0","$150","$0","$520","$810","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmogold2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100001","Keystone HMO Platinum Preferred $10/$20/$100","33871PA010",,"PAN001","PAS001","PAF001","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100001-01","Keystone HMO Platinum Preferred $10/$20/$100","Standard Platinum On Exchange Plan","91.53%",,"No","Yes","No","100%",,"$0","$260","$0","$150","$0","$1,440","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOPlatinumPreferred_10_20_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040002-02","Keystone HMO Gold","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmogoldZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040002-03","Keystone HMO Gold","Limited Cost Sharing Plan Variation","81.23%",,"No","Yes","No","100%",,"$0","$1,700","$0","$150","$0","$520","$810","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmogoldLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100002","Keystone HMO Platinum Preferred $20/$40/$150","33871PA010",,"PAN001","PAS001","PAF002","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100002-01","Keystone HMO Platinum Preferred $20/$40/$150","Standard Platinum On Exchange Plan","88.34%",,"No","Yes","No","100%",,"$0","$390","$0","$150","$0","$1,610","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOPlatinumPreferred_20_40_150_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-01","Keystone HMO Silver","Standard Silver On Exchange Plan","70.04%",,"Yes","Yes","No","100%",,"$2,500","$210","$810","$150","$2,190","$480","$0","$80","$0","$0","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilver2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-02","Keystone HMO Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilverZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-03","Keystone HMO Silver","Limited Cost Sharing Plan Variation","70.04%",,"Yes","Yes","No","100%",,"$2,500","$210","$810","$150","$2,190","$480","$0","$80","$0","$0","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilverLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-04","Keystone HMO Silver","73% AV Level Silver Plan","72.88%",,"Yes","Yes","No","100%",,"$2,000","$200","$810","$150","$2,000","$440","$80","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilver73CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-06","Keystone HMO Silver","94% AV Level Silver Plan","94.58%",,"Yes","Yes","No","100%",,"$0","$40","$450","$150","$0","$90","$420","$80","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilver94CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100003","Keystone HMO Gold Preferred $30/$60/$650","33871PA010",,"PAN001","PAS001","PAF003","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100003-01","Keystone HMO Gold Preferred $30/$60/$650","Standard Gold On Exchange Plan","81.94%",,"No","Yes","No","100%",,"$0","$1,460","$0","$150","$0","$1,810","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOGoldPreferred_30_60_650_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF019","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-01","Keystone HMO Silver Proactive","Standard Silver On Exchange Plan","71.90%",,"No","Yes","Yes","47%","53%","$0","$1,200","$0","$150","$0","$600","$1,010","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$5,500","$5500 per person","$11000 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilverproactive_indiv_2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100004","Keystone HMO Gold Classic $1,000/$25/$50/90%","33871PA010",,"PAN001","PAS001","PAF003","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100004-01","Keystone HMO Gold Classic $1,000/$25/$50/90%","Standard Gold On Exchange Plan","78.53%",,"No","Yes","No","100%",,"$1,000","$120","$360","$150","$160","$1,610","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOGoldClassic_1000_25_50_90_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF019","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-02","Keystone HMO Silver Proactive","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","47%","53%","$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilverproactiveZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF019","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-03","Keystone HMO Silver Proactive","Limited Cost Sharing Plan Variation","71.90%",,"No","Yes","Yes","47%","53%","$0","$1,200","$0","$150","$0","$600","$1,010","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$5,500","$5500 per person","$11000 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilverproactiveLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF019","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-04","Keystone HMO Silver Proactive","73% AV Level Silver Plan","73.96%",,"No","Yes","Yes","47%","53%","$0","$1,000","$0","$150","$0","$600","$1,010","$80","$0","$0","$0","$0","$500","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$5,300","$5300 per person","$10600 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilverproactive73CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF019","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-05","Keystone HMO Silver Proactive","87% AV Level Silver Plan","87.12%",,"No","Yes","Yes","47%","53%","$0","$230","$0","$150","$0","$230","$610","$80","$0","$0","$0","$0","$500","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$1,000","$1000 per person","$2000 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilverproactive87CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF019","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-06","Keystone HMO Silver Proactive","94% AV Level Silver Plan","94.66%",,"No","Yes","Yes","47%","53%","$0","$130","$0","$150","$0","$190","$200","$80","$0","$0","$0","$0","$500","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$100","$100 per person","$200 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmosilverproactive94CSR2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF018","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040005-01","Keystone HMO Gold Proactive","Standard Gold On Exchange Plan","79.11%",,"No","Yes","Yes","45%","55%","$0","$880","$0","$150","$0","$500","$1,010","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmogoldproactive_indiv_2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100035","Keystone HMO Gold Classic $2,000/$40/$80/100%","33871PA010",,"PAN001","PAS001","PAF003","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100035-01","Keystone HMO Gold Classic $2,000/$40/$80/100%","Standard Gold On Exchange Plan","78.20%",,"No","Yes","No","100%",,"$2,000","$170","$0","$150","$160","$1,730","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOGoldClassic_2000_40_80_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF018","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040005-02","Keystone HMO Gold Proactive","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","45%","55%","$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmogoldproactiveZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100037","Keystone HMO Silver Secure $3,500/$40/$80/$600","33871PA010",,"PAN001","PAS001","PAF005","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100037-01","Keystone HMO Silver Secure $3,500/$40/$80/$600","Standard Silver On Exchange Plan","69.26%",,"No","Yes","No","100%",,"$3,500","$1,370","$0","$150","$160","$1,830","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOSilverSecure_3500_40_80_600_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100007","Keystone HMO Bronze Essential $6,850/$50/$100/$700","33871PA010",,"PAN001","PAS001","PAF012","Existing","HMO","Bronze","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0100007-01","Keystone HMO Bronze Essential $6,850/$50/$100/$700","Standard Bronze On Exchange Plan","61.98%",,"Yes","Yes","No","100%",,"$4,490","$230","$0","$150","$2,890","$400","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOBronzeEssential_6850_50_100_700_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100008","Keystone HMO Gold Proactive","33871PA010",,"PAN001","PAS001","PAF006","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary5s","33871PA0100008-01","Keystone HMO Gold Proactive","Standard Gold On Exchange Plan","79.04%",,"No","Yes","Yes","45%","55%","$0","$880","$0","$150","$0","$500","$1,010","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOGoldProactive_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020013","Gold PPO 1000/0/20","45127PA002","7588667726","PAN003","PAS002","PAF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020013-00","Gold PPO 1000/0/20","Standard Gold Off Exchange Plan",,"0.797972202301025","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$800","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$1,000","$1000 per person","$2000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%","$300","$300 per person","$600 per group","0.00%","$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002001300.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","Yes","45-5492167","45127PA0030002","Dental PPO Plan 2","45127PA003",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030002-00","Dental PPO Plan 2","Standard Low Off Exchange Plan","71.55%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2017/45127PA0030002-2017.pdf"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","Yes","45-5492167","45127PA0030003","Dental PPO Plan 3","45127PA003",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030003-00","Dental PPO Plan 3","Standard Low Off Exchange Plan","71.55%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2017/45127PA0030003-2017.pdf"
"2017","PA","46518","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","46518PA0010001","Dentegra Dental PPO Pediatric Basic Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010001-17"
"2017","PA","46518","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","46518PA0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","46518PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://dentegra.com/hcx/pa/46518pa0020001-17","","46518PA0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0020001-17"
"2017","PA","46518","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","46518PA0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","46518PA002",,"PAN001","PAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://dentegra.com/hcx/pa/46518pa0020008-17","","46518PA0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0020008-17"
"2017","PA","46518","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","46518PA0010008","Dentegra Dental PPO Family Preferred Plan","46518PA001",,"PAN001","PAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010008-17"
"2017","PA","46518","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","46518PA0010007","Dentegra Dental PPO Family Basic Plan","46518PA001",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010007-17"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0100009","Keystone HMO Silver Proactive","33871PA010",,"PAN001","PAS001","PAF007","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary5s","33871PA0100009-01","Keystone HMO Silver Proactive","Standard Silver On Exchange Plan","71.86%",,"No","Yes","Yes","47%","53%","$0","$1,200","$0","$150","$0","$600","$1,010","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$5,500","$5500 per person","$11000 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneHMOSilverProactive_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF013","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","33871PA0040001-01","Keystone HMO Platinum","Standard Platinum On Exchange Plan","89.01%",,"No","Yes","No","100%",,"$0","$900","$0","$150","$0","$1,570","$0","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmoplatinum2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110001","Keystone DPOS Platinum Preferred $10/$20/$100","33871PA011",,"PAN001","PAS001","PAF008","Existing","POS","Platinum","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110001-01","Keystone DPOS Platinum Preferred $10/$20/$100","Standard Platinum On Exchange Plan","91.53%",,"No","Yes","No","100%",,"$0","$260","$0","$150","$0","$1,440","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSPlatinumPreferred_10_20_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF013","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","33871PA0040001-02","Keystone HMO Platinum","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmoplatinumZeroCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF013","Existing","HMO","Platinum","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2017-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","33871PA0040001-03","Keystone HMO Platinum","Limited Cost Sharing Plan Variation","89.01%",,"No","Yes","No","100%",,"$0","$900","$0","$150","$0","$1,570","$0","$80","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2017/hmoplatinumLimitedCost2017.pdf","https://www.ibx4you.com/ffm/brochure2017"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110002","Keystone DPOS Platinum Preferred $20/$40/$150","33871PA011",,"PAN001","PAS001","PAF009","Existing","POS","Platinum","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110002-01","Keystone DPOS Platinum Preferred $20/$40/$150","Standard Platinum On Exchange Plan","88.34%",,"No","Yes","No","100%",,"$0","$390","$0","$150","$0","$1,610","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSPlatinumPreferred_20_40_150_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110003","Keystone DPOS Gold Preferred $30/$60/$650","33871PA011",,"PAN001","PAS001","PAF010","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110003-01","Keystone DPOS Gold Preferred $30/$60/$650","Standard Gold On Exchange Plan","81.94%",,"No","Yes","No","100%",,"$0","$1,460","$0","$150","$0","$1,810","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSGoldPreferred_30_60_650_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110004","Keystone DPOS Gold Classic $1,000/$25/$50/90%","33871PA011",,"PAN001","PAS001","PAF010","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110004-01","Keystone DPOS Gold Classic $1,000/$25/$50/90%","Standard Gold On Exchange Plan","78.53%",,"No","Yes","No","100%",,"$1,000","$120","$360","$150","$160","$1,610","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSGoldClassic_1000_25_50_90_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110005","Keystone DPOS Gold Classic $2,000/$40/$80/100%","33871PA011",,"PAN001","PAS001","PAF023","Existing","POS","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110005-01","Keystone DPOS Gold Classic $2,000/$40/$80/100%","Standard Gold On Exchange Plan","78.20%",,"No","Yes","No","100%",,"$2,000","$170","$0","$150","$160","$1,730","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSGoldClassic_2000_40_80_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110006","Keystone DPOS Silver Classic $2,500/$25/$50/70%","33871PA011",,"PAN001","PAS001","PAF011","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110006-01","Keystone DPOS Silver Classic $2,500/$25/$50/70%","Standard Silver On Exchange Plan","70.75%",,"No","Yes","No","100%",,"$2,500","$160","$810","$150","$160","$290","$1,010","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSSilverClassic_2500_25_50_70_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110007","Keystone DPOS Silver Secure $3,500/$40/$80/$600","33871PA011",,"PAN001","PAS001","PAF024","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110007-01","Keystone DPOS Silver Secure $3,500/$40/$80/$600","Standard Silver On Exchange Plan","69.26%",,"No","Yes","No","100%",,"$3,500","$1,370","$0","$150","$160","$1,830","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSSilverSecure_3500_40_80_600_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110008","Keystone DPOS Silver Classic $4,250/$40/$80/100%","33871PA011",,"PAN001","PAS001","PAF024","Existing","POS","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110008-01","Keystone DPOS Silver Classic $4,250/$40/$80/100%","Standard Silver On Exchange Plan","68.78%",,"No","Yes","No","100%",,"$4,250","$170","$0","$150","$160","$1,830","$0","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","0.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSSilverClassic_4250_40_80_100_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110009","Keystone DPOS Silver Classic $2,750/$30/$60/50%","33871PA011",,"PAN001","PAS001","PAF011","Existing","POS","Silver","Not Applicable","No","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110009-01","Keystone DPOS Silver Classic $2,750/$30/$60/50%","Standard Silver On Exchange Plan",,"0.703495800495148","No","Yes","No","100%",,"$2,750","$160","$1,360","$150","$160","$330","$1,010","$80","$0","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","50.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSSilverClassic_2750_30_60_50_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","33871","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","23-2405376","33871PA0110010","Keystone DPOS Bronze Essential $6,850/$50/$100/$700","33871PA011",,"PAN001","PAS001","PAF012","Existing","POS","Bronze","Not Applicable","Yes","On the Exchange","Yes","Yes","A referral is required to see a participating professional provider for Physical Therapy/Occupational Therapy, routine radiology, and spinal manipulations, and a requisition form for lab work.","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Dental Care (Pediatric), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9934",,,"2017-01-01",,"No",,"No",,"No",,"http://www.ibx.com/ffm/formulary4s","33871PA0110010-01","Keystone DPOS Bronze Essential $6,850/$50/$100/$700","Standard Bronze On Exchange Plan","61.98%",,"Yes","Yes","No","100%",,"$4,490","$230","$0","$150","$2,890","$400","$0","$80","$0","$0","$0","$0","$1,000","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$40,000","$40000 per person","$80000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.ibx.com/pdfs/custom/shop/2017/KeystoneDPOSBronzeEssential_6850_50_100_700_on.pdf","https://www.ibx.com/ffm/shop/2017brochure"
"2017","PA","38086","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0397286","38086PA0030001","Renaissance Group Dental PPO, EHB Certified","38086PA003",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","38086PA0030001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","38086","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0397286","38086PA0030002","Renaissance Group Dental PPO, EHB Certified","38086PA003",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","38086PA0030002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","38086","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0397286","38086PA0050001","Renaissance Group Dental Indemnity, EHB Certified","38086PA005",,"PAN001","PAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","38086PA0050001-00","Renaissance Group Dental Indemnity, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","38086","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0397286","38086PA0050002","Renaissance Group Dental Indemnity, EHB Certified","38086PA005",,"PAN001","PAS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","38086PA0050002-00","Renaissance Group Dental Indemnity, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","Yes","45-5492167","45127PA0050001","Dental Select Basic","45127PA005",,"PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency","Yes","Emergency","No","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0050001-00","Dental Select Basic","Standard Low Off Exchange Plan","70.52%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2017/45127PA0050001-2017.pdf"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","Yes","45-5492167","45127PA0050001","Dental Select Basic","45127PA005",,"PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency","Yes","Emergency","No","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0050001-01","Dental Select Basic","Standard Low On Exchange Plan","70.52%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2017/45127PA0050001-2017.pdf"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020008","Silver PPO 4500/0/10","45127PA002","7588667726","PAN003","PAS002","PAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-00","Silver PPO 4500/0/10","Standard Silver Off Exchange Plan",,"0.709405064582825","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%","$4,500","$4500 per person","$9000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002000800.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","Yes","45-5492167","45127PA0030001","Dental PPO Plan 1","45127PA003",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030001-00","Dental PPO Plan 1","Standard Low Off Exchange Plan","71.55%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2017/45127PA0030001-2017.pdf"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","Yes","45-5492167","45127PA0030001","Dental PPO Plan 1","45127PA003",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030001-01","Dental PPO Plan 1","Standard Low On Exchange Plan","71.55%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2017/45127PA0030001-2017.pdf"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020008","Silver PPO 4500/0/10","45127PA002","7588667726","PAN003","PAS002","PAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-01","Silver PPO 4500/0/10","Standard Silver On Exchange Plan",,"0.709405064582825","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%","$4,500","$4500 per person","$9000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002000801.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020008","Silver PPO 4500/0/10","45127PA002","7588667726","PAN003","PAS002","PAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-02","Silver PPO 4500/0/10","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002000802.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020008","Silver PPO 4500/0/10","45127PA002","7588667726","PAN003","PAS002","PAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-03","Silver PPO 4500/0/10","Limited Cost Sharing Plan Variation",,"0.709405064582825","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%","$4,500","$4500 per person","$9000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002000803.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020008","Silver PPO 4500/0/10","45127PA002","7588667726","PAN003","PAS002","PAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-04","Silver PPO 4500/0/10","73% AV Level Silver Plan",,"0.731121122837067","Yes","Yes","Yes","40%","60%","$4,000","$10","$0","$200","$4,000","$90","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%","$4,000","$4000 per person","$8000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002000804.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020008","Silver PPO 4500/0/10","45127PA002","7588667726","PAN003","PAS002","PAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-05","Silver PPO 4500/0/10","87% AV Level Silver Plan",,"0.875010669231415","Yes","Yes","Yes","40%","60%","$1,100","$10","$0","$200","$1,100","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0.00%","$1,100","$1100 per person","$2200 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002000805.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020008","Silver PPO 4500/0/10","45127PA002","7588667726","PAN003","PAS002","PAF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-06","Silver PPO 4500/0/10","94% AV Level Silver Plan",,"0.945588171482086","Yes","Yes","Yes","40%","60%","$300","$0","$0","$200","$300","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","$2,350","$2350 per person","$4700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%","$250","$250 per person","$500 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002000806.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020013","Gold PPO 1000/0/20","45127PA002","7588667726","PAN003","PAS002","PAF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020013-01","Gold PPO 1000/0/20","Standard Gold On Exchange Plan",,"0.797972202301025","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$800","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$1,000","$1000 per person","$2000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%","$300","$300 per person","$600 per group","0.00%","$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002001301.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020013","Gold PPO 1000/0/20","45127PA002","7588667726","PAN003","PAS002","PAF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020013-02","Gold PPO 1000/0/20","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002001302.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","45127","SERFF","2016-09-28 04:33:02","Individual","No","45-5492167","45127PA0020013","Gold PPO 1000/0/20","45127PA002","7588667726","PAN003","PAS002","PAF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage.  Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020013-03","Gold PPO 1000/0/20","Limited Cost Sharing Plan Variation",,"0.797972202301025","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$800","$2,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$1,000","$1000 per person","$2000 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%","$300","$300 per person","$600 per group","0.00%","$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2017/45127PA002001303.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2017","PA","46518","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","46518PA0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","46518PA002",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://dentegra.com/hcx/pa/46518pa0020007-17","","46518PA0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0020007-17"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","55995PA0010001","DentaTrust PPO - Pediatric High Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010001-00","DentaTrust PPO - Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbPA.dentalcareplus.com","https://hixindsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","55995PA0020003","DentaSpan Family High Option","55995PA002","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbPA.dentalcareplus.com","https://hixsgsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","55995PA0020003","DentaSpan Family High Option","55995PA002","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbPA.dentalcareplus.com","https://hixsgsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","55995PA0010001","DentaTrust PPO - Pediatric High Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010001-01","DentaTrust PPO - Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbPA.dentalcareplus.com","https://hixindsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","55995PA0010002","DentaTrust PPO - Pediatric Low Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010002-00","DentaTrust PPO - Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbPA.dentalcareplus.com","https://hixindsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","55995PA0020004","DentaSpan Family Low Option","55995PA002","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbPA.dentalcareplus.com","https://hixsgsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","55995PA0020004","DentaSpan Family Low Option","55995PA002","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbPA.dentalcareplus.com","https://hixsgsbPA.dentalcareplus.com"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0490001","Alliance Flex Blue PPO $500","70194PA049",,"PAN002","PAS009","PAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0490001-01","Alliance Flex Blue PPO $500","Standard Gold On Exchange Plan","81.08%","0.82849532365799","No","Yes","Yes","80%","20%","$500","$100","$0","$0","$500","$300","$0","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$1,500","$1500 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2095120745/SE_2095120745_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/CPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0490002","Alliance Flex Blue PPO $1250","70194PA049",,"PAN002","PAS009","PAF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0490002-00","Alliance Flex Blue PPO $1250","Standard Gold Off Exchange Plan",,"0.797264814376831","No","Yes","Yes","80%","20%","$1,250","$100","$0","$0","$1,250","$300","$0","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$3,750","$3750 per person","$7500 per group","30.00%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520001","my Lehigh Valley Flex Blue PPO 1000G","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520001-02","my Lehigh Valley Flex Blue PPO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110148295/I_2110148295_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","72299","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","72299PA0010001","TruAssure Basic Adult or Child Dental Plan","72299PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA"
"2017","PA","72299","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-3757528","72299PA0030001","TruAssure Dental Small Group Basic Plan","72299PA003",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72299PA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","55995","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","55995PA0010002","DentaTrust PPO - Pediatric Low Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010002-01","DentaTrust PPO - Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbPA.dentalcareplus.com","https://hixindsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","55995PA0030003","DentaSpan Dental-Family High Option-Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0030003-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbPA.dentalcareplus.com","https://hixsgsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","55995PA0030004","DentaSpan Dental-Family Low Option-Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0030004-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbPA.dentalcareplus.com","https://hixsgsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","55995PA0010003","DentaTrust-PPO Family High Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbPA.dentalcareplus.com","https://hixindsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","55995PA0030001","DentaSpan Pediatric High Option- Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0030001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbPA.dentalcareplus.com","https://hixsgsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","55995PA0010003","DentaTrust-PPO Family High Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbPA.dentalcareplus.com","https://hixindsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","55995PA0030002","DentaSpan Pediatric High Option- Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0030002-00","DentaSpan Pediatric High Option- Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbPA.dentalcareplus.com","https://hixsgsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","55995PA0010004","DentaTrust-PPO Family Low Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbPA.dentalcareplus.com","https://hixindsbPA.dentalcareplus.com"
"2017","PA","55995","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","55995PA0010004","DentaTrust-PPO Family Low Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbPA.dentalcareplus.com","https://hixindsbPA.dentalcareplus.com"
"2017","PA","61775","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","57-0523959","61775PA0020001","Group Dental Policy","61775PA002",,"PAN001","PAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","61775PA0020001-00","Group Dental Policy","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020065","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020065-00","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","Standard Platinum Off Exchange Plan",,"0.914910912513733","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM51_HMO_RX1F12_EB02_0117_1217_62560PA002006500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006500"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020065","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020065-01","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","Standard Platinum On Exchange Plan",,"0.914910912513733","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM23_HMO_RX1F12_EB02_0117_1217_62560PA002006501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006501"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020067","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020067-00","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","Standard Platinum Off Exchange Plan",,"0.895824432373047","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM53_HMO_RX1F12_EB02_0117_1217_62560PA002006700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006700"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020067","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020067-01","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","Standard Platinum On Exchange Plan",,"0.895824432373047","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM25_HMO_RX1F12_EB02_0117_1217_62560PA002006701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006701"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020055","UPMC Small Business Advantage Silver HMO $3,000 $20/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020055-00","UPMC Small Business Advantage Silver HMO $3,000 $20/$50 - Standard Network","Standard Silver Off Exchange Plan",,"0.719026148319244","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM50_HMO_RX1F12_EB02_0117_1217_62560PA002005500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002005500"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020055","UPMC Small Business Advantage Silver HMO $3,000 $20/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020055-01","UPMC Small Business Advantage Silver HMO $3,000 $20/$50 - Standard Network","Standard Silver On Exchange Plan",,"0.719026148319244","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM22_HMO_RX1F12_EB02_0117_1217_62560PA002005501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002005501"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020066","UPMC Small Business Advantage Gold HMO $1,000 $20/$45 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020066-00","UPMC Small Business Advantage Gold HMO $1,000 $20/$45 - Standard Network","Standard Gold Off Exchange Plan",,"0.8181312084198","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM52_HMO_RX1F12_EB02_0117_1217_62560PA002006600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006600"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020066","UPMC Small Business Advantage Gold HMO $1,000 $20/$45 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020066-01","UPMC Small Business Advantage Gold HMO $1,000 $20/$45 - Standard Network","Standard Gold On Exchange Plan",,"0.8181312084198","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM24_HMO_RX1F12_EB02_0117_1217_62560PA002006601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006601"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020068","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020068-00","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","Standard Gold Off Exchange Plan",,"0.80351984500885","No","Yes","No","100%",,"$2,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM54_HMO_RX1F12_EB02_0117_1217_62560PA002006800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006800"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020068","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020068-01","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","Standard Gold On Exchange Plan",,"0.80351984500885","No","Yes","No","100%",,"$2,000","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM26_HMO_RX1F12_EB02_0117_1217_62560PA002006801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006801"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020069","UPMC Small Business Advantage Gold HMO $1,500 $10/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020069-00","UPMC Small Business Advantage Gold HMO $1,500 $10/$40 - Standard Network","Standard Gold Off Exchange Plan",,"0.806377351284027","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM55_HMO_RX1F12_EB02_0117_1217_62560PA002006900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006900"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020069","UPMC Small Business Advantage Gold HMO $1,500 $10/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020069-01","UPMC Small Business Advantage Gold HMO $1,500 $10/$40 - Standard Network","Standard Gold On Exchange Plan",,"0.806377351284027","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM27_HMO_RX1F12_EB02_0117_1217_62560PA002006901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002006901"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020070","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","62560PA002",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020070-00","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","Standard Bronze Off Exchange Plan","61.98%","0.623678267002106","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,100","$800","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM56_HMO_RX1F47_EB02_0117_1217_62560PA002007000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002007000"
"2017","PA","62560","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","46-2824537","62560PA0020070","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","62560PA002",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2017_RxList.aspx","62560PA0020070-01","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","Standard Bronze On Exchange Plan","61.98%","0.623678267002106","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,100","$800","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM28_HMO_RX1F47_EB02_0117_1217_62560PA002007001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_62560PA002007001"
"2017","PA","67430","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","25-1844144","67430PA0040004","UPMC Dental Advantage Basic","67430PA004",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.303","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","https://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040004-00","UPMC Dental Advantage Basic","Standard Low Off Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_67430PA004000400"
"2017","PA","67430","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","25-1844144","67430PA0040004","UPMC Dental Advantage Basic","67430PA004",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.303","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","https://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040004-01","UPMC Dental Advantage Basic","Standard Low On Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_67430PA004000401"
"2017","PA","67430","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","25-1844144","67430PA0040005","UPMC Dental Advantage Standard","67430PA004",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.159","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","https://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040005-00","UPMC Dental Advantage Standard","Standard Low Off Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_67430PA004000500"
"2017","PA","67430","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","25-1844144","67430PA0040005","UPMC Dental Advantage Standard","67430PA004",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.159","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","https://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040005-01","UPMC Dental Advantage Standard","Standard Low On Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_67430PA004000501"
"2017","PA","67430","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","25-1844144","67430PA0040006","UPMC Dental Advantage Premium","67430PA004",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.137","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","https://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040006-00","UPMC Dental Advantage Premium","Standard Low Off Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_67430PA004000600"
"2017","PA","67430","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","25-1844144","67430PA0040006","UPMC Dental Advantage Premium","67430PA004",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.137","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","https://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040006-01","UPMC Dental Advantage Premium","Standard Low On Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.upmchealthplan.com/marketplace/details.aspx?plan=2017_SG_67430PA004000601"
"2017","PA","67499","SERFF","2016-08-20 11:23:22","Individual","Yes","39-1263473","67499PA0010001","Humana Dental Smart Choice","67499PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9877","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","67499PA0010001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857127"
"2017","PA","67499","SERFF","2016-08-20 11:23:22","Individual","Yes","39-1263473","67499PA0010001","Humana Dental Smart Choice","67499PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9877","Guaranteed Rate","2017-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","67499PA0010001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857127"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","Individual","Yes","59-0397210","68711PA0030001","DentaQuest EPO Pediatric High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030001-00","DentaQuest EPO Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","59-0397210","68711PA0020003","DentaQuest EPO Family High","68711PA002",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0020003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","59-0397210","68711PA0020003","DentaQuest EPO Family High","68711PA002",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0020003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","Individual","Yes","59-0397210","68711PA0030001","DentaQuest EPO Pediatric High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030001-01","DentaQuest EPO Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","59-0397210","68711PA0020004","DentaQuest EPO Family Low","68711PA002",,"PAN002","PAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0020004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","59-0397210","68711PA0020004","DentaQuest EPO Family Low","68711PA002",,"PAN002","PAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0020004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","59-0397210","68711PA0020005","DentaQuest EPO Family Preventative","68711PA002",,"PAN002","PAS001",,"New","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0020005-00","DentaQuest EPO Family Preventative","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","Individual","Yes","59-0397210","68711PA0030003","DentaQuest EPO Family High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","Individual","Yes","59-0397210","68711PA0030003","DentaQuest EPO Family High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","59-0397210","68711PA0020005","DentaQuest EPO Family Preventative","68711PA002",,"PAN002","PAS001",,"New","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0020005-01","DentaQuest EPO Family Preventative","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","Individual","Yes","59-0397210","68711PA0030004","DentaQuest EPO Family Low","68711PA003",,"PAN002","PAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","Individual","Yes","59-0397210","68711PA0030004","DentaQuest EPO Family Low","68711PA003",,"PAN002","PAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510004","my Premier Blue Flex PPO 6000BQE","70194PA051",,"PAN002","PAS013","PAF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510004-00","my Premier Blue Flex PPO 6000BQE","Standard Bronze Off Exchange Plan",,"0.61567747592926","Yes","Yes","Yes","85%","15%","$6,000","$0","$500","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%","$6,000","$6000 per person","$12000 per group","50.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0220006","Shared Cost PPO $1500","70194PA022",,"PAN001","PAS003","PAF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0220006-00","Shared Cost PPO $1500","Standard Gold Off Exchange Plan",,"0.80565482378006","No","Yes","No","100%",,"$1,500","$10","$600","$0","$1,500","$400","$10","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1700","70194PA015",,"PAN001","PAS010","PAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150005-02","Health Savings Blue PPO 1700","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110143265/I_2110143265_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1700","70194PA015",,"PAN001","PAS010","PAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150005-03","Health Savings Blue PPO 1700","Limited Cost Sharing Plan Variation",,"0.791006028652191","Yes","Yes","No","100%",,"$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group",,,,"$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110143314/I_2110143314_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","Individual","Yes","59-0397210","68711PA0030005","DentaQuest EPO Family Preventative","68711PA003",,"PAN002","PAS001",,"New","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030005-00","DentaQuest EPO Family Preventative","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","68711","SERFF","2016-08-20 11:23:22","Individual","Yes","59-0397210","68711PA0030005","DentaQuest EPO Family Preventative","68711PA003",,"PAN002","PAS001",,"New","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030005-01","DentaQuest EPO Family Preventative","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0200002","Comprehensive Care EPO $2000 70% a Community Blue Plan","70194PA020",,"PAN001","PAS001","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0200002-00","Comprehensive Care EPO $2000 70% a Community Blue Plan","Standard Silver Off Exchange Plan","71.39%","0.726364970207214","No","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510001","my Premier Blue Flex PPO 1700GQ","70194PA051",,"PAN002","PAS013","PAF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510001-00","my Premier Blue Flex PPO 1700GQ","Standard Gold Off Exchange Plan",,"0.78779125213623","Yes","Yes","Yes","85%","15%","$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510001","my Premier Blue Flex PPO 1700GQ","70194PA051",,"PAN002","PAS013","PAF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510001-01","my Premier Blue Flex PPO 1700GQ","Standard Gold On Exchange Plan",,"0.78779125213623","Yes","Yes","Yes","85%","15%","$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110148567/I_2110148567_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0200002","Comprehensive Care EPO $2000 70% a Community Blue Plan","70194PA020",,"PAN001","PAS001","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0200002-01","Comprehensive Care EPO $2000 70% a Community Blue Plan","Standard Silver On Exchange Plan","71.39%","0.726364970207214","No","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2097021986/SE_2097021986_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510001","my Premier Blue Flex PPO 1700GQ","70194PA051",,"PAN002","PAS013","PAF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510001-02","my Premier Blue Flex PPO 1700GQ","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110148751/I_2110148751_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0200004","Comprehensive Care EPO $2000 70% a Community Blue Plan","70194PA020",,"PAN001","PAS002","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0200004-00","Comprehensive Care EPO $2000 70% a Community Blue Plan","Standard Silver Off Exchange Plan","71.39%","0.726364970207214","No","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0200004","Comprehensive Care EPO $2000 70% a Community Blue Plan","70194PA020",,"PAN001","PAS002","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0200004-01","Comprehensive Care EPO $2000 70% a Community Blue Plan","Standard Silver On Exchange Plan","71.39%","0.726364970207214","No","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,800","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2097020297/SE_2097020297_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510001","my Premier Blue Flex PPO 1700GQ","70194PA051",,"PAN002","PAS013","PAF003","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510001-03","my Premier Blue Flex PPO 1700GQ","Limited Cost Sharing Plan Variation",,"0.78779125213623","Yes","Yes","Yes","85%","15%","$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110148780/I_2110148780_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510002","my Premier Blue Flex PPO 2700SQE","70194PA051",,"PAN002","PAS013","PAF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510002-00","my Premier Blue Flex PPO 2700SQE","Standard Silver Off Exchange Plan",,"0.683219134807587","Yes","Yes","Yes","85%","15%","$2,700","$0","$900","$0","$2,700","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%","$2,700","$2700 per person","$5400 per group","40.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510002","my Premier Blue Flex PPO 2700SQE","70194PA051",,"PAN002","PAS013","PAF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510002-01","my Premier Blue Flex PPO 2700SQE","Standard Silver On Exchange Plan",,"0.683219134807587","Yes","Yes","Yes","85%","15%","$2,700","$0","$900","$0","$2,700","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%","$2,700","$2700 per person","$5400 per group","40.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111528218/I_2111528218_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510002","my Premier Blue Flex PPO 2700SQE","70194PA051",,"PAN002","PAS013","PAF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510002-02","my Premier Blue Flex PPO 2700SQE","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111528892/I_2111528892_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510002","my Premier Blue Flex PPO 2700SQE","70194PA051",,"PAN002","PAS013","PAF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510002-03","my Premier Blue Flex PPO 2700SQE","Limited Cost Sharing Plan Variation",,"0.683219134807587","Yes","Yes","Yes","85%","15%","$2,700","$0","$900","$0","$2,700","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%","$2,700","$2700 per person","$5400 per group","40.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111528775/I_2111528775_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510002","my Premier Blue Flex PPO 2700SQE","70194PA051",,"PAN002","PAS013","PAF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510002-04","my Premier Blue Flex PPO 2700SQE","73% AV Level Silver Plan",,"0.736256837844849","Yes","Yes","Yes","85%","15%","$2,250","$0","$500","$0","$2,250","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","10.00%","$2,250","$2250 per person","$4500 per group","30.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111538089/I_2111538089_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510002","my Premier Blue Flex PPO 2700SQE","70194PA051",,"PAN002","PAS013","PAF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510002-05","my Premier Blue Flex PPO 2700SQE","87% AV Level Silver Plan",,"0.865484595298767","Yes","Yes","Yes","85%","15%","$2,250","$0","$500","$0","$2,250","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","30.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111538628/I_2111538628_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510002","my Premier Blue Flex PPO 2700SQE","70194PA051",,"PAN002","PAS013","PAF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510002-06","my Premier Blue Flex PPO 2700SQE","94% AV Level Silver Plan",,"0.933670341968536","Yes","Yes","Yes","85%","15%","$300","$0","$700","$0","$300","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%","$300","$300 per person","$600 per group","30.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111538707/I_2111538707_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510003","my Premier Blue Flex PPO 3200S","70194PA051",,"PAN002","PAS013","PAF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510003-00","my Premier Blue Flex PPO 3200S","Standard Silver Off Exchange Plan","68.73%","0.687331914901733","No","Yes","Yes","85%","15%","$3,200","$300","$700","$0","$1,600","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20.00%","$5,000","$5000 per person","$10000 per group","40.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510003","my Premier Blue Flex PPO 3200S","70194PA051",,"PAN002","PAS013","PAF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510003-01","my Premier Blue Flex PPO 3200S","Standard Silver On Exchange Plan","68.73%","0.687331914901733","No","Yes","Yes","85%","15%","$3,200","$300","$700","$0","$1,600","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20.00%","$5,000","$5000 per person","$10000 per group","40.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111697901/I_2111697901_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510003","my Premier Blue Flex PPO 3200S","70194PA051",,"PAN002","PAS013","PAF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510003-02","my Premier Blue Flex PPO 3200S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111698004/I_2111698004_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510003","my Premier Blue Flex PPO 3200S","70194PA051",,"PAN002","PAS013","PAF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510003-03","my Premier Blue Flex PPO 3200S","Limited Cost Sharing Plan Variation","68.73%","0.687331914901733","No","Yes","Yes","85%","15%","$3,200","$300","$700","$0","$1,600","$700","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20.00%","$5,000","$5000 per person","$10000 per group","40.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112489589/I_2112489589_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510003","my Premier Blue Flex PPO 3200S","70194PA051",,"PAN002","PAS013","PAF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510003-04","my Premier Blue Flex PPO 3200S","73% AV Level Silver Plan","72.23%","0.726532399654388","No","Yes","Yes","85%","15%","$3,000","$10","$900","$0","$1,600","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%","$4,000","$4000 per person","$8000 per group","40.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111698688/I_2111698688_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510003","my Premier Blue Flex PPO 3200S","70194PA051",,"PAN002","PAS013","PAF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510003-05","my Premier Blue Flex PPO 3200S","87% AV Level Silver Plan","86.23%","0.883162260055542","No","Yes","Yes","85%","15%","$700","$10","$700","$0","$700","$400","$90","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","10.00%","$1,050","$1050 per person","$2100 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111698435/I_2111698435_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510003","my Premier Blue Flex PPO 3200S","70194PA051",,"PAN002","PAS013","PAF001","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510003-06","my Premier Blue Flex PPO 3200S","94% AV Level Silver Plan","93.76%","0.941719114780426","No","Yes","Yes","85%","15%","$250","$10","$500","$0","$250","$300","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$375","$375 per person","$750 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111698332/I_2111698332_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510004","my Premier Blue Flex PPO 6000BQE","70194PA051",,"PAN002","PAS013","PAF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510004-01","my Premier Blue Flex PPO 6000BQE","Standard Bronze On Exchange Plan",,"0.61567747592926","Yes","Yes","Yes","85%","15%","$6,000","$0","$500","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%","$6,000","$6000 per person","$12000 per group","50.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109505970/I_2109505970_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510004","my Premier Blue Flex PPO 6000BQE","70194PA051",,"PAN002","PAS013","PAF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510004-02","my Premier Blue Flex PPO 6000BQE","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109677566/I_2109677566_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0510004","my Premier Blue Flex PPO 6000BQE","70194PA051",,"PAN002","PAS013","PAF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0510004-03","my Premier Blue Flex PPO 6000BQE","Limited Cost Sharing Plan Variation",,"0.61567747592926","Yes","Yes","Yes","85%","15%","$6,000","$0","$500","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%","$6,000","$6000 per person","$12000 per group","50.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109668643/I_2109668643_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0210002","Flex EPO $1650 80%/70% A Community Blue Plan","70194PA021",,"PAN002","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0210002-00","Flex EPO $1650 80%/70% A Community Blue Plan","Standard Silver Off Exchange Plan",,"0.714334964752197","Yes","Yes","Yes","90%","10%","$1,650","$0","$1,100","$0","$1,650","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500001","Alliance Flex Blue PPO 1000","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500001-00","Alliance Flex Blue PPO 1000","Standard Gold Off Exchange Plan",,"0.787954926490784","No","Yes","Yes","85%","15%","$1,000","$700","$100","$0","$1,000","$500","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500001","Alliance Flex Blue PPO 1000","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500001-01","Alliance Flex Blue PPO 1000","Standard Gold On Exchange Plan",,"0.787954926490784","No","Yes","Yes","85%","15%","$1,000","$700","$100","$0","$1,000","$500","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110148929/I_2110148929_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0210002","Flex EPO $1650 80%/70% A Community Blue Plan","70194PA021",,"PAN002","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0210002-01","Flex EPO $1650 80%/70% A Community Blue Plan","Standard Silver On Exchange Plan",,"0.714334964752197","Yes","Yes","Yes","90%","10%","$1,650","$0","$1,100","$0","$1,650","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2096720724/SE_2096720724_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/CPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0210004","Flex EPO $1650 80%/70% A Community Blue Plan","70194PA021",,"PAN002","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0210004-00","Flex EPO $1650 80%/70% A Community Blue Plan","Standard Silver Off Exchange Plan",,"0.716006100177765","Yes","Yes","Yes","98%","2%","$1,650","$0","$1,100","$0","$1,650","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500001","Alliance Flex Blue PPO 1000","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500001-02","Alliance Flex Blue PPO 1000","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110149297/I_2110149297_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500001","Alliance Flex Blue PPO 1000","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500001-03","Alliance Flex Blue PPO 1000","Limited Cost Sharing Plan Variation",,"0.787954926490784","No","Yes","Yes","85%","15%","$1,000","$700","$1,000","$0","$1,000","$500","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110149402/I_2110149402_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0210004","Flex EPO $1650 80%/70% A Community Blue Plan","70194PA021",,"PAN002","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0210004-01","Flex EPO $1650 80%/70% A Community Blue Plan","Standard Silver On Exchange Plan",,"0.716006100177765","Yes","Yes","Yes","98%","2%","$1,650","$0","$1,100","$0","$1,650","$0","$1,000","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%","$1,650","$1650 per person","$3300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2096728469/SE_2096728469_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/CPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500002","Alliance Flex Blue PPO 2300","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500002-00","Alliance Flex Blue PPO 2300","Standard Silver Off Exchange Plan",,"0.686237454414368","No","Yes","Yes","85%","15%","$2,300","$1,300","$1,000","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500002","Alliance Flex Blue PPO 2300","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500002-01","Alliance Flex Blue PPO 2300","Standard Silver On Exchange Plan",,"0.686237454414368","No","Yes","Yes","85%","15%","$2,300","$1,300","$1,000","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112506295/I_2112506295_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500002","Alliance Flex Blue PPO 2300","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500002-02","Alliance Flex Blue PPO 2300","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111702827/I_2111702827_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500002","Alliance Flex Blue PPO 2300","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500002-03","Alliance Flex Blue PPO 2300","Limited Cost Sharing Plan Variation",,"0.686237454414368","No","Yes","Yes","85%","15%","$2,300","$1,300","$1,000","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111702662/I_2111702662_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500002","Alliance Flex Blue PPO 2300","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500002-04","Alliance Flex Blue PPO 2300","73% AV Level Silver Plan",,"0.727667927742004","No","Yes","Yes","85%","15%","$2,100","$1,300","$1,000","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111702914/I_2111702914_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500002","Alliance Flex Blue PPO 2300","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500002-05","Alliance Flex Blue PPO 2300","87% AV Level Silver Plan",,"0.866966307163239","No","Yes","Yes","85%","15%","$700","$700","$500","$0","$700","$600","$90","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","10.00%","$1,200","$1200 per person","$2400 per group","30.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111703039/I_2111703039_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0500002","Alliance Flex Blue PPO 2300","70194PA050",,"PAN002","PAS009","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0500002-06","Alliance Flex Blue PPO 2300","94% AV Level Silver Plan",,"0.941543400287628","No","Yes","Yes","85%","15%","$250","$600","$600","$0","$250","$400","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$400","$400 per person","$800 per group","30.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111703303/I_2111703303_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0240006","Shared Cost PPO $1500","70194PA024",,"PAN002","PAS006","PAF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0240006-00","Shared Cost PPO $1500","Standard Gold Off Exchange Plan",,"0.80565482378006","No","Yes","No","100%",,"$1,500","$10","$600","$0","$1,500","$400","$10","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1700","70194PA015",,"PAN001","PAS010","PAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150005-00","Health Savings Blue PPO 1700","Standard Gold Off Exchange Plan",,"0.791006028652191","Yes","Yes","No","100%",,"$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group",,,,"$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1700","70194PA015",,"PAN001","PAS010","PAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150005-01","Health Savings Blue PPO 1700","Standard Gold On Exchange Plan",,"0.791006028652191","Yes","Yes","No","100%",,"$1,700","$0","$600","$0","$1,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group",,,,"$6,500","$13000 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110143111/I_2110143111_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0240006","Shared Cost PPO $1500","70194PA024",,"PAN002","PAS006","PAF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0240006-01","Shared Cost PPO $1500","Standard Gold On Exchange Plan",,"0.80565482378006","No","Yes","No","100%",,"$1,500","$10","$600","$0","$1,500","$400","$10","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2096718024/SE_2096718024_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/CPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0220006","Shared Cost PPO $1500","70194PA022",,"PAN001","PAS003","PAF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0220006-01","Shared Cost PPO $1500","Standard Gold On Exchange Plan",,"0.80565482378006","No","Yes","No","100%",,"$1,500","$10","$600","$0","$1,500","$400","$10","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2096129051/SE_2096129051_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO Embedded 2700","70194PA015",,"PAN001","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150003-00","Health Savings Blue PPO Embedded 2700","Standard Silver Off Exchange Plan",,"0.681438386440277","Yes","Yes","No","100%",,"$2,700","$0","$900","$0","$2,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$10800 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO Embedded 2700","70194PA015",,"PAN001","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150003-01","Health Savings Blue PPO Embedded 2700","Standard Silver On Exchange Plan",,"0.681438386440277","Yes","Yes","No","100%",,"$2,700","$0","$900","$0","$2,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$10800 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111522255/I_2111522255_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO Embedded 2700","70194PA015",,"PAN001","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150003-02","Health Savings Blue PPO Embedded 2700","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111526117/I_2111526117_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO Embedded 2700","70194PA015",,"PAN001","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150003-03","Health Savings Blue PPO Embedded 2700","Limited Cost Sharing Plan Variation",,"0.681438386440277","Yes","Yes","No","100%",,"$2,700","$0","$900","$0","$2,700","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$10800 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111525459/I_2111525459_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO Embedded 2700","70194PA015",,"PAN001","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150003-04","Health Savings Blue PPO Embedded 2700","73% AV Level Silver Plan",,"0.720906138420105","Yes","Yes","No","100%",,"$2,700","$0","$500","$0","$2,700","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%",,,,,"$5,400","$10800 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111527038/I_2111527038_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO Embedded 2700","70194PA015",,"PAN001","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150003-05","Health Savings Blue PPO Embedded 2700","87% AV Level Silver Plan",,"0.862460255622864","Yes","Yes","No","100%",,"$900","$0","$600","$0","$900","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","10.00%",,,,,"$5,400","$10800 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111696790/I_2111696790_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO Embedded 2700","70194PA015",,"PAN001","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0150003-06","Health Savings Blue PPO Embedded 2700","94% AV Level Silver Plan",,"0.93080735206604","Yes","Yes","No","100%",,"$300","$0","$700","$0","$300","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"$5,400","$10800 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111527126/I_2111527126_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0230002","Health Savings PPO Embedded Q$4750","70194PA023",,"PAN001","PAS003","PAF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0230002-00","Health Savings PPO Embedded Q$4750","Standard Bronze Off Exchange Plan",,"0.619694888591766","Yes","Yes","No","100%",,"$4,750","$0","$1,000","$0","$4,750","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Flex Blue PPO 500","70194PA016",,"PAN001","PAS010","PAF006","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0160003-00","Comprehensive Care Flex Blue PPO 500","Standard Platinum Off Exchange Plan",,"0.88160228729248","No","Yes","Yes","85%","15%","$500","$20","$700","$0","$500","$200","$200","$0","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$1,300","$1300 per person","$2600 per group","40.00%","$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Flex Blue PPO 500","70194PA016",,"PAN001","PAS010","PAF006","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0160003-01","Comprehensive Care Flex Blue PPO 500","Standard Platinum On Exchange Plan",,"0.88160228729248","No","Yes","Yes","85%","15%","$500","$20","$700","$0","$500","$200","$200","$0","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$1,300","$1300 per person","$2600 per group","40.00%","$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111872070/I_2111872070_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0230002","Health Savings PPO Embedded Q$4750","70194PA023",,"PAN001","PAS003","PAF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0230002-01","Health Savings PPO Embedded Q$4750","Standard Bronze On Exchange Plan",,"0.619694888591766","Yes","Yes","No","100%",,"$4,750","$0","$1,000","$0","$4,750","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109765065/SE_2109765065_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0250002","Health Savings PPO Embedded Q$4750","70194PA025",,"PAN002","PAS006","PAF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0250002-00","Health Savings PPO Embedded Q$4750","Standard Bronze Off Exchange Plan",,"0.619694888591766","Yes","Yes","No","100%",,"$4,750","$0","$1,000","$0","$4,750","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Flex Blue PPO 500","70194PA016",,"PAN001","PAS010","PAF006","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0160003-02","Comprehensive Care Flex Blue PPO 500","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111890026/I_2111890026_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Flex Blue PPO 500","70194PA016",,"PAN001","PAS010","PAF006","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0160003-03","Comprehensive Care Flex Blue PPO 500","Limited Cost Sharing Plan Variation",,"0.88160228729248","No","Yes","Yes","85%","15%","$500","$20","$700","$0","$500","$200","$200","$0","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$1,300","$1300 per person","$2600 per group","40.00%","$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111890436/I_2111890436_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0250002","Health Savings PPO Embedded Q$4750","70194PA025",,"PAN002","PAS006","PAF013","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0250002-01","Health Savings PPO Embedded Q$4750","Standard Bronze On Exchange Plan",,"0.619694888591766","Yes","Yes","No","100%",,"$4,750","$0","$1,000","$0","$4,750","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109907318/SE_2109907318_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/CPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0490001","Alliance Flex Blue PPO $500","70194PA049",,"PAN002","PAS009","PAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0490001-00","Alliance Flex Blue PPO $500","Standard Gold Off Exchange Plan","81.08%","0.82849532365799","No","Yes","Yes","80%","20%","$500","$100","$0","$0","$500","$300","$0","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$1,500","$1500 per person","$3000 per group","30.00%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520001","my Lehigh Valley Flex Blue PPO 1000G","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520001-00","my Lehigh Valley Flex Blue PPO 1000G","Standard Gold Off Exchange Plan",,"0.787250399589539","No","Yes","Yes","85%","15%","$1,000","$600","$1,000","$0","$1,000","$400","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520001","my Lehigh Valley Flex Blue PPO 1000G","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520001-01","my Lehigh Valley Flex Blue PPO 1000G","Standard Gold On Exchange Plan",,"0.787250399589539","No","Yes","Yes","85%","15%","$1,000","$600","$1,000","$0","$1,000","$400","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110148240/I_2110148240_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520001","my Lehigh Valley Flex Blue PPO 1000G","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520001-03","my Lehigh Valley Flex Blue PPO 1000G","Limited Cost Sharing Plan Variation",,"0.787250399589539","No","Yes","Yes","85%","15%","$1,000","$600","$1,000","$0","$1,000","$400","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110148349/I_2110148349_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0490002","Alliance Flex Blue PPO $1250","70194PA049",,"PAN002","PAS009","PAF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0490002-01","Alliance Flex Blue PPO $1250","Standard Gold On Exchange Plan",,"0.797264814376831","No","Yes","Yes","80%","20%","$1,250","$100","$0","$0","$1,250","$300","$0","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$3,750","$3750 per person","$7500 per group","30.00%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2095120960/SE_2095120960_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/CPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0490004","Alliance Flex Blue PPO $1600","70194PA049",,"PAN002","PAS009","PAF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0490004-00","Alliance Flex Blue PPO $1600","Standard Gold Off Exchange Plan",,"0.795677840709686","No","Yes","Yes","80%","20%","$1,600","$100","$0","$0","$1,600","$300","$0","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","0.00%","$4,000","$4000 per person","$8000 per group","30.00%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520002","my Lehigh Valley Flex Blue PPO 2900S","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520002-00","my Lehigh Valley Flex Blue PPO 2900S","Standard Silver Off Exchange Plan",,"0.685910224914551","No","Yes","Yes","85%","15%","$2,900","$1,200","$800","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520002","my Lehigh Valley Flex Blue PPO 2900S","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520002-01","my Lehigh Valley Flex Blue PPO 2900S","Standard Silver On Exchange Plan",,"0.685910224914551","No","Yes","Yes","85%","15%","$2,900","$1,200","$800","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111698974/I_2111698974_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0490004","Alliance Flex Blue PPO $1600","70194PA049",,"PAN002","PAS009","PAF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0490004-01","Alliance Flex Blue PPO $1600","Standard Gold On Exchange Plan",,"0.795677840709686","No","Yes","Yes","80%","20%","$1,600","$100","$0","$0","$1,600","$300","$0","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","0.00%","$4,000","$4000 per person","$8000 per group","30.00%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111263303/SE_2111263303_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/CPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0490003","Alliance Flex Blue PPO $2500","70194PA049",,"PAN002","PAS009","PAF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0490003-00","Alliance Flex Blue PPO $2500","Standard Silver Off Exchange Plan","70.20%","0.728450119495392","No","Yes","Yes","80%","20%","$2,500","$200","$0","$0","$1,600","$400","$0","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%","$5,000","$5000 per person","$10000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520002","my Lehigh Valley Flex Blue PPO 2900S","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520002-02","my Lehigh Valley Flex Blue PPO 2900S","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111699841/I_2111699841_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520002","my Lehigh Valley Flex Blue PPO 2900S","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520002-03","my Lehigh Valley Flex Blue PPO 2900S","Limited Cost Sharing Plan Variation",,"0.685910224914551","No","Yes","Yes","85%","15%","$2,900","$1,200","$800","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111699774/I_2111699774_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","54-1637426","70194PA0490003","Alliance Flex Blue PPO $2500","70194PA049",,"PAN002","PAS009","PAF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1788724309","70194PA0490003-01","Alliance Flex Blue PPO $2500","Standard Silver On Exchange Plan","70.20%","0.728450119495392","No","Yes","Yes","80%","20%","$2,500","$200","$0","$0","$1,600","$400","$0","$0","$0","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%","$5,000","$5000 per person","$10000 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2095121205/SE_2095121205_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/CPA"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520002","my Lehigh Valley Flex Blue PPO 2900S","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520002-04","my Lehigh Valley Flex Blue PPO 2900S","73% AV Level Silver Plan",,"0.734912693500519","No","Yes","Yes","85%","15%","$2,100","$1,200","$1,100","$0","$1,600","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111699888/I_2111699888_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520002","my Lehigh Valley Flex Blue PPO 2900S","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520002-05","my Lehigh Valley Flex Blue PPO 2900S","87% AV Level Silver Plan",,"0.866966307163239","No","Yes","Yes","85%","15%","$700","$700","$500","$0","$700","$600","$90","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","10.00%","$1,200","$1200 per person","$2400 per group","30.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111700365/I_2111700365_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70194","SERFF","2017-01-23 20:15:25","Individual","No","54-1637426","70194PA0520002","my Lehigh Valley Flex Blue PPO 2900S","70194PA052",,"PAN002","PAS012","PAF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0520002-06","my Lehigh Valley Flex Blue PPO 2900S","94% AV Level Silver Plan",,"0.941543400287628","No","Yes","Yes","85%","15%","$250","$600","$600","$0","$250","$400","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$400","$400 per person","$800 per group","30.00%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111700311/I_2111700311_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2017_ProductBrochure.pdf"
"2017","PA","70406","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","70406PA0040002","EHB High PPO","70406PA004",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70406PA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","PA","70406","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","70406PA0040001","EHB Low PPO","70406PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70406PA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","PA","70406","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","70406PA0030002","EHB High Passive","70406PA003",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70406PA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","PA","70406","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","70406PA0030001","EHB Low Passive","70406PA003",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70406PA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010007","BESTDental Premium","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","71933PA0020003","BESTOne Advantage Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/2017/PA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","71933PA0020003","BESTOne Advantage Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/2017/PA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010007","BESTDental Premium","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010008","BESTDental Standard - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","71933PA0020004","BESTOne Plus Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/2017/PA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","71933PA0020004","BESTOne Plus Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/2017/PA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010008","BESTDental Standard - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010010","BESTDental Choice - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010010","BESTDental Choice - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010009","BESTDental Standard - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","71933PA0020005","BESTOne Plus Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/2017/PA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","71933PA0020005","BESTOne Plus Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/2017/PA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010009","BESTDental Standard - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","71933PA0020006","BESTOne Basic Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/2017/PA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010011","BESTDental Choice - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010011","BESTDental Choice - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","Individual","Yes","95-6042390","71933PA0020006","BESTOne Basic Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/2017/PA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010012","BESTDental Value","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","71933","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","95-6042390","71933PA0010012","BESTDental Value","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","72299","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-3757528","72299PA0040001","TruAssure Dental Small Group Preferred Plan","72299PA004",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72299PA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","72299","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","72299PA0010001","TruAssure Basic Adult or Child Dental Plan","72299PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA"
"2017","PA","72299","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","72299PA0020001","TruAssure Preferred Adult or Child Dental Plan","72299PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA"
"2017","PA","72299","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","72299PA0020001","TruAssure Preferred Adult or Child Dental Plan","72299PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060002","my Priority Blue Flex HMO 2100S","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060002-05","my Priority Blue Flex HMO 2100S","87% AV Level Silver Plan",,"0.870644450187683","No","Yes","Yes","80%","20%","$700","$10","$700","$0","$700","$300","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","10.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112479862/I_2112479862_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060002","my Priority Blue Flex HMO 2100S","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060002-06","my Priority Blue Flex HMO 2100S","94% AV Level Silver Plan",,"0.940270960330963","No","Yes","Yes","80%","20%","$250","$10","$500","$0","$250","$250","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$400","$400 per person","$800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112489852/I_2112489852_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","23-1667011","82110PA0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020001-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","Individual","Yes","23-1667011","82110PA0010001","Delta Dental PPO Pediatric Basic Plan","82110PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010001-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","Individual","Yes","23-1667011","82110PA0010002","Delta Dental PPO Pediatric Preferred Plan","82110PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010002-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","23-1667011","82110PA0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020002-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","23-1667011","82110PA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020006-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020006-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","Individual","Yes","23-1667011","82110PA0010006","Delta Dental PPO Basic Plan for Families","82110PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010006-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","Individual","Yes","23-1667011","82110PA0010004","Delta Dental PPO Preferred Plan for Families","82110PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010004-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","23-1667011","82110PA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020004-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020004-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","23-1667011","82110PA0040006","DeltaCare USA Basic Plan for Families for Small Businesses","82110PA004",,"PAN002","PAS002",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","82110PA0040006-01","DeltaCare USA Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040006-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","Individual","Yes","23-1667011","82110PA0030006","DeltaCare USA Basic Plan for Families","82110PA003",,"PAN002","PAS002",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","82110PA0030006-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030006-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","Individual","Yes","23-1667011","82110PA0030004","DeltaCare USA Preferred Plan for Families","82110PA003",,"PAN002","PAS002",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","82110PA0030004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030004-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","23-1667011","82110PA0040004","DeltaCare USA Preferred Plan for Families for Small Businesses","82110PA004",,"PAN002","PAS002",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","82110PA0040004-01","DeltaCare USA Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040004-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","Individual","Yes","23-1667011","82110PA0030001","DeltaCare USA Pediatric Basic Plan","82110PA003",,"PAN002","PAS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","82110PA0030001-00","DeltaCare USA Pediatric Basic Plan","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030001-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","23-1667011","82110PA0040001","DeltaCare USA Pediatric Basic Plan for Small Businesses","82110PA004",,"PAN002","PAS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","82110PA0040001-00","DeltaCare USA Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040001-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","23-1667011","82110PA0040002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","82110PA004",,"PAN002","PAS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","82110PA0040002-00","DeltaCare USA Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040002-17"
"2017","PA","82110","SERFF","2016-08-20 11:23:22","Individual","Yes","23-1667011","82110PA0030002","DeltaCare USA Pediatric Preferred Plan","82110PA003",,"PAN002","PAS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","82110PA0030002-00","DeltaCare USA Pediatric Preferred Plan","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030002-17"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060005","my Priority Blue Flex HMO 1700GQ","83731PA006",,"PAN001","PAS001","PAF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060005-01","my Priority Blue Flex HMO 1700GQ","Standard Gold On Exchange Plan",,"0.786719739437103","Yes","Yes","Yes","80%","20%","$1,700","$10","$600","$0","$1,700","$300","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112316012/I_2112316012_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060005","my Priority Blue Flex HMO 1700GQ","83731PA006",,"PAN001","PAS001","PAF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060005-02","my Priority Blue Flex HMO 1700GQ","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112370157/I_2112370157_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060005","my Priority Blue Flex HMO 1700GQ","83731PA006",,"PAN001","PAS001","PAF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060005-03","my Priority Blue Flex HMO 1700GQ","Limited Cost Sharing Plan Variation",,"0.786719739437103","Yes","Yes","Yes","80%","20%","$1,700","$10","$600","$0","$1,700","$300","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112374714/I_2112374714_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","SD","25868","SERFF","2016-06-10 05:33:41","Individual","Yes","46-0309258","25868SD0010004","Delta Dental Individual & Family Enhanced Plan","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  The Delta Dental Plan Association has a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0010004-00","Delta Dental Individual & Family Enhanced Plan","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d132697.aspx","http://www.deltadentalsd.com/documents/d132697.aspx"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060001","my Priority Blue Flex HMO 6800B","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060001-00","my Priority Blue Flex HMO 6800B","Standard Bronze Off Exchange Plan","60.83%","0.622513949871063","No","Yes","Yes","80%","20%","$6,800","$10","$100","$0","$1,700","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","30.00%","$6,800","$6800 per person","$13600 per group","60.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060001","my Priority Blue Flex HMO 6800B","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060001-01","my Priority Blue Flex HMO 6800B","Standard Bronze On Exchange Plan","60.83%","0.622513949871063","No","Yes","Yes","80%","20%","$6,800","$10","$100","$0","$1,700","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","30.00%","$6,800","$6800 per person","$13600 per group","60.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113136464/I_2113136464_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060001","my Priority Blue Flex HMO 6800B","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060001-02","my Priority Blue Flex HMO 6800B","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113172304/I_2113172304_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060001","my Priority Blue Flex HMO 6800B","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060001-03","my Priority Blue Flex HMO 6800B","Limited Cost Sharing Plan Variation","60.83%","0.622513949871063","No","Yes","Yes","80%","20%","$6,800","$10","$100","$0","$1,700","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","30.00%","$6,800","$6800 per person","$13600 per group","60.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113169191/I_2113169191_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060002","my Priority Blue Flex HMO 2100S","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060002-00","my Priority Blue Flex HMO 2100S","Standard Silver Off Exchange Plan",,"0.687111079692841","No","Yes","Yes","80%","20%","$2,100","$10","$1,500","$0","$1,700","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060002","my Priority Blue Flex HMO 2100S","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060002-01","my Priority Blue Flex HMO 2100S","Standard Silver On Exchange Plan",,"0.687111079692841","No","Yes","Yes","80%","20%","$2,100","$10","$1,500","$0","$1,700","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112430253/I_2112430253_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060002","my Priority Blue Flex HMO 2100S","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060002-02","my Priority Blue Flex HMO 2100S","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112436340/I_2112436340_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060002","my Priority Blue Flex HMO 2100S","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060002-03","my Priority Blue Flex HMO 2100S","Limited Cost Sharing Plan Variation",,"0.687111079692841","No","Yes","Yes","80%","20%","$2,100","$10","$1,500","$0","$1,700","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112439013/I_2112439013_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060002","my Priority Blue Flex HMO 2100S","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060002-04","my Priority Blue Flex HMO 2100S","73% AV Level Silver Plan",,"0.727288901805878","No","Yes","Yes","80%","20%","$2,100","$10","$1,400","$0","$1,700","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112446472/I_2112446472_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060003","my Priority Blue Flex HMO 2750SQE","83731PA006",,"PAN001","PAS001","PAF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060003-00","my Priority Blue Flex HMO 2750SQE","Standard Silver Off Exchange Plan",,"0.680536210536957","Yes","Yes","Yes","80%","20%","$2,750","$0","$900","$0","$2,750","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%","$2,750","$2750 per person","$5500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060003","my Priority Blue Flex HMO 2750SQE","83731PA006",,"PAN001","PAS001","PAF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060003-01","my Priority Blue Flex HMO 2750SQE","Standard Silver On Exchange Plan",,"0.680536210536957","Yes","Yes","Yes","80%","20%","$2,750","$0","$900","$0","$2,750","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%","$2,750","$2750 per person","$5500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111963355/I_2111963355_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","84496","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","84496PA0030002","EHB High Passive","84496PA003",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84496PA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","PA","84496","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","84496PA0030001","EHB Low Passive","84496PA003",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84496PA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000","31195SD008",,"SDN002","SDS002","SDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-00","Sanford TRUE $4,000","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000","31195SD008",,"SDN002","SDS002","SDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-01","Sanford TRUE $4,000","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000","31195SD008",,"SDN002","SDS002","SDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-02","Sanford TRUE $4,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_4000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000","31195SD008",,"SDN002","SDS002","SDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-03","Sanford TRUE $4,000","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_4000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000","31195SD008",,"SDN002","SDS002","SDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-04","Sanford TRUE $4,000","73% AV Level Silver Plan",,"0.720419943332672","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,550","$3550 per person","$7100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,550","$3550 per person","$7100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_4000_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060003","my Priority Blue Flex HMO 2750SQE","83731PA006",,"PAN001","PAS001","PAF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060003-02","my Priority Blue Flex HMO 2750SQE","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113791450/I_2113791450_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060003","my Priority Blue Flex HMO 2750SQE","83731PA006",,"PAN001","PAS001","PAF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060003-03","my Priority Blue Flex HMO 2750SQE","Limited Cost Sharing Plan Variation",,"0.680536210536957","Yes","Yes","Yes","80%","20%","$2,750","$0","$900","$0","$2,750","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%","$2,750","$2750 per person","$5500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113791576/I_2113791576_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060003","my Priority Blue Flex HMO 2750SQE","83731PA006",,"PAN001","PAS001","PAF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060003-04","my Priority Blue Flex HMO 2750SQE","73% AV Level Silver Plan",,"0.720936715602875","Yes","Yes","Yes","80%","20%","$2,250","$0","$1,500","$0","$1,700","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$5500 per group","20.00%","$2,250","$2250 per person","$4500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113791609/I_2113791609_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060003","my Priority Blue Flex HMO 2750SQE","83731PA006",,"PAN001","PAS001","PAF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060003-05","my Priority Blue Flex HMO 2750SQE","87% AV Level Silver Plan",,"0.861978054046631","Yes","Yes","Yes","80%","20%","$900","$10","$600","$0","$900","$300","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","10.00%","$900","$900 per person","$1800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113791621/I_2113791621_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060003","my Priority Blue Flex HMO 2750SQE","83731PA006",,"PAN001","PAS001","PAF012","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060003-06","my Priority Blue Flex HMO 2750SQE","94% AV Level Silver Plan",,"0.93081659078598","Yes","Yes","Yes","80%","20%","$350","$0","$700","$0","$350","$0","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113791681/I_2113791681_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060004","my Priority Blue Flex HMO 1000G","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060004-00","my Priority Blue Flex HMO 1000G","Standard Gold Off Exchange Plan",,"0.787343919277191","No","Yes","Yes","80%","20%","$1,000","$10","$600","$0","$1,000","$400","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$2,000","$2000 per person","$4000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060004","my Priority Blue Flex HMO 1000G","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060004-01","my Priority Blue Flex HMO 1000G","Standard Gold On Exchange Plan",,"0.787343919277191","No","Yes","Yes","80%","20%","$1,000","$10","$600","$0","$1,000","$400","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$2,000","$2000 per person","$4000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111870240/I_2111870240_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060004","my Priority Blue Flex HMO 1000G","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060004-02","my Priority Blue Flex HMO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113789164/I_2113789164_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060004","my Priority Blue Flex HMO 1000G","83731PA006",,"PAN001","PAS001","PAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060004-03","my Priority Blue Flex HMO 1000G","Limited Cost Sharing Plan Variation",,"0.787343919277191","No","Yes","Yes","80%","20%","$1,000","$10","$600","$0","$1,000","$400","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$2,000","$2000 per person","$4000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113786207/I_2113786207_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0060005","my Priority Blue Flex HMO 1700GQ","83731PA006",,"PAN001","PAS001","PAF014","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060005-00","my Priority Blue Flex HMO 1700GQ","Standard Gold Off Exchange Plan",,"0.786719739437103","Yes","Yes","Yes","80%","20%","$1,700","$10","$600","$0","$1,700","$300","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","$3,250","$6500 per person","$6500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%","$1,700","$3400 per person","$3400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,,
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070001","my Lehigh Valley Flex Blue HMO 2500S","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070001-00","my Lehigh Valley Flex Blue HMO 2500S","Standard Silver Off Exchange Plan",,"0.692341148853302","No","Yes","Yes","85%","15%","$2,500","$10","$1,400","$0","$1,700","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070001","my Lehigh Valley Flex Blue HMO 2500S","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070001-01","my Lehigh Valley Flex Blue HMO 2500S","Standard Silver On Exchange Plan",,"0.697676777839661","No","Yes","Yes","85%","15%","$2,500","$10","$1,400","$0","$1,700","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112693874/I_2112693874_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070001","my Lehigh Valley Flex Blue HMO 2500S","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070001-02","my Lehigh Valley Flex Blue HMO 2500S","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113795052/I_2113795052_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070001","my Lehigh Valley Flex Blue HMO 2500S","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070001-03","my Lehigh Valley Flex Blue HMO 2500S","Limited Cost Sharing Plan Variation",,"0.697676777839661","No","Yes","Yes","85%","15%","$2,500","$10","$1,400","$0","$1,700","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113792333/I_2113792333_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070001","my Lehigh Valley Flex Blue HMO 2500S","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070001-04","my Lehigh Valley Flex Blue HMO 2500S","73% AV Level Silver Plan",,"0.729348123073578","No","Yes","Yes","85%","15%","$2,500","$10","$1,400","$0","$1,700","$400","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$4,200","$4200 per person","$8400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113704702/I_2113704702_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070001","my Lehigh Valley Flex Blue HMO 2500S","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070001-05","my Lehigh Valley Flex Blue HMO 2500S","87% AV Level Silver Plan",,"0.863692224025726","No","Yes","Yes","85%","15%","$900","$10","$600","$0","$900","$400","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","10.00%","$1,200","$1200 per person","$2400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113710850/I_2113710850_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070001","my Lehigh Valley Flex Blue HMO 2500S","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070001-06","my Lehigh Valley Flex Blue HMO 2500S","94% AV Level Silver Plan",,"0.941542387008667","No","Yes","Yes","85%","15%","$250","$10","$500","$0","$250","$200","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$400","$400 per person","$800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113714828/I_2113714828_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070002","my Lehigh Valley Flex Blue HMO 1000G","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070002-00","my Lehigh Valley Flex Blue HMO 1000G","Standard Gold Off Exchange Plan",,"0.793725788593292","No","Yes","Yes","85%","15%","$1,000","$10","$1,300","$0","$1,000","$200","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070002","my Lehigh Valley Flex Blue HMO 1000G","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070002-01","my Lehigh Valley Flex Blue HMO 1000G","Standard Gold On Exchange Plan",,"0.793725788593292","No","Yes","Yes","85%","15%","$1,000","$10","$1,300","$0","$1,000","$200","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2112138242/I_2112138242_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070002","my Lehigh Valley Flex Blue HMO 1000G","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070002-02","my Lehigh Valley Flex Blue HMO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113796430/I_2113796430_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","83731","SERFF","2016-11-14 20:15:42","Individual","No","23-2413324","83731PA0070002","my Lehigh Valley Flex Blue HMO 1000G","83731PA007",,"PAN001","PAS002","PAF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","No",,"Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070002-03","my Lehigh Valley Flex Blue HMO 1000G","Limited Cost Sharing Plan Variation",,"0.793725788593292","No","Yes","Yes","85%","15%","$1,000","$10","$1,300","$0","$1,000","$200","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2113796286/I_2113796286_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2017_ProductBrochure.pdf"
"2017","PA","84496","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","84496PA0040002","EHB High PPO","84496PA004",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84496PA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","PA","84496","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","84496PA0040001","EHB Low PPO","84496PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84496PA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","PA","94118","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0098400","94118PA0040002","EHB High PPO","94118PA004",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","94118PA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","PA","94118","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0098400","94118PA0040001","EHB Low PPO","94118PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","94118PA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","PA","94118","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0098400","94118PA0030002","EHB High Passive","94118PA003",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","94118PA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","PA","94118","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","47-0098400","94118PA0030001","EHB Low Passive","94118PA003",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","94118PA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","PA","98060","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","13-5581829","98060PA0170001","EHB Basic Dental Plan (Low)","98060PA017",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0170001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","PA","98060","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","13-5581829","98060PA0190001","Family Basic Dental Plan (Low)","98060PA019",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0190001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49121"
"2017","PA","98060","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","13-5581829","98060PA0190001","Family Basic Dental Plan (Low)","98060PA019",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0190001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49121"
"2017","PA","98060","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","13-5581829","98060PA0200001","Family Enhanced Dental Plan (High)","98060PA020",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.86","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0200001-00","Family Enhanced Dental Plan (High)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49123"
"2017","PA","98060","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","13-5581829","98060PA0200001","Family Enhanced Dental Plan (High)","98060PA020",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.86","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0200001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49123"
"2017","SD","11782","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","36-0883760","11782SD0040002","EHB High PPO","11782SD004",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","11782SD0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","SD","11782","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","36-0883760","11782SD0040001","EHB Low PPO","11782SD004",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","11782SD0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","SD","11782","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","36-0883760","11782SD0030002","EHB High Passive","11782SD003",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","11782SD0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","SD","11782","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","36-0883760","11782SD0030001","EHB Low Passive","11782SD003",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","11782SD0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","SD","13380","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","47-0098400","13380SD0040002","EHB High PPO","13380SD004",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","13380SD0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","SD","13380","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","47-0098400","13380SD0040001","EHB Low PPO","13380SD004",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","13380SD0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","SD","13380","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","47-0098400","13380SD0030002","EHB High Passive","13380SD003",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","13380SD0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","SD","13380","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","47-0098400","13380SD0030001","EHB Low Passive","13380SD003",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","13380SD0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","SD","25868","SERFF","2016-06-10 05:33:41","Individual","Yes","46-0309258","25868SD0010003","Delta Dental Individual and Family Standard Plan","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  The Delta Dental Plan Association has a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0010003-00","Delta Dental Individual and Family Standard Plan","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d132696.aspx","http://www.deltadentalsd.com/documents/d132696.aspx"
"2017","SD","25868","SERFF","2016-06-10 05:33:41","SHOP (Small Group)","Yes","46-0309258","25868SD0020003","Delta Dental Small Group Standard Plan","25868SD002","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  The Delta Dental Plan Association has a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0020003-00","Delta Dental Small Group Standard Plan","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d132698.aspx","http://www.deltadentalsd.com/documents/d132698.aspx"
"2017","SD","25868","SERFF","2016-06-10 05:33:41","SHOP (Small Group)","Yes","46-0309258","25868SD0020004","Delta Dental Small Group Enhanced Plan","25868SD002","7164425200","SDN001","SDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  The Delta Dental Plan Association has a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0020004-00","Delta Dental Small Group Enhanced Plan","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d132699.aspx","http://www.deltadentalsd.com/documents/d132699.aspx"
"2017","SD","26240","SERFF","2016-05-16 03:02:31","SHOP (Small Group)","Yes","57-0523959","26240SD0030001","Group Dental Policy","26240SD003",,"SDN001","SDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","26240SD0030001-00","Group Dental Policy","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SD","26240","SERFF","2016-05-16 03:02:31","SHOP (Small Group)","Yes","57-0523959","26240SD0020001","Pediatric Only Group Dental Policy","26240SD002",,"SDN001","SDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","26240SD0020001-00","Pediatric Only Group Dental Policy","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SD","26240","SERFF","2016-05-16 03:02:31","SHOP (Small Group)","Yes","57-0523959","26240SD0020002","Pediatric Only Group Dental Policy","26240SD002",,"SDN001","SDS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","traditional with inside maximums","Yes","traditional with inside maximums","Yes",,"","26240SD0020002-00","Pediatric Only Group Dental Policy","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090005","Sanford Simplicity $6,000","31195SD009",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090005-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan",,"0.618343114852905","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000","31195SD008",,"SDN001","SDS001","SDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-00","Sanford Simplicity $5,000","Standard Bronze Off Exchange Plan",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000","31195SD008",,"SDN001","SDS001","SDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-01","Sanford Simplicity $5,000","Standard Bronze On Exchange Plan",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090005","Sanford Simplicity $6,000","31195SD009",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090005-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan",,"0.618343114852905","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000","31195SD008",,"SDN001","SDS001","SDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-02","Sanford Simplicity $5,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_5000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000","31195SD008",,"SDN001","SDS001","SDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-03","Sanford Simplicity $5,000","Limited Cost Sharing Plan Variation",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_5000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-00","Sanford TRUE $5,000","Standard Bronze Off Exchange Plan",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6559 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-01","Sanford TRUE $5,000","Standard Bronze On Exchange Plan",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6559 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-02","Sanford TRUE $5,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_5000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-03","Sanford TRUE $5,000","Limited Cost Sharing Plan Variation",,"0.617847621440887","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$5,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6559 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_5000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000","31195SD008",,"SDN002","SDS002","SDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-05","Sanford TRUE $4,000","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$1,400","$0","$0","$200","$1,400","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_4000_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000","31195SD008",,"SDN002","SDS002","SDF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-06","Sanford TRUE $4,000","94% AV Level Silver Plan",,"0.932620525360107","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_4000_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan",,"0.618333578109741","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090004","Sanford Simplicity $4,500","31195SD009",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only.","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090004-00","Sanford Simplicity $4,500","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$3,600","$0","$400","$200","$4,500","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090004","Sanford Simplicity $4,500","31195SD009",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only.","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090004-01","Sanford Simplicity $4,500","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$3,600","$0","$400","$200","$4,500","$0","$300","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan",,"0.618333578109741","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-02","Sanford Simplicity $6,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-03","Sanford Simplicity $6,000","Limited Cost Sharing Plan Variation",,"0.618333578109741","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-00","Sanford TRUE $6,000","Standard Bronze Off Exchange Plan",,"0.618333578109741","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090007","Sanford Simplicity $1,250","31195SD009",,"SDN001","SDS001","SDF005","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090007-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.798430681228638","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$700","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090007","Sanford Simplicity $1,250","31195SD009",,"SDN001","SDS001","SDF005","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090007-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.798430681228638","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$700","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080004","Sanford Simplicity $7,150","31195SD008",,"SDN001","SDS001","SDF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080004-01","Sanford Simplicity $7,150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_7150.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020009","Avera 2500","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-02","Avera 2500 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65301/avera-2500-zero-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090003","Sanford Simplicity $3,500","31195SD009",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090003-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090003","Sanford Simplicity $3,500","31195SD009",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090003-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090008","Sanford Simplicity $2,700","31195SD009",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090008-00","Sanford Simplicity $2,700","Standard Silver Off Exchange Plan",,"0.697694897651672","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090008","Sanford Simplicity $2,700","31195SD009",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090008-01","Sanford Simplicity $2,700","Standard Silver On Exchange Plan",,"0.697694897651672","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$700","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","59141","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","93-0242990","59141SD0040002","EHB High PPO","59141SD004",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","59141SD0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","SD","59141","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","93-0242990","59141SD0040001","EHB Low PPO","59141SD004",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","59141SD0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","SD","59141","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","93-0242990","59141SD0030002","EHB High Passive","59141SD003",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","59141SD0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","SD","59141","SERFF","2016-05-12 11:31:06","SHOP (Small Group)","Yes","93-0242990","59141SD0030001","EHB Low Passive","59141SD003",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","59141SD0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010004","Molina Marketplace Options Silver Plan","18167UT001",,"UTN001","UTS001","UTF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993317493902859",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010004-04","Molina Marketplace Options Silver Plan","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020009","Avera 2500","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-03","Avera 2500 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.713380932807922","No","Yes","No","100%",,"$2,500","$0","$1,430","$0","$120","$1,350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65298/avera-2500-limited-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020009","Avera 2500","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-04","Avera 2500","73% AV Level Silver Plan",,"0.739704430103302","No","Yes","No","100%",,"$2,500","$0","$1,490","$0","$130","$920","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65296/avera-2300-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020009","Avera 2500","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-05","Avera 1000","87% AV Level Silver Plan",,"0.875231146812439","No","Yes","No","100%",,"$1,000","$0","$1,000","$0","$130","$460","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65284/avera-1000-09-05-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-01","Sanford TRUE $6,000","Standard Bronze On Exchange Plan",,"0.618333578109741","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-02","Sanford TRUE $6,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-03","Sanford TRUE $6,000","Limited Cost Sharing Plan Variation",,"0.618333578109741","Yes","Yes","No","100%",,"$3,600","$20","$300","$200","$800","$2,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090001","Sanford Simplicity $500","31195SD009",,"SDN001","SDS001","SDF006","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090001-00","Sanford Simplicity $500","Standard Platinum Off Exchange Plan",,"0.904879629611969","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,250","31195SD008",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.798427879810333","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$600","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,250","31195SD008",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.798427879810333","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$600","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","SHOP (Small Group)","No","91-1842494","31195SD0090001","Sanford Simplicity $500","31195SD009",,"SDN001","SDS001","SDF006","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090001-01","Sanford Simplicity $500","Standard Platinum On Exchange Plan",,"0.904879629611969","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/sg_sd_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,250","31195SD008",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-02","Sanford Simplicity $1,250","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_1250_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,250","31195SD008",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-03","Sanford Simplicity $1,250","Limited Cost Sharing Plan Variation",,"0.798427879810333","Yes","Yes","No","100%",,"$1,300","$20","$600","$200","$600","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_1250_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-00","Sanford TRUE $3,500","Standard Silver Off Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-01","Sanford TRUE $3,500","Standard Silver On Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-02","Sanford TRUE $3,500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-03","Sanford TRUE $3,500","Limited Cost Sharing Plan Variation",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD2017/i_sd_true_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-04","Sanford TRUE $3,500","73% AV Level Silver Plan",,"0.735015869140625","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$400","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-05","Sanford TRUE $3,500","87% AV Level Silver Plan",,"0.874877214431763","Yes","Yes","No","100%",,"$900","$10","$0","$200","$400","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-06","Sanford TRUE $3,500","94% AV Level Silver Plan",,"0.942311346530914","Yes","Yes","No","100%",,"$300","$10","$200","$200","$200","$300","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_true_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-00","Sanford Simplicity $4,000","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-01","Sanford Simplicity $4,000","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-02","Sanford Simplicity $4,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_4000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-03","Sanford Simplicity $4,000","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_4000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-04","Sanford Simplicity $4,000","73% AV Level Silver Plan",,"0.722920358181","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,550","$3550 per person","$7100 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7100 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_4000_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-05","Sanford Simplicity $4,000","87% AV Level Silver Plan",,"0.863974511623383","Yes","Yes","No","100%",,"$1,400","$0","$0","$200","$1,400","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_4000_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-06","Sanford Simplicity $4,000","94% AV Level Silver Plan",,"0.932620525360107","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_4000_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-02","Sanford Simplicity $3,500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-03","Sanford Simplicity $3,500","Limited Cost Sharing Plan Variation",,"0.705689072608948","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$500","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-04","Sanford Simplicity $3,500","73% AV Level Silver Plan",,"0.735015869140625","Yes","Yes","No","100%",,"$3,000","$20","$300","$200","$400","$900","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-05","Sanford Simplicity $3,500","87% AV Level Silver Plan",,"0.874877214431763","Yes","Yes","No","100%",,"$700","$10","$800","$200","$400","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-06","Sanford Simplicity $3,500","94% AV Level Silver Plan",,"0.942311346530914","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$300","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","31195","SERFF","2017-04-21 20:15:32","Individual","No","91-1842494","31195SD0080004","Sanford Simplicity $7,150","31195SD008",,"SDN001","SDS001","SDF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080004-00","Sanford Simplicity $7,150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,900","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2017/i_sd_simplicity_7150.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2017.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020021","Avera 3000","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-00","Avera 3000","Standard Silver Off Exchange Plan",,"0.706780612468719","No","Yes","No","100%",,"$3,000","$20","$1,280","$0","$140","$1,460","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65310/avera-3000-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010021","Avera 1000","60536SD001","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010021-00","Avera 1000","Standard Gold Off Exchange Plan",,"0.818951725959778","No","Yes","No","100%",,"$1,000","$20","$2,290","$0","$0","$1,520","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65270/avera-1000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010021","Avera 1000","60536SD001","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010021-01","Avera 1000","Standard Gold On Exchange Plan",,"0.818951725959778","No","Yes","No","100%",,"$1,000","$20","$2,290","$0","$0","$1,520","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65270/avera-1000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020021","Avera 3000","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-01","Avera 3000","Standard Silver On Exchange Plan",,"0.706780612468719","No","Yes","No","100%",,"$3,000","$20","$1,280","$0","$140","$1,460","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65310/avera-3000-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020021","Avera 3000","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-02","Avera 3000 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65308/avera-3000-zero-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020021","Avera 3000","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-03","Avera 3000 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.706780612468719","No","Yes","No","100%",,"$3,000","$20","$1,280","$0","$140","$1,460","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65306/avera-3000-limited-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020021","Avera 3000","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-04","Avera 2600","73% AV Level Silver Plan",,"0.737832009792328","No","Yes","No","100%",,"$2,600","$70","$1,400","$0","$120","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65304/avera-2600-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020021","Avera 3000","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-05","Avera 1000","87% AV Level Silver Plan",,"0.875231146812439","No","Yes","No","100%",,"$1,000","$0","$1,000","$0","$120","$570","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65286/avera-1000-21-05-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020021","Avera 3000","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-06","Avera 400","94% AV Level Silver Plan",,"0.944031000137329","No","Yes","No","100%",,"$400","$0","$300","$0","$100","$170","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65281/avera-400-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010020","Avera 2000","60536SD001","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010020-00","Avera 2000","Standard Gold Off Exchange Plan",,"0.790311932563782","No","Yes","No","100%",,"$2,000","$20","$1,580","$0","$0","$1,520","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65272/avera-2000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020006","Avera 1500","60536SD002","7942203176","SDN001","SDS001","SDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020006-00","Avera 1500","Standard Gold Off Exchange Plan",,"0.798640131950378","No","Yes","No","100%",,"$1,500","$0","$1,150","$0","$130","$1,320","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65294/avera-1500-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020006","Avera 1500","60536SD002","7942203176","SDN001","SDS001","SDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020006-01","Avera 1500","Standard Gold On Exchange Plan",,"0.798640131950378","No","Yes","No","100%",,"$1,500","$0","$1,150","$0","$130","$1,320","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65294/avera-1500-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010020","Avera 2000","60536SD001","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010020-01","Avera 2000","Standard Gold On Exchange Plan",,"0.790311932563782","No","Yes","No","100%",,"$2,000","$20","$1,580","$0","$0","$1,520","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65272/avera-2000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010019","Avera 500","60536SD001","7942203176","SDN001","SDS001","SDF004","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010019-00","Avera 500","Standard Platinum Off Exchange Plan",,"0.89091569185257","No","Yes","No","100%",,"$500","$240","$1,270","$0","$0","$640","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65372/avera-500sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020006","Avera 1500","60536SD002","7942203176","SDN001","SDS001","SDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020006-02","Avera 1500 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65293/avera-1500-zero-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020006","Avera 1500","60536SD002","7942203176","SDN001","SDS001","SDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020006-03","Avera 1500 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.798640131950378","No","Yes","No","100%",,"$1,500","$0","$1,150","$0","$130","$1,320","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65290/avera-1500-limited-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010019","Avera 500","60536SD001","7942203176","SDN001","SDS001","SDF004","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010019-01","Avera 500","Standard Platinum On Exchange Plan",,"0.89091569185257","No","Yes","No","100%",,"$500","$240","$1,270","$0","$0","$640","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65372/avera-500sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020009","Avera 2500","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-00","Avera 2500","Standard Silver Off Exchange Plan",,"0.713380932807922","No","Yes","No","100%",,"$2,500","$0","$1,430","$0","$120","$1,350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65302/avera-2500-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020009","Avera 2500","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-01","Avera 2500","Standard Silver On Exchange Plan",,"0.713380932807922","No","Yes","No","100%",,"$2,500","$0","$1,430","$0","$120","$1,350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65302/avera-2500-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020009","Avera 2500","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-06","Avera 350","94% AV Level Silver Plan",,"0.945002555847168","No","Yes","No","100%",,"$350","$0","$350","$0","$100","$130","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65280/avera-350-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-00","Avera 4000","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/65317/avera-4000-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-01","Avera 4000","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/65317/avera-4000-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-02","Avera 4000 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.avera.org/app/files/public/65316/avera-4000-zero-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020010","Avera 2500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-04","Avera 2500 with Pediatric Dental","73% AV Level Silver Plan",,"0.739704430103302","No","Yes","No","100%",,"$2,500","$0","$1,490","$0","$120","$920","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65295/avera-2300-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020023","Avera 5000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-02","Avera 5000 Zero Cost Share with Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65322/avera-5000-zero-cost-share-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010004","Molina Marketplace Options Silver Plan","18167UT001",,"UTN001","UTS001","UTF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993317493902859",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010004-03","Molina Marketplace Options Silver Plan","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-03","Avera 4000 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65315/avera-4000-limited-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-04","Avera 3200","73% AV Level Silver Plan",,"0.738653838634491","Yes","Yes","No","100%",,"$3,200","$0","$0","$0","$3,200","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65311/avera-3200-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-05","Avera 1300","87% AV Level Silver Plan",,"0.868040502071381","Yes","Yes","No","100%",,"$1,300","$0","$0","$0","$1,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65288/avera-1300-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-06","Avera 500","94% AV Level Silver Plan",,"0.942757964134216","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65282/avera-500-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020024","Avera 6550","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-00","Avera 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,010","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/65528/avera-6550-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020024","Avera 6550","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-01","Avera 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,010","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/65528/avera-6550-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020024","Avera 6550","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-02","Avera 6550 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.avera.org/app/files/public/65527/avera-6550-zero-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020024","Avera 6550","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-03","Avera 6550 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,010","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65526/avera-6550-limited-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010025","Avera 3000","60536SD001","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010025-00","Avera 3000","Standard Silver Off Exchange Plan",,"0.714086532592773","No","Yes","No","100%",,"$3,000","$20","$1,280","$0","$140","$1,530","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65273/avera-3000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020018","Avera 7150","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020018-00","Avera 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$4,150","$0","$0","$0","$4,590","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65328/avera-7150-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020018","Avera 7150","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020018-01","Avera 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$4,150","$0","$0","$0","$4,590","$0","$0","$0","$0","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65328/avera-7150-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010025","Avera 3000","60536SD001","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010025-01","Avera 3000","Standard Silver On Exchange Plan",,"0.714086532592773","No","Yes","No","100%",,"$3,000","$20","$1,280","$0","$140","$1,530","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65273/avera-3000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010023","Avera 4000","60536SD001","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010023-00","Avera 4000","Standard Silver Off Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.avera.org/app/files/public/65275/avera-4000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010023","Avera 4000","60536SD001","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010023-01","Avera 4000","Standard Silver On Exchange Plan",,"0.698700070381165","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.avera.org/app/files/public/65275/avera-4000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010017","Avera 4500","60536SD001","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010017-00","Avera 4500","Standard Bronze Off Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,450","$0","$4,500","$0","$390","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.avera.org/app/files/public/65318/avera-4500-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010017","Avera 4500","60536SD001","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010017-01","Avera 4500","Standard Bronze On Exchange Plan",,"0.619072020053864","Yes","Yes","No","100%",,"$4,500","$0","$1,450","$0","$4,500","$0","$390","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.avera.org/app/files/public/65318/avera-4500-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010015","Avera 3500","60536SD001","7942203176","SDN001","SDS001","SDF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010015-00","Avera 3500","Standard Silver Off Exchange Plan",,"0.718232452869415","No","Yes","No","100%",,"$3,500","$20","$1,500","$0","$140","$1,620","$30","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65274/avera-3500sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020007","Avera 1500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-00","Avera 1500 with Pediatric Dental","Standard Gold Off Exchange Plan",,"0.798640131950378","No","Yes","No","100%",,"$1,500","$0","$1,150","$0","$130","$1,320","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65291/avera-1500-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020007","Avera 1500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-01","Avera 1500 with Pediatric Dental","Standard Gold On Exchange Plan",,"0.798640131950378","No","Yes","No","100%",,"$1,500","$0","$1,150","$0","$130","$1,320","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65291/avera-1500-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010015","Avera 3500","60536SD001","7942203176","SDN001","SDS001","SDF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010015-01","Avera 3500","Standard Silver On Exchange Plan",,"0.718232452869415","No","Yes","No","100%",,"$3,500","$20","$1,500","$0","$140","$1,620","$30","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65274/avera-3500sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020007","Avera 1500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-02","Avera 1500 Zero Cost Share with Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.avera.org/app/files/public/65292/avera-1500-zero-cost-share-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020007","Avera 1500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-03","Avera 1500 Limited Cost Share with Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.798640131950378","No","Yes","No","100%",,"$1,500","$0","$1,150","$0","$130","$1,320","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65289/avera-1500-limited-cost-share-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020010","Avera 2500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-00","Avera 2500 with Pediatric Dental","Standard Silver Off Exchange Plan",,"0.713380932807922","No","Yes","No","100%",,"$2,500","$0","$1,430","$0","$120","$1,350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65299/avera-2500-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020010","Avera 2500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-01","Avera 2500 with Pediatric Dental","Standard Silver On Exchange Plan",,"0.713380932807922","No","Yes","No","100%",,"$2,500","$0","$1,430","$0","$120","$1,350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65299/avera-2500-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020010","Avera 2500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-02","Avera 2500 Zero Cost Share with Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65300/avera-2500-zero-cost-share-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020010","Avera 2500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-03","Avera 2500 Limited Cost Share with Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.713380932807922","No","Yes","No","100%",,"$2,500","$0","$1,430","$0","$120","$1,350","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65297/avera-2500-limited-cost-share-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020010","Avera 2500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-05","Avera 1000 with Pediatric Dental","87% AV Level Silver Plan",,"0.875231146812439","No","Yes","No","100%",,"$1,000","$0","$1,000","$0","$120","$460","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65285/avera-1000-10-05-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","Individual","Yes","95-6042390","61214SD0020003","BESTOne Advantage Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010007","BESTDental Premium","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Premium_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010007","BESTDental Premium","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Premium_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","Individual","Yes","95-6042390","61214SD0020003","BESTOne Advantage Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010008","BESTDental Standard - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Standard-H_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","Individual","Yes","95-6042390","61214SD0020004","BESTOne Plus Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","Individual","Yes","95-6042390","61214SD0020004","BESTOne Plus Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010008","BESTDental Standard - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Standard-H_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010010","BESTDental Choice - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Choice-H_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010010","BESTDental Choice - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Choice-H_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010009","BESTDental Standard - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Standard-L_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","Individual","Yes","95-6042390","61214SD0020005","BESTOne Plus Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","Individual","Yes","95-6042390","61214SD0020005","BESTOne Plus Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010009","BESTDental Standard - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Standard-L_Plan.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020010","Avera 2500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-06","Avera 350 with Pediatric Dental","94% AV Level Silver Plan",,"0.945002555847168","No","Yes","No","100%",,"$350","$0","$350","$0","$100","$130","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65279/avera-350-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020022","Avera 3000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-00","Avera 3000 with Pediatric Dental","Standard Silver Off Exchange Plan",,"0.706780612468719","No","Yes","No","100%",,"$3,000","$20","$1,280","$0","$140","$1,460","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65371/avera-3000-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010026","Avera 5000","60536SD001","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010026-00","Avera 5000","Standard Bronze Off Exchange Plan",,"0.618477821350098","No","Yes","No","100%",,"$570","$40","$2,030","$0","$140","$1,450","$430","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65276/avera-5000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010026","Avera 5000","60536SD001","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010026-01","Avera 5000","Standard Bronze On Exchange Plan",,"0.618477821350098","No","Yes","No","100%",,"$570","$40","$2,030","$0","$140","$1,450","$430","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65276/avera-5000sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020022","Avera 3000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-01","Avera 3000 with Pediatric Dental","Standard Silver On Exchange Plan",,"0.706780612468719","No","Yes","No","100%",,"$3,000","$20","$1,280","$0","$140","$1,460","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65371/avera-3000-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020022","Avera 3000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-02","Avera 3000 Zero Cost Share with Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65307/avera-3000-zero-cost-share-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010022","Avera 1500","60536SD001","7942203176","SDN001","SDS001","SDF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010022-00","Avera 1500","Standard Gold Off Exchange Plan",,"0.80336207151413","No","Yes","No","100%",,"$1,500","$10","$1,150","$0","$320","$1,090","$10","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65271/avera-1500sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","46-0451539","60536SD0010022","Avera 1500","60536SD001","7942203176","SDN001","SDS001","SDF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0010022-01","Avera 1500","Standard Gold On Exchange Plan",,"0.80336207151413","No","Yes","No","100%",,"$1,500","$10","$1,150","$0","$320","$1,090","$10","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/65271/avera-1500sd-2017.pdf","http://www.avera.org/app/files/public/65557/2017-small-employer-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020022","Avera 3000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-03","Avera 3000 Limited Cost Share with Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.706780612468719","No","Yes","No","100%",,"$3,000","$20","$1,280","$0","$140","$1,460","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65305/avera-3000-limited-cost-share-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020022","Avera 3000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-04","Avera 2600 with Pediatric Dental","73% AV Level Silver Plan",,"0.737832009792328","No","Yes","No","100%",,"$2,600","$70","$1,400","$0","$120","$1,200","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65303/avera-2600-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020022","Avera 3000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-05","Avera 1000 with Pediatric Dental","87% AV Level Silver Plan",,"0.875231146812439","No","Yes","No","100%",,"$1,000","$0","$1,000","$0","$120","$570","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65287/avera-1000-22-05-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020022","Avera 3000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-06","Avera 400 with Pediatric Dental","94% AV Level Silver Plan",,"0.944031000137329","No","Yes","No","100%",,"$400","$0","$300","$0","$100","$170","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0.00%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65370/avera-400-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020028","Avera 3500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Silver","Design 1","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020028-00","Avera 3500 with Pediatric Dental","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$30","$750","$0","$140","$1,410","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65314/avera-3500-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020028","Avera 3500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Silver","Design 1","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020028-01","Avera 3500 with Pediatric Dental","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$30","$750","$0","$140","$1,410","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65314/avera-3500-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020028","Avera 3500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Silver","Design 1","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020028-02","Avera 3500 with Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.avera.org/app/files/public/65313/avera-3500-zero-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020028","Avera 3500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Silver","Design 1","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020028-03","Avera 3500 with Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$30","$750","$0","$140","$1,410","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65312/avera-3500-limited-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020028","Avera 3500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Silver","Design 1","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020028-04","Avera 3000 with Pediatric Dental","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$0","$140","$1,250","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65309/avera-3000-28-04-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020028","Avera 3500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Silver","Design 1","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020028-05","Avera 700 with Pediatric Dental","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$130","$0","$130","$640","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65283/avera-700-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020028","Avera 3500 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Silver","Design 1","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020028-06","Avera 250 with Pediatric Dental","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$350","$0","$130","$270","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/65278/avera-250-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020012","Avera 5000","60536SD002","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020012-00","Avera 5000","Standard Bronze Off Exchange Plan",,"0.618477821350098","No","Yes","No","100%",,"$5,000","$0","$900","$0","$1,200","$1,300","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65324/avera-5000-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020012","Avera 5000","60536SD002","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020012-01","Avera 5000","Standard Bronze On Exchange Plan",,"0.618477821350098","No","Yes","No","100%",,"$5,000","$0","$900","$0","$1,200","$1,300","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65324/avera-5000-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020012","Avera 5000","60536SD002","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020012-02","Avera 5000 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65323/avera-5000-zero-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020012","Avera 5000","60536SD002","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020012-03","Avera 5000 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.618477821350098","No","Yes","No","100%",,"$5,000","$0","$900","$0","$1,200","$1,300","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65320/avera-5000-limited-cost-share-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020023","Avera 5000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-00","Avera 5000 with Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.618477821350098","No","Yes","No","100%",,"$5,000","$0","$900","$0","$1,200","$1,300","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65321/avera-5000-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020023","Avera 5000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-01","Avera 5000 with Pediatric Dental","Standard Bronze On Exchange Plan",,"0.618477821350098","No","Yes","No","100%",,"$5,000","$0","$900","$0","$1,200","$1,300","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65321/avera-5000-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","60536","SERFF","2017-01-27 18:01:23","Individual","No","46-0451539","60536SD0020023","Avera 5000 with Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-03","Avera 5000 Limited Cost Share with Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.618477821350098","No","Yes","No","100%",,"$5,000","$0","$900","$0","$1,200","$1,300","$0","$0","$0","$0","$0","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/65319/avera-5000-limited-cost-share-with-pediatric-dental-2017.pdf","http://www.avera.org/app/files/public/65556/2017-individual-brochure.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010011","BESTDental Choice - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Choice-L_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","Individual","Yes","95-6042390","61214SD0020006","BESTOne Basic Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","Individual","Yes","95-6042390","61214SD0020006","BESTOne Basic Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010011","BESTDental Choice - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Choice-L_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010012","BESTDental Value","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Value_Plan.pdf"
"2017","SD","61214","SERFF","2016-07-15 03:34:06","SHOP (Small Group)","Yes","95-6042390","61214SD0010012","BESTDental Value","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2017/SD_BESTDental_Value_Plan.pdf"
"2017","UT","14948","SERFF","2016-08-23 04:37:23","Individual","Yes","86-0672505","14948UT0010002","DeltaCare USA Pediatric Preferred Plan","14948UT001",,"UTN001","UTS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010002-00","DeltaCare USA Pediatric Preferred Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0010002-17"
"2017","UT","14948","SERFF","2016-08-23 04:37:23","Individual","Yes","86-0672505","14948UT0010001","DeltaCare USA Pediatric Basic Plan","14948UT001",,"UTN001","UTS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010001-00","DeltaCare USA Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0010001-17"
"2017","UT","14948","SERFF","2016-08-23 04:37:23","Individual","Yes","86-0672505","14948UT0040001","DeltaCare USA Basic Plan for Families","14948UT004",,"UTN001","UTS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.73","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0040001-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0040001-17"
"2017","UT","14948","SERFF","2016-08-23 04:37:23","Individual","Yes","86-0672505","14948UT0040002","DeltaCare USA Preferred Plan for Families","14948UT004",,"UTN001","UTS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.57","Guaranteed Rate","2017-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0040002-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0040002-17"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.994993547202589",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010001-00","Molina Marketplace Gold Plan","Standard Gold Off Exchange Plan",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.994993547202589",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010001-01","Molina Marketplace Gold Plan","Standard Gold On Exchange Plan",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.994993547202589",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010001-02","Molina Marketplace Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.994993547202589",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010001-03","Molina Marketplace Gold Plan","Limited Cost Sharing Plan Variation",,"0.785289108753204","No","Yes","No","100%",,"$1,030","$240","$890","$150","$1,020","$720","$180","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$1,025","$1025 per person","$2050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-gold-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993157668761726",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010002-00","Molina Marketplace Silver Plan","Standard Silver Off Exchange Plan",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993157668761726",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010002-01","Molina Marketplace Silver Plan","Standard Silver On Exchange Plan",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993157668761726",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010002-02","Molina Marketplace Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993157668761726",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010002-03","Molina Marketplace Silver Plan","Limited Cost Sharing Plan Variation",,"0.719651222229004","No","Yes","No","100%",,"$2,400","$230","$1,340","$150","$2,400","$400","$10","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993157668761726",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010002-04","Molina Marketplace Silver Plan","73% AV Level Silver Plan",,"0.739960968494415","No","Yes","No","100%",,"$2,270","$290","$1,340","$150","$2,270","$400","$40","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","$2,275","$2275 per person","$4550 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,275","$2275 per person","$4550 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993157668761726",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010002-05","Molina Marketplace Silver Plan","87% AV Level Silver Plan",,"0.879880011081696","No","Yes","No","100%",,"$500","$180","$890","$150","$500","$320","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993157668761726",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010002-06","Molina Marketplace Silver Plan","94% AV Level Silver Plan",,"0.9497309923172","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.992475038146159",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010003-00","Molina Marketplace Bronze Plan","Standard Bronze Off Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.992475038146159",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010003-01","Molina Marketplace Bronze Plan","Standard Bronze On Exchange Plan",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.992475038146159",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010003-02","Molina Marketplace Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.992475038146159",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010003-03","Molina Marketplace Bronze Plan","Limited Cost Sharing Plan Variation",,"0.619094729423523","Yes","Yes","No","100%",,"$6,650","$20","$240","$150","$2,420","$1,320","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-bronze-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010004","Molina Marketplace Options Silver Plan","18167UT001",,"UTN001","UTS001","UTF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993317493902859",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010004-00","Molina Marketplace Options Silver Plan","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010004","Molina Marketplace Options Silver Plan","18167UT001",,"UTN001","UTS001","UTF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993317493902859",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010004-01","Molina Marketplace Options Silver Plan","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$2,420","$600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010004","Molina Marketplace Options Silver Plan","18167UT001",,"UTN001","UTS001","UTF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993317493902859",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010004-02","Molina Marketplace Options Silver Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010004","Molina Marketplace Options Silver Plan","18167UT001",,"UTN001","UTS001","UTF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993317493902859",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010004-05","Molina Marketplace Options Silver Plan","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,010","$150","$700","$270","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010004","Molina Marketplace Options Silver Plan","18167UT001",,"UTN001","UTS001","UTF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993317493902859",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010004-06","Molina Marketplace Options Silver Plan","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010005","Molina Marketplace Options Bronze Plan","18167UT001",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.992689570528141",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010005-00","Molina Marketplace Options Bronze Plan","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010005","Molina Marketplace Options Bronze Plan","18167UT001",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.992689570528141",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010005-01","Molina Marketplace Options Bronze Plan","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010005","Molina Marketplace Options Bronze Plan","18167UT001",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.992689570528141",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010005-02","Molina Marketplace Options Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-zero-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","18167","SERFF","2016-11-18 20:15:51","Individual","No","33-0617992","18167UT0010005","Molina Marketplace Options Bronze Plan","18167UT001",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.992689570528141",,,"2017-01-01","2017-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/formulary-2017.pdf","18167UT0010005-03","Molina Marketplace Options Bronze Plan","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$0","$320","$150","$2,420","$0","$1,420","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2017.pdf","http://www.molinahealthcare.com/members/ut/en-US/PDF/Marketplace/brochure-2017.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0070001","Healthy Premier Bronze w/3 Copays before Deductible","42261UT007",,"UTN001","UTS001","UTF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070001-02","Healthy Premier Bronze w/3 Copays before Deductible","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","0","0","0","0","0","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"0","$0 per person","$0 per group",,,,"0","$0 per person","$0 per group","0","$0 per person","$0 per group","0","$0 per person","$0 per group","0%",,,,,"0","$0 per person","$0 per group","0","$0 per person","$0 per group","0","$0 per person","$0 per group","0%",,,,,"0","$0 per person","$0 per group","0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronzecopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronzecopayzero.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0070001","Healthy Premier Bronze w/3 Copays before Deductible","42261UT007",,"UTN001","UTS001","UTF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070001-03","Healthy Premier Bronze w/3 Copays before Deductible","Limited Cost Sharing Plan Variation",,"0.610696732997894","No","Yes","No","100%",,"5039","140","1971","60","1670","1085","3905","55","770","0","1155","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronzecopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronzecopaylimited.pdf"
"2017","UT","42757","SERFF","2016-08-23 04:37:23","Individual","Yes","95-6042390","42757UT0020004","BESTOne Plus High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020004-00","BESTOne Plus High","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTOne_Dental_Plus-High_Plan.pdf"
"2017","UT","42757","SERFF","2016-08-23 04:37:23","Individual","Yes","95-6042390","42757UT0020004","BESTOne Plus High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020004-01","BESTOne Plus High","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTOne_Dental_Plus-High_Plan.pdf"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0010001","EMI Health Choice PPO (High)","40335UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.5435","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0010001-00","EMI Health Choice PPO (High)","Standard High Off Exchange Plan","84.00%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0010001","EMI Health Choice PPO (High)","40335UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.5435","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0010001-01","EMI Health Choice PPO (High)","Standard High On Exchange Plan","84.00%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","42757","SERFF","2016-08-23 04:37:23","Individual","Yes","95-6042390","42757UT0020003","BESTOne Advantage High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020003-00","BESTOne Advantage High","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTOne_Dental_Advantage-High_Plan.pdf"
"2017","UT","42757","SERFF","2016-08-23 04:37:23","Individual","Yes","95-6042390","42757UT0020003","BESTOne Advantage High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020003-01","BESTOne Advantage High","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTOne_Dental_Advantage-High_Plan.pdf"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0020001","EMI Health Advantage Co-Pay","40335UT002",,"UTN002","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.7","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0020001-00","EMI Health Advantage Co-Pay","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0020001","EMI Health Advantage Co-Pay","40335UT002",,"UTN002","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.7","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0020001-01","EMI Health Advantage Co-Pay","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0020002","EMI Health Choice PPO","40335UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.5348","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0020002-00","EMI Health Choice PPO","Standard High Off Exchange Plan","84.00%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0020002","EMI Health Choice PPO","40335UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.5348","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0020002-01","EMI Health Choice PPO","Standard High On Exchange Plan","84.00%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0110001","EMI Health EHB Pediatric Plan – Advantage Network","40335UT011",,"UTN002","UTS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0110001-00","EMI Health EHB Pediatric Plan – Advantage Network","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0110001","EMI Health EHB Pediatric Plan – Advantage Network","40335UT011",,"UTN002","UTS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0110001-01","EMI Health EHB Pediatric Plan – Advantage Network","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0110002","EMI Health EHB Pediatric Plan – Premier Network","40335UT011",,"UTN001","UTS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0110002-00","EMI Health EHB Pediatric Plan – Premier Network","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","40335","SERFF","2016-08-23 04:37:23","Individual","Yes","20-4023720","40335UT0110002","EMI Health EHB Pediatric Plan – Premier Network","40335UT011",,"UTN001","UTS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0110002-01","EMI Health EHB Pediatric Plan – Premier Network","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0050003","Healthy Premier Bronze","42261UT005",,"UTN001","UTS002","UTF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050003-00","Healthy Premier Bronze","Standard Bronze Off Exchange Plan",,"0.603660583496094","No","Yes","No","100%",,"3000","0","4150","60","1732","0","5418","55","600","500","999","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","75%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","75%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronze.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- bronze.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0050003","Healthy Premier Bronze","42261UT005",,"UTN001","UTS002","UTF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050003-01","Healthy Premier Bronze","Standard Bronze On Exchange Plan",,"0.603660583496094","No","Yes","No","100%",,"3000","0","4150","60","1732","0","5418","55","600","500","999","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","75%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","75%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronze.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- bronze.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0050003","Healthy Premier Bronze","42261UT005",,"UTN001","UTS002","UTF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050003-02","Healthy Premier Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","0","0","0","0","0","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronzezero.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronzezero.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0050003","Healthy Premier Bronze","42261UT005",,"UTN001","UTS002","UTF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050003-03","Healthy Premier Bronze","Limited Cost Sharing Plan Variation",,"0.603660583496094","No","Yes","No","100%",,"3000","0","4150","60","1732","0","5418","55","600","500","999","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","75%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","75%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronzelimited.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronzelimited.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060001","Healthy Premier Gold Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060001-00","Healthy Premier Gold Copay","Standard Gold Off Exchange Plan",,"0.789600610733032","No","Yes","No","100%",,"1000","110","1240","60","1250","745","1082","55","874","620","48","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-goldcopay.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- goldcopay.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060001","Healthy Premier Gold Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060001-01","Healthy Premier Gold Copay","Standard Gold On Exchange Plan",,"0.789600610733032","No","Yes","No","100%",,"1000","110","1240","60","1250","745","1082","55","874","620","48","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-goldcopay.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- goldcopay.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060001","Healthy Premier Gold Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060001-02","Healthy Premier Gold Copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","0","0","0","0","0","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-goldcopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-goldcopayzero.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060001","Healthy Premier Gold Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060001-03","Healthy Premier Gold Copay","Limited Cost Sharing Plan Variation",,"0.789600610733032","No","Yes","No","100%",,"1000","110","1240","60","1250","745","1082","55","874","620","48","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-goldcopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-goldcopaylimited.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-00","Healthy Premier Silver Copay","Standard Silver Off Exchange Plan",,"0.681726932525635","No","Yes","No","100%",,"$3,500","$120","$3,530","$60","$1,776","$88","$1,454","$55","$674","$725","$145","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silvercopay.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- silvercopay.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-01","Healthy Premier Silver Copay","Standard Silver On Exchange Plan",,"0.681726932525635","No","Yes","No","100%",,"$3,500","$120","$3,530","$60","$1,776","$88","$1,454","$55","$674","$725","$145","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silvercopay.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- silvercopay.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-02","Healthy Premier Silver Copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silvercopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silvercopayzero.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-03","Healthy Premier Silver Copay","Limited Cost Sharing Plan Variation",,"0.681726932525635","No","Yes","No","100%",,"$3,500","$120","$3,530","$60","$1,776","$88","$1,454","$55","$674","$725","$145","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silvercopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silvercopaylimited.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-04","Healthy Premier Silver Copay","73% AV Level Silver Plan",,"0.729929804801941","No","Yes","No","100%",,"$2,700","$90","$2,910","$60","$1,796","$665","$1,454","$55","$777","$620","$145","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier- silvercsr73.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- silvercsr73.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-05","Healthy Premier Silver Copay","87% AV Level Silver Plan",,"0.866496384143829","No","Yes","No","100%",,"$400","$60","$1,890","$60","$550","$450","$1,003","$55","$400","$590","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier- silvercsr87.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- silvercsr87.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-06","Healthy Premier Silver Copay","94% AV Level Silver Plan",,"0.934730887413025","No","Yes","No","100%",,"$0","$12","$1,240","$60","$0","$113","$544","$55","$0","$530","$48","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silvercsr94.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- silvercsr94.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060003","Healthy Premier Bronze HSA","42261UT006",,"UTN001","UTS001","UTF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060003-00","Healthy Premier Bronze HSA","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronzehsa.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- bronzehsa.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060003","Healthy Premier Bronze HSA","42261UT006",,"UTN001","UTS001","UTF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060003-01","Healthy Premier Bronze HSA","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronzehsa.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- bronzehsa.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060003","Healthy Premier Bronze HSA","42261UT006",,"UTN001","UTS001","UTF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060003-02","Healthy Premier Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronzehsazero.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- bronzehsazero.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0060003","Healthy Premier Bronze HSA","42261UT006",,"UTN001","UTS001","UTF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060003-03","Healthy Premier Bronze HSA","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronzehsalimited.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronzehsalimited.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0070001","Healthy Premier Bronze w/3 Copays before Deductible","42261UT007",,"UTN001","UTS001","UTF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070001-00","Healthy Premier Bronze w/3 Copays before Deductible","Standard Bronze Off Exchange Plan",,"0.610696732997894","No","Yes","No","100%",,"5039","140","1971","60","1670","1085","3905","55","770","0","1155","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronze3copays.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- bronze3copays.pdf"
"2017","UT","42261","SERFF","2017-01-25 20:15:24","Individual","No","47-2293857","42261UT0070001","Healthy Premier Bronze w/3 Copays before Deductible","42261UT007",,"UTN001","UTS001","UTF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2017-01-01","2017-12-31","No","Urgent and Emergent Only","No","Urgent and Emergent Only","No","https://uhealthplan.trustcommerce.com/","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070001-01","Healthy Premier Bronze w/3 Copays before Deductible","Standard Bronze On Exchange Plan",,"0.610696732997894","No","Yes","No","100%",,"5039","140","1971","60","1670","1085","3905","55","770","0","1155","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronze3copays.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier- bronze3copays.pdf"
"2017","UT","42757","SERFF","2016-08-23 04:37:23","Individual","Yes","95-6042390","42757UT0020005","BESTOne Plus","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020005-00","BESTOne Plus","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTOne_Dental_Plus-Low_Plan.pdf"
"2017","UT","42757","SERFF","2016-08-23 04:37:23","Individual","Yes","95-6042390","42757UT0020005","BESTOne Plus","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020005-01","BESTOne Plus","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTOne_Dental_Plus-Low_Plan.pdf"
"2017","UT","42757","SERFF","2016-08-23 04:37:23","Individual","Yes","95-6042390","42757UT0020006","BESTOne Basic","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020006-00","BESTOne Basic","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTOne_Dental_Basic-Low_Plan.pdf"
"2017","UT","42757","SERFF","2016-08-23 04:37:23","Individual","Yes","95-6042390","42757UT0020006","BESTOne Basic","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020006-01","BESTOne Basic","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTOne_Dental_Basic-Low_Plan.pdf"
"2017","UT","71246","SERFF","2016-08-23 04:37:23","Individual","Yes","94-2761537","71246UT0030001","Delta Dental PPO Basic Plan for Families","71246UT003",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.57","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0030001-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0030001-17"
"2017","UT","71246","SERFF","2016-08-23 04:37:23","Individual","Yes","94-2761537","71246UT0040001","Delta Dental PPO Preferred Plan for Families","71246UT004",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.55","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0040001-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0040001-17"
"2017","UT","87169","SERFF","2016-08-23 04:37:23","Individual","Yes","47-0397286","87169UT0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","87169UT004",,"UTN001","UTS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.682","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0040001-00","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","UT","87169","SERFF","2016-08-23 04:37:23","Individual","Yes","47-0397286","87169UT0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","87169UT004",,"UTN001","UTS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.682","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/UT_EHB_High_2017","http://www.renaissancedental.com/UT_EHB_High_2017"
"2017","UT","87169","SERFF","2016-08-23 04:37:23","Individual","Yes","47-0397286","87169UT0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","87169UT004",,"UTN001","UTS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.83","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0040002-00","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","UT","87169","SERFF","2016-08-23 04:37:23","Individual","Yes","47-0397286","87169UT0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","87169UT004",,"UTN001","UTS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.83","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/UT_EHB_Low_2017","http://www.renaissancedental.com/UT_EHB_Low_2017"
"2017","UT","87169","SERFF","2016-08-23 04:37:23","Individual","Yes","47-0397286","87169UT0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","87169UT005",,"UTN001","UTS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0050001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","UT","87169","SERFF","2016-08-23 04:37:23","Individual","Yes","47-0397286","87169UT0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","87169UT005",,"UTN001","UTS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/UT_Ped_High_2017","http://www.renaissancedental.com/UT_Ped_High_2017"
"2017","UT","87169","SERFF","2016-08-23 04:37:23","Individual","Yes","47-0397286","87169UT0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","87169UT005",,"UTN001","UTS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0050002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","UT","87169","SERFF","2016-08-23 04:37:23","Individual","Yes","47-0397286","87169UT0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","87169UT005",,"UTN001","UTS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/UT_Ped_Low_2017","http://www.renaissancedental.com/UT_Ped_Low_2017"
"2017","VA","10207","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","52-1358219","10207VA0430003","BlueChoice HMO 1000","10207VA043",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998019757058502",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0430003-00","BlueChoice HMO 1000","Standard Gold Off Exchange Plan","81.05%",,"Yes","Yes","No","100%",,"$1,000","$15","$845","$30","$1,000","$360","$338","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/AHHVC77ARXCVCB7EN012017.pdf",
"2017","UT","46958","SERFF","2016-08-23 04:37:23","Individual","Yes","39-1263473","46958UT0470001","Humana Dental Smart Choice Basic","46958UT047",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Members can go to any in-network provider nationwide and receive the in-network level of benefits; however, if using out-of-network providers, the covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.  In-network providers are included in the nationwide network and should be used if at all possible.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","46958UT0470001-01","Humana Dental Smart Choice Basic","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$45","$45 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2857166"
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,500","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483460419864",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380011-04","BlueChoice HMO Silver $1,500 A","73% AV Level Silver Plan","73.75%",,"Yes","Yes","No","100%",,"$1,150","$500","$0","$30","$1,150","$0","$40","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$2300 per person","$2300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/AHHVCN6GRXCVCN6QN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,500","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483460419864",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380011-05","BlueChoice HMO Silver $1,500 B","87% AV Level Silver Plan","87.62%",,"Yes","Yes","No","100%",,"$0","$200","$0","$30","$0","$0","$244","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/AHAVCN6GRXXVCN6TN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,500","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483460419864",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380011-06","BlueChoice HMO Silver $1,500 C","94% AV Level Silver Plan","94.21%",,"Yes","Yes","No","100%",,"$0","$100","$0","$30","$0","$0","$244","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/AHAVCN6HRXXVCN6LN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF011","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996477338036996",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0400002-00","BlueChoice Plus Silver $2,500","Standard Silver Off Exchange Plan","71.00%",,"No","Yes","No","100%",,"$2,525","$500","$0","$30","$2,580","$390","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/ATNVBN6FRXXVBN6LN012017.pdf",
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020023","Select Value Preference Gold 1000 w/ no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF011","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020023-00","Select Value Preference Gold 1000 w/ no deductible for office visits","Standard Gold Off Exchange Plan",,"0.784771621227264","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$690","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1036","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_w/_no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I40A1036"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020023","Select Value Preference Gold 1000 w/ no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF011","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020023-01","Select Value Preference Gold 1000 w/ no deductible for office visits","Standard Gold On Exchange Plan",,"0.784771621227264","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$690","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1037","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_w/_no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I40A1037"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020023","Select Value Preference Gold 1000 w/ no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF011","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020023-02","Select Value Preference Gold 1000 w/ no deductible for office visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1038","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_w/_no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A1038"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020023","Select Value Preference Gold 1000 w/ no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF011","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020023-03","Select Value Preference Gold 1000 w/ no deductible for office visits","Limited Cost Sharing Plan Variation",,"0.784771621227264","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$690","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1039","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_w/_no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I40A1039"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/ no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF011","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-00","Select Med Preference Gold 1000 w/ no deductible for office visits","Standard Gold Off Exchange Plan",,"0.784771621227264","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$690","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0910","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_w/_no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I30A0910"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/ no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF011","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-01","Select Med Preference Gold 1000 w/ no deductible for office visits","Standard Gold On Exchange Plan",,"0.784771621227264","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$690","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0911","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_w/_no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I30A0911"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/ no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF011","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-02","Select Med Preference Gold 1000 w/ no deductible for office visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0912","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_w/_no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A0912"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/ no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF011","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-03","Select Med Preference Gold 1000 w/ no deductible for office visits","Limited Cost Sharing Plan Variation",,"0.784771621227264","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$690","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0913","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_w/_no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I30A0913"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020024","Select Value Preference Silver 1500","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-00","Select Value Preference Silver 1500","Standard Silver Off Exchange Plan",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1040","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1500&csr=standard_silver_off_exchange_plan&id=I40A1040"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020024","Select Value Preference Silver 1500","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-01","Select Value Preference Silver 1500","Standard Silver On Exchange Plan",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1041","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1500&csr=standard_silver_on_exchange_plan&id=I40A1041"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020024","Select Value Preference Silver 1500","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-02","Select Value Preference Silver 1500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1042","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1500&csr=zero_cost_sharing_plan_variation&id=I40A1042"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020024","Select Value Preference Silver 1500","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-03","Select Value Preference Silver 1500","Limited Cost Sharing Plan Variation",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1043","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1500&csr=limited_cost_sharing_plan_variation&id=I40A1043"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020024","Select Value Preference Silver 1500","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-04","Select Value Preference Silver 1500","73% AV Level Silver Plan",,"0.733925521373749","No","Yes","No","100%",,"$1,300","$20","$1,660","$150","$1,300","$720","$310","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1044","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1500&csr=73_av_level_silver_plan&id=I40A1044"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020024","Select Value Preference Silver 1500","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-05","Select Value Preference Silver 1500","87% AV Level Silver Plan",,"0.878862380981445","No","Yes","No","100%",,"$300","$20","$1,310","$150","$300","$750","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1045","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1500&csr=87_av_level_silver_plan&id=I40A1045"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020024","Select Value Preference Silver 1500","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-06","Select Value Preference Silver 1500","94% AV Level Silver Plan",,"0.942502677440643","No","Yes","No","100%",,"$100","$20","$340","$150","$100","$500","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1046","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1500&csr=94_av_level_silver_plan&id=I40A1046"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1500","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-00","Select Med Preference Silver 1500","Standard Silver Off Exchange Plan",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0903","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1500&csr=standard_silver_off_exchange_plan&id=I30A0903"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1500","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-01","Select Med Preference Silver 1500","Standard Silver On Exchange Plan",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0904","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1500&csr=standard_silver_on_exchange_plan&id=I30A0904"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1500","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-02","Select Med Preference Silver 1500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0905","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1500&csr=zero_cost_sharing_plan_variation&id=I30A0905"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1500","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-03","Select Med Preference Silver 1500","Limited Cost Sharing Plan Variation",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0906","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1500&csr=limited_cost_sharing_plan_variation&id=I30A0906"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1500","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-04","Select Med Preference Silver 1500","73% AV Level Silver Plan",,"0.733925521373749","No","Yes","No","100%",,"$1,300","$20","$1,660","$150","$1,300","$720","$310","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0907","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1500&csr=73_av_level_silver_plan&id=I30A0907"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1500","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-05","Select Med Preference Silver 1500","87% AV Level Silver Plan",,"0.878862380981445","No","Yes","No","100%",,"$300","$20","$1,310","$150","$300","$750","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0908","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1500&csr=87_av_level_silver_plan&id=I30A0908"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1500","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-06","Select Med Preference Silver 1500","94% AV Level Silver Plan",,"0.942502677440643","No","Yes","No","100%",,"$100","$20","$340","$150","$100","$500","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0909","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1500&csr=94_av_level_silver_plan&id=I30A0909"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020025","Select Value Preference Bronze 6350 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020025-00","Select Value Preference Bronze 6350 w/limited office visit waiver","Standard Bronze Off Exchange Plan",,"0.618003606796265","No","Yes","No","100%",,"$6,350","$20","$270","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1047","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_6350_w/_limited_office_visit_waiver&csr=standard_bronze_off_exchange_plan&id=I40A1047"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020025","Select Value Preference Bronze 6350 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020025-01","Select Value Preference Bronze 6350 w/limited office visit waiver","Standard Bronze On Exchange Plan",,"0.618003606796265","No","Yes","No","100%",,"$6,350","$20","$270","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1048","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_6350_w/_limited_office_visit_waiver&csr=standard_bronze_on_exchange_plan&id=I40A1048"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020025","Select Value Preference Bronze 6350 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020025-02","Select Value Preference Bronze 6350 w/limited office visit waiver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1049","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_6350_w/_limited_office_visit_waiver&csr=zero_cost_sharing_plan_variation&id=I40A1049"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020025","Select Value Preference Bronze 6350 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020025-03","Select Value Preference Bronze 6350 w/limited office visit waiver","Limited Cost Sharing Plan Variation",,"0.618003606796265","No","Yes","No","100%",,"$6,350","$20","$270","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1050","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_6350_w/_limited_office_visit_waiver&csr=limited_cost_sharing_plan_variation&id=I40A1050"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 6350 w/limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-00","Select Med Preference Bronze 6350 w/limited office visit waiver","Standard Bronze Off Exchange Plan",,"0.618003606796265","No","Yes","No","100%",,"$6,350","$20","$270","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0914","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_6350_w/_limited_office_visit_waiver&csr=standard_bronze_off_exchange_plan&id=I30A0914"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 6350 w/limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-01","Select Med Preference Bronze 6350 w/limited office visit waiver","Standard Bronze On Exchange Plan",,"0.618003606796265","No","Yes","No","100%",,"$6,350","$20","$270","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0915","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_6350_w/_limited_office_visit_waiver&csr=standard_bronze_on_exchange_plan&id=I30A0915"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 6350 w/limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-02","Select Med Preference Bronze 6350 w/limited office visit waiver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0916","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_6350_w/_limited_office_visit_waiver&csr=zero_cost_sharing_plan_variation&id=I30A0916"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 6350 w/limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-03","Select Med Preference Bronze 6350 w/limited office visit waiver","Limited Cost Sharing Plan Variation",,"0.618003606796265","No","Yes","No","100%",,"$6,350","$20","$270","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0917","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_6350_w/_limited_office_visit_waiver&csr=limited_cost_sharing_plan_variation&id=I30A0917"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020026","Select Value Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-00","Select Value Preference Silver 3800 Copay Plan","Standard Silver Off Exchange Plan",,"0.695206940174103","No","Yes","No","100%",,"$3,800","$570","$0","$150","$3,800","$380","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1051","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=standard_silver_off_exchange_plan&id=I40A1051"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020026","Select Value Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-01","Select Value Preference Silver 3800 Copay Plan","Standard Silver On Exchange Plan",,"0.695206940174103","No","Yes","No","100%",,"$3,800","$570","$0","$150","$3,800","$380","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1052","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=standard_silver_on_exchange_plan&id=I40A1052"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020026","Select Value Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-02","Select Value Preference Silver 3800 Copay Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1053","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=zero_cost_sharing_plan_variation&id=I40A1053"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020026","Select Value Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-03","Select Value Preference Silver 3800 Copay Plan","Limited Cost Sharing Plan Variation",,"0.695206940174103","No","Yes","No","100%",,"$3,800","$570","$0","$150","$3,800","$380","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1054","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=limited_cost_sharing_plan_variation&id=I40A1054"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020026","Select Value Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-04","Select Value Preference Silver 3800 Copay Plan","73% AV Level Silver Plan",,"0.735684990882874","No","Yes","No","100%",,"$3,500","$520","$0","$150","$3,500","$270","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1055","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=73_av_level_silver_plan&id=I40A1055"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020026","Select Value Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-05","Select Value Preference Silver 3800 Copay Plan","87% AV Level Silver Plan",,"0.873380541801453","No","Yes","No","100%",,"$350","$1,020","$30","$150","$350","$750","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1056","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=87_av_level_silver_plan&id=I40A1056"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020026","Select Value Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-06","Select Value Preference Silver 3800 Copay Plan","94% AV Level Silver Plan",,"0.933300316333771","No","Yes","No","100%",,"$100","$320","$10","$150","$100","$500","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1057","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=94_av_level_silver_plan&id=I40A1057"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN001","UTS001","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-00","Select Med Preference Silver 3800 Copay Plan","Standard Silver Off Exchange Plan",,"0.695206940174103","No","Yes","No","100%",,"$3,800","$570","$0","$150","$3,800","$380","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0918","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=standard_silver_off_exchange_plan&id=I30A0918"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN001","UTS001","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-01","Select Med Preference Silver 3800 Copay Plan","Standard Silver On Exchange Plan",,"0.695206940174103","No","Yes","No","100%",,"$3,800","$570","$0","$150","$3,800","$380","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0919","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=standard_silver_on_exchange_plan&id=I30A0919"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN001","UTS001","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-02","Select Med Preference Silver 3800 Copay Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0920","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=zero_cost_sharing_plan_variation&id=I30A0920"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN001","UTS001","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-03","Select Med Preference Silver 3800 Copay Plan","Limited Cost Sharing Plan Variation",,"0.695206940174103","No","Yes","No","100%",,"$3,800","$570","$0","$150","$3,800","$380","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0921","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=limited_cost_sharing_plan_variation&id=I30A0921"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN001","UTS001","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-04","Select Med Preference Silver 3800 Copay Plan","73% AV Level Silver Plan",,"0.735684990882874","No","Yes","No","100%",,"$3,500","$520","$0","$150","$3,500","$270","$90","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0922","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=73_av_level_silver_plan&id=I30A0922"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN001","UTS001","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-05","Select Med Preference Silver 3800 Copay Plan","87% AV Level Silver Plan",,"0.873380541801453","No","Yes","No","100%",,"$350","$1,020","$30","$150","$350","$750","$160","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0923","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=87_av_level_silver_plan&id=I30A0923"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN001","UTS001","UTF014","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-06","Select Med Preference Silver 3800 Copay Plan","94% AV Level Silver Plan",,"0.933300316333771","No","Yes","No","100%",,"$100","$320","$10","$150","$100","$500","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0924","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=94_av_level_silver_plan&id=I30A0924"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020027","Select Value HealthSave Bronze 5750 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF016","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020027-00","Select Value HealthSave Bronze 5750 (HSA Qualified)","Standard Bronze Off Exchange Plan",,"0.619816184043884","Yes","Yes","No","100%",,"5,750.00","20.00","450.00","150.00","5,270.00","$0","$0","80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","per person not applicable","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1058","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_5750_(hsa_qualified)&csr=standard_bronze_off_exchange_plan&id=I40A1058"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020027","Select Value HealthSave Bronze 5750 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF016","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020027-01","Select Value HealthSave Bronze 5750 (HSA Qualified)","Standard Bronze On Exchange Plan",,"0.619816184043884","Yes","Yes","No","100%",,"5,750.00","20.00","450.00","150.00","5,270.00","$0.00","$0.00","80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","per person not applicable","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1060","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_5750_(hsa_qualified)&csr=standard_bronze_on_exchange_plan&id=I40A1060"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020027","Select Value HealthSave Bronze 5750 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF016","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020027-02","Select Value HealthSave Bronze 5750 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1062","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_5750_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I40A1062"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020027","Select Value HealthSave Bronze 5750 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF016","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020027-03","Select Value HealthSave Bronze 5750 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.619816184043884","Yes","Yes","No","100%",,"5,750.00","20.00","450.00","150.00","5,270.00","$0.00","$0.00","80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","per person not applicable","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1064","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_5750_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I40A1064"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 5750 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF016","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-00","Select Med HealthSave Bronze 5750 (HSA Qualified)","Standard Bronze Off Exchange Plan",,"0.619816184043884","Yes","Yes","No","100%",,"5,750.00","20.00","450.00","150.00","5,270.00","$0","$0","80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","per person not applicable","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0925","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_5750_(hsa_qualified)&csr=standard_bronze_off_exchange_plan&id=I30A0925"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 5750 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF016","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-01","Select Med HealthSave Bronze 5750 (HSA Qualified)","Standard Bronze On Exchange Plan",,"0.619816184043884","Yes","Yes","No","100%",,"5,750.00","20.00","450.00","150.00","5,270.00","$0.00","$0.00","80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","per person not applicable","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0927","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_5750_(hsa_qualified)&csr=standard_bronze_on_exchange_plan&id=I30A0927"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 5750 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF016","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-02","Select Med HealthSave Bronze 5750 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0929","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_5750_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I30A0929"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 5750 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF016","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-03","Select Med HealthSave Bronze 5750 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.619816184043884","Yes","Yes","No","100%",,"5,750.00","20.00","450.00","150.00","5,270.00","$0.00","$0.00","80.00","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","per person not applicable","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0931","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_5750_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I30A0931"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-00","Select Value HealthSave Silver 2500 (HSA Qualified)","Standard Silver Off Exchange Plan",,"0.684252619743347","Yes","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$460","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1066","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2500_(hsa_qualified)&csr=standard_silver_off_exchange_plan&id=I40A1066"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-01","Select Value HealthSave Silver 2500 (HSA Qualified)","Standard Silver On Exchange Plan",,"0.684252619743347","Yes","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$460","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1068","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2500_(hsa_qualified)&csr=standard_silver_on_exchange_plan&id=I40A1068"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-02","Select Value HealthSave Silver 2500 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1070","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2500_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I40A1070"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-03","Select Value HealthSave Silver 2500 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.684252619743347","Yes","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$460","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1072","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2500_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I40A1072"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-04","Select Value HealthSave Silver 2500 (HSA Qualified)","73% AV Level Silver Plan",,"0.739049673080444","Yes","Yes","No","100%",,"$1,500","$20","$1,070","$150","$1,500","$620","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1074","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2500_(hsa_qualified)&csr=73_av_level_silver_plan&id=I40A1074"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-05","Select Value HealthSave Silver 2500 (not HSA Qualified)","87% AV Level Silver Plan",,"0.872231245040894","Yes","Yes","No","100%",,"$700","$0","$800","$150","$700","$460","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","per person not applicable","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1076","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2500_(not_hsa_qualified)&csr=87_av_level_silver_plan&id=I40A1076"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-06","Select Value HealthSave Silver 2500 (not HSA Qualified)","94% AV Level Silver Plan",,"0.932041466236115","Yes","Yes","No","100%",,"$250","$10","$330","$150","$250","$250","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1078","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2500_(not_hsa_qualified)&csr=94_av_level_silver_plan&id=I40A1078"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-00","Select Med HealthSave Silver 2500 (HSA Qualified)","Standard Silver Off Exchange Plan",,"0.684252619743347","Yes","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$460","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0937","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2500_(hsa_qualified)&csr=standard_silver_off_exchange_plan&id=I30A0937"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-01","Select Med HealthSave Silver 2500 (HSA Qualified)","Standard Silver On Exchange Plan",,"0.684252619743347","Yes","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$460","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0939","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2500_(hsa_qualified)&csr=standard_silver_on_exchange_plan&id=I30A0939"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-02","Select Med HealthSave Silver 2500 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0941","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2500_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I30A0941"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-03","Select Med HealthSave Silver 2500 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.684252619743347","Yes","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$460","$150","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0943","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2500_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I30A0943"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-04","Select Med HealthSave Silver 2500 (HSA Qualified)","73% AV Level Silver Plan",,"0.739049673080444","Yes","Yes","No","100%",,"$1,500","$20","$1,070","$150","$1,500","$620","$200","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0945","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2500_(hsa_qualified)&csr=73_av_level_silver_plan&id=I30A0945"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-05","Select Med HealthSave Silver 2500 (not HSA Qualified)","87% AV Level Silver Plan",,"0.872231245040894","Yes","Yes","No","100%",,"$700","$0","$800","$150","$700","$460","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","per person not applicable","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0947","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2500_(not_hsa_qualified)&csr=87_av_level_silver_plan&id=I30A0947"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 2500 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-06","Select Med HealthSave Silver 2500 (not HSA Qualified)","94% AV Level Silver Plan",,"0.932041466236115","Yes","Yes","No","100%",,"$250","$10","$330","$150","$250","$250","$50","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0949","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2500_(not_hsa_qualified)&csr=94_av_level_silver_plan&id=I30A0949"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130006","Select Value Preference Benchmark Silver 1500","68781UT013",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130006-00","Select Value Preference Benchmark Silver 1500","Standard Silver Off Exchange Plan",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1084","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1500&csr=standard_silver_off_exchange_plan&id=I40A1084"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130006","Select Value Preference Benchmark Silver 1500","68781UT013",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130006-01","Select Value Preference Benchmark Silver 1500","Standard Silver On Exchange Plan",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1085","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1500&csr=standard_silver_on_exchange_plan&id=I40A1085"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130006","Select Value Preference Benchmark Silver 1500","68781UT013",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130006-02","Select Value Preference Benchmark Silver 1500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1086","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1500&csr=zero_cost_sharing_plan_variation&id=I40A1086"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130006","Select Value Preference Benchmark Silver 1500","68781UT013",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130006-03","Select Value Preference Benchmark Silver 1500","Limited Cost Sharing Plan Variation",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1087","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1500&csr=limited_cost_sharing_plan_variation&id=I40A1087"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130006","Select Value Preference Benchmark Silver 1500","68781UT013",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130006-04","Select Value Preference Benchmark Silver 1500","73% AV Level Silver Plan",,"0.733925521373749","No","Yes","No","100%",,"$1,300","$20","$1,660","$150","$1,300","$720","$310","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1088","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1500&csr=73_av_level_silver_plan&id=I40A1088"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130006","Select Value Preference Benchmark Silver 1500","68781UT013",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130006-05","Select Value Preference Benchmark Silver 1500","87% AV Level Silver Plan",,"0.878167390823364","No","Yes","No","100%",,"$300","$20","$1,310","$150","$300","$750","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1089","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1500&csr=87_av_level_silver_plan&id=I40A1089"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130006","Select Value Preference Benchmark Silver 1500","68781UT013",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130006-06","Select Value Preference Benchmark Silver 1500","94% AV Level Silver Plan",,"0.942502677440643","No","Yes","No","100%",,"$100","$20","$340","$150","$100","$500","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1090","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1500&csr=94_av_level_silver_plan&id=I40A1090"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1500","68781UT013",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-00","Select Med Preference Benchmark Silver 1500","Standard Silver Off Exchange Plan",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0951","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1500&csr=standard_silver_off_exchange_plan&id=I30A0951"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1500","68781UT013",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-01","Select Med Preference Benchmark Silver 1500","Standard Silver On Exchange Plan",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0952","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1500&csr=standard_silver_on_exchange_plan&id=I30A0952"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1500","68781UT013",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-02","Select Med Preference Benchmark Silver 1500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0953","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1500&csr=zero_cost_sharing_plan_variation&id=I30A0953"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1500","68781UT013",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-03","Select Med Preference Benchmark Silver 1500","Limited Cost Sharing Plan Variation",,"0.696612954139709","No","Yes","No","100%",,"$1,500","$20","$2,670","$150","$1,500","$670","$500","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0954","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1500&csr=limited_cost_sharing_plan_variation&id=I30A0954"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1500","68781UT013",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-04","Select Med Preference Benchmark Silver 1500","73% AV Level Silver Plan",,"0.733925521373749","No","Yes","No","100%",,"$1,300","$20","$1,660","$150","$1,300","$720","$310","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0955","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1500&csr=73_av_level_silver_plan&id=I30A0955"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1500","68781UT013",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-05","Select Med Preference Benchmark Silver 1500","87% AV Level Silver Plan",,"0.878167390823364","No","Yes","No","100%",,"$300","$20","$1,310","$150","$300","$750","$210","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0956","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1500&csr=87_av_level_silver_plan&id=I30A0956"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1500","68781UT013",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-06","Select Med Preference Benchmark Silver 1500","94% AV Level Silver Plan",,"0.942502677440643","No","Yes","No","100%",,"$100","$20","$340","$150","$100","$500","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0957","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1500&csr=94_av_level_silver_plan&id=I30A0957"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130011","Select Value Preference Benchmark Bronze 5700","68781UT013",,"UTN002","UTS002","UTF018","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130011-00","Select Value Preference Benchmark Bronze 5700","Standard Bronze Off Exchange Plan",,"0.604438900947571","No","Yes","No","100%",,"$5,700","$20","$470","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1091","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_bronze_5700&csr=standard_bronze_off_exchange_plan&id=I40A1091"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130011","Select Value Preference Benchmark Bronze 5700","68781UT013",,"UTN002","UTS002","UTF018","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130011-01","Select Value Preference Benchmark Bronze 5700","Standard Bronze On Exchange Plan",,"0.604438900947571","No","Yes","No","100%",,"$5,700","$20","$470","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1092","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_bronze_5700&csr=standard_bronze_on_exchange_plan&id=I40A1092"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130011","Select Value Preference Benchmark Bronze 5700","68781UT013",,"UTN002","UTS002","UTF018","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130011-02","Select Value Preference Benchmark Bronze 5700","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1093","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_bronze_5700&csr=zero_cost_sharing_plan_variation&id=I40A1093"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130011","Select Value Preference Benchmark Bronze 5700","68781UT013",,"UTN002","UTS002","UTF018","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130011-03","Select Value Preference Benchmark Bronze 5700","Limited Cost Sharing Plan Variation",,"0.604438900947571","No","Yes","No","100%",,"$5,700","$20","$470","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1094","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_bronze_5700&csr=limited_cost_sharing_plan_variation&id=I40A1094"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5700","68781UT013",,"UTN001","UTS001","UTF018","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-00","Select Med Preference Benchmark Bronze 5700","Standard Bronze Off Exchange Plan",,"0.604438900947571","No","Yes","No","100%",,"$5,700","$20","$470","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0958","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_bronze_5700&csr=standard_bronze_off_exchange_plan&id=I30A0958"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5700","68781UT013",,"UTN001","UTS001","UTF018","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-01","Select Med Preference Benchmark Bronze 5700","Standard Bronze On Exchange Plan",,"0.604438900947571","No","Yes","No","100%",,"$5,700","$20","$470","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0959","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_bronze_5700&csr=standard_bronze_on_exchange_plan&id=I30A0959"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5700","68781UT013",,"UTN001","UTS001","UTF018","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-02","Select Med Preference Benchmark Bronze 5700","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0960","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_bronze_5700&csr=zero_cost_sharing_plan_variation&id=I30A0960"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5700","68781UT013",,"UTN001","UTS001","UTF018","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-03","Select Med Preference Benchmark Bronze 5700","Limited Cost Sharing Plan Variation",,"0.604438900947571","No","Yes","No","100%",,"$5,700","$20","$470","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0961","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_bronze_5700&csr=limited_cost_sharing_plan_variation&id=I30A0961"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020031","Select Value Millennial 7150 (Catastrophic Plan","68781UT002",,"UTN002","UTS002","UTF021","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020031-00","Select Value Millennial 7150 (Catastrophic Plan","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1080","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_millennial_7150_(catastrophic_plan&csr=standard_catastrophic_off_exchange_plan&id=I40A1080"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020031","Select Value Millennial 7150 (Catastrophic Plan","68781UT002",,"UTN002","UTS002","UTF021","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020031-01","Select Value Millennial 7150 (Catastrophic Plan","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1082","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_millennial_7150_(catastrophic_plan&csr=standard_catastrophic_on_exchange_plan&id=I40A1082"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020019","Select Med Millennial 7150 (Catastrophic Plan)","68781UT002",,"UTN001","UTS001","UTF021","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020019-00","Select Med Millennial 7150 (Catastrophic Plan)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0933","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_millennial_7150_(catastrophic_plan)&csr=standard_catastrophic_off_exchange_plan&id=I30A0933"
"2017","UT","68781","SERFF","2016-08-23 04:37:23","Individual","No","87-0409820","68781UT0020019","Select Med Millennial 7150 (Catastrophic Plan)","68781UT002",,"UTN001","UTS001","UTF021","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2017-01-01","2017-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020019-01","Select Med Millennial 7150 (Catastrophic Plan)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0935","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_millennial_7150_(catastrophic_plan)&csr=standard_catastrophic_on_exchange_plan&id=I30A0935"
"2017","UT","68809","SERFF","2016-08-23 04:37:23","Individual","Yes","91-1857813","68809UT0010009","Premier Choice","68809UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.56","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is allowed outside of the Service Area.","Yes","http://www.premierlife.com/payment","","68809UT0010009-00","Premier Choice","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/prospective-members/hbex","https://www.premierlife.com/prospective-members/hbex"
"2017","UT","68809","SERFF","2016-08-23 04:37:23","Individual","Yes","91-1857813","68809UT0010009","Premier Choice","68809UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.56","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is allowed outside of the Service Area.","Yes","http://www.premierlife.com/payment","","68809UT0010009-01","Premier Choice","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/prospective-members/hbex","https://www.premierlife.com/prospective-members/hbex"
"2017","UT","71246","SERFF","2016-08-23 04:37:23","Individual","Yes","94-2761537","71246UT0010002","Delta Dental PPO Pediatric Preferred Plan","71246UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010002-17"
"2017","UT","71246","SERFF","2016-08-23 04:37:23","Individual","Yes","94-2761537","71246UT0010001","Delta Dental PPO Pediatric Basic Plan","71246UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010001-17"
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483425422718",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380001-00","BlueChoice HMO Silver $3,500","Standard Silver Off Exchange Plan","69.32%",,"No","Yes","No","100%",,"$3,525","$500","$0","$30","$1,500","$390","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHNVCN6ERXXVCN6NN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483425422718",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380001-01","BlueChoice HMO Silver $3,500","Standard Silver On Exchange Plan","69.32%",,"No","Yes","No","100%",,"$3,525","$500","$0","$30","$1,500","$390","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHNVCN6ERXXVCN6NN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","52-1358219","10207VA0430003","BlueChoice HMO 1000","10207VA043",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998019757058502",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0430003-01","BlueChoice HMO 1000","Standard Gold On Exchange Plan","81.05%",,"Yes","Yes","No","100%",,"$1,000","$15","$845","$30","$1,000","$360","$338","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/AHHVC77ARXCVCB7EN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483425422718",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380001-02","BlueChoice HMO Silver $3,500 NA0","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHAVCN6MRXXVCN65N012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","52-1358219","10207VA0430006","BlueChoice HMO HSA/HRA 2000","10207VA043",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998019841687628",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0430006-00","BlueChoice HMO HSA/HRA 2000","Standard Silver Off Exchange Plan","71.13%",,"Yes","Yes","No","100%",,"$2,000","$515","$0","$30","$2,000","$400","$210","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://content.carefirst.com/sbc/AHHVC76ARXCVCC6AN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","52-1358219","10207VA0430006","BlueChoice HMO HSA/HRA 2000","10207VA043",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998019841687628",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0430006-01","BlueChoice HMO HSA/HRA 2000","Standard Silver On Exchange Plan","71.13%",,"Yes","Yes","No","100%",,"$2,000","$515","$0","$30","$2,000","$400","$210","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://content.carefirst.com/sbc/AHHVC76ARXCVCC6AN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483425422718",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380001-03","BlueChoice HMO Silver $3,500 NAL","Limited Cost Sharing Plan Variation","69.32%",,"No","Yes","No","100%",,"$3,525","$500","$0","$30","$1,500","$390","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHNVCN6HRXXVCN6NN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483425422718",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380001-04","BlueChoice HMO Silver $3,500 A","73% AV Level Silver Plan","73.83%",,"No","Yes","No","100%",,"$1,525","$500","$0","$30","$1,500","$390","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHNVCN6GRXXVCN6SN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","52-1358219","10207VA0440004","BlueChoice Advantage 90%/70%","10207VA044",,"VAN002","VAS001","VAF008","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998019785492215",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0440004-00","BlueChoice Advantage 90%/70%","Standard Platinum Off Exchange Plan","90.13%",,"Yes","Yes","No","100%",,"$0","$15","$523","$30","$0","$400","$233","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/AAVVB78ARXXVBB8CN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","SHOP (Small Group)","No","52-1358219","10207VA0440004","BlueChoice Advantage 90%/70%","10207VA044",,"VAN002","VAS001","VAF008","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998019785492215",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0440004-01","BlueChoice Advantage 90%/70%","Standard Platinum On Exchange Plan","90.13%",,"Yes","Yes","No","100%",,"$0","$15","$523","$30","$0","$400","$233","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/AAVVB78ARXXVBB8CN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483425422718",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380001-05","BlueChoice HMO Silver $3,500 B","87% AV Level Silver Plan","87.96%",,"No","Yes","No","100%",,"$0","$215","$0","$30","$0","$400","$244","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHAVCN6KRXXVCN6QN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483425422718",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380001-06","BlueChoice HMO Silver $3,500 C","94% AV Level Silver Plan","94.69%",,"No","Yes","No","100%",,"$0","$100","$0","$30","$0","$0","$244","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHAVCN6LRXXVCN6PN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN002","VAS001","VAF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996473810174952",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380003-00","HealthyBlue HMO Gold $1,000","Standard Gold Off Exchange Plan","79.16%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HENVCN7ERXXVCN7LN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN002","VAS001","VAF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996473810174952",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380003-01","HealthyBlue HMO Gold $1,000","Standard Gold On Exchange Plan","79.16%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HENVCN7ERXXVCN7LN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN002","VAS001","VAF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996473810174952",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380003-02","HealthyBlue HMO Gold $1,000 NA0","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HENVCN7HRXXVCN71N012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN002","VAS001","VAF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996473810174952",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380003-03","HealthyBlue HMO Gold $1,000 NAL","Limited Cost Sharing Plan Variation","79.16%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HENVCN7FRXXVCN7LN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,500","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483460419864",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380011-00","BlueChoice HMO HSA Silver $1,500","Standard Silver Off Exchange Plan","71.31%",,"Yes","Yes","No","100%",,"$1,500","$515","$0","$30","$1,500","$475","$184","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://content.carefirst.com/sbc/AHHVCN6FRXCVCN6PN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,500","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483460419864",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380011-01","BlueChoice HMO HSA Silver $1,500","Standard Silver On Exchange Plan","71.31%",,"Yes","Yes","No","100%",,"$1,500","$515","$0","$30","$1,500","$475","$184","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://content.carefirst.com/sbc/AHHVCN6ERXCVCN6PN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,500","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483460419864",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380011-02","BlueChoice HMO Silver $1,500 NA0","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://content.carefirst.com/sbc/AHAVCN6JRXXVCN65N012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,500","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996483460419864",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380011-03","BlueChoice HMO Silver $1,500 NAL","Limited Cost Sharing Plan Variation","71.31%",,"Yes","Yes","No","100%",,"$1,500","$515","$0","$30","$1,500","$475","$184","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/AHHVCN6HRXCVCN6RN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF011","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996477338036996",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0400002-01","BlueChoice Plus Silver $2,500","Standard Silver On Exchange Plan","71.00%",,"No","Yes","No","100%",,"$2,525","$500","$0","$30","$2,580","$390","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/ATNVBN6ERXXVBN6LN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF011","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996477338036996",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0400002-02","BlueChoice Plus Silver $2,500 NA0","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/ATPVBN6FRXXVBN65N012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF011","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996477338036996",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0400002-03","BlueChoice Plus Silver $2,500 NAL","Limited Cost Sharing Plan Variation","71.00%",,"No","Yes","No","100%",,"$2,525","$500","$0","$30","$2,580","$390","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/ATNVBN6GRXXVBN6LN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF011","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996477338036996",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0400002-04","BlueChoice Plus Silver $2,500 A","73% AV Level Silver Plan","73.48%",,"No","Yes","No","100%",,"$1,725","$500","$0","$30","$1,950","$420","$106","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/ATNVBN6HRXXVBN6QN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF011","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996477338036996",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0400002-05","BlueChoice Plus Silver $2,500 B","87% AV Level Silver Plan","86.97%",,"No","Yes","No","100%",,"$0","$215","$0","$30","$0","$480","$244","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/ATPVBN6DRXXVBN6NN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF011","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996477338036996",,,"2017-01-01","2017-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","10207VA0400002-06","BlueChoice Plus Silver $2,500 C","94% AV Level Silver Plan","93.75%",,"No","Yes","No","100%",,"$0","$100","$0","$30","$0","$0","$244","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/ATPVBN6ERXXVBN6MN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380004","BlueChoice HMO Young Adult $7,150","10207VA038",,"VAN003","VAS001","VAF010","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996468137533584",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380004-00","BlueChoice HMO Young Adult $7,150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$4,230","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/AHHVCN9HRXCVCN9MN012017.pdf",
"2017","VA","10207","SERFF","2017-01-23 20:15:25","Individual","No","52-1358219","10207VA0380004","BlueChoice HMO Young Adult $7,150","10207VA038",,"VAN003","VAS001","VAF010","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996468137533584",,,"2017-01-01","2017-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"http://www.carefirst.com/acarx","10207VA0380004-01","BlueChoice HMO Young Adult $7,150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$4,230","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/AHHVCN9HRXCVCN9MN012017.pdf",
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120007","Innovation Health Leap Catastrophic","12028VA012",,"VAN001","VAS001","VAF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120007-00","Innovation Health Leap Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719591_Off.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120007","Innovation Health Leap Catastrophic","12028VA012",,"VAN001","VAS001","VAF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120007-01","Innovation Health Leap Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719591_On.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120028","Innovation Health Leap Bronze","12028VA012",,"VAN001","VAS001","VAF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120028-00","Innovation Health Leap Bronze","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719590_Off.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120028","Innovation Health Leap Bronze","12028VA012",,"VAN001","VAS001","VAF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120028-01","Innovation Health Leap Bronze","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719590_On.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120028","Innovation Health Leap Bronze","12028VA012",,"VAN001","VAS001","VAF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120028-02","Innovation Health Leap Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719590_AIAN0.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120028","Innovation Health Leap Bronze","12028VA012",,"VAN001","VAS001","VAF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120028-03","Innovation Health Leap Bronze","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719590_AIANLTD.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120015-00","Innovation Health Leap Silver Basic","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_718710_Off.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120015-01","Innovation Health Leap Silver Basic","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_718710_On.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120015-02","Innovation Health Leap Silver Basic","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_718710_AIAN0.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120015-03","Innovation Health Leap Silver Basic","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_718710_AIANLTD.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120015-04","Innovation Health Leap Silver Basic","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_718710_CSR73.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120015-05","Innovation Health Leap Silver Basic","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_718710_CSR87.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120015-06","Innovation Health Leap Silver Basic","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_718710_CSR94.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120030","Innovation Health Leap Silver Diabetes","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120030-00","Innovation Health Leap Silver Diabetes","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719604_Off.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120030","Innovation Health Leap Silver Diabetes","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120030-01","Innovation Health Leap Silver Diabetes","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719604_On.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120030","Innovation Health Leap Silver Diabetes","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120030-02","Innovation Health Leap Silver Diabetes","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719604_AIAN0.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120030","Innovation Health Leap Silver Diabetes","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120030-03","Innovation Health Leap Silver Diabetes","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719604_AIANLTD.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120030","Innovation Health Leap Silver Diabetes","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120030-04","Innovation Health Leap Silver Diabetes","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719604_CSR73.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120030","Innovation Health Leap Silver Diabetes","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120030-05","Innovation Health Leap Silver Diabetes","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719604_CSR87.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120030","Innovation Health Leap Silver Diabetes","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120030-06","Innovation Health Leap Silver Diabetes","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719604_CSR94.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120031","Innovation Health Leap Silver Healthy Minds","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120031-00","Innovation Health Leap Silver Healthy Minds","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719600_Off.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120031","Innovation Health Leap Silver Healthy Minds","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120031-01","Innovation Health Leap Silver Healthy Minds","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719600_On.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120031","Innovation Health Leap Silver Healthy Minds","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120031-02","Innovation Health Leap Silver Healthy Minds","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719600_AIAN0.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120031","Innovation Health Leap Silver Healthy Minds","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120031-03","Innovation Health Leap Silver Healthy Minds","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719600_AIANLTD.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120031","Innovation Health Leap Silver Healthy Minds","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120031-04","Innovation Health Leap Silver Healthy Minds","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719600_CSR73.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120031","Innovation Health Leap Silver Healthy Minds","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120031-05","Innovation Health Leap Silver Healthy Minds","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719600_CSR87.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120031","Innovation Health Leap Silver Healthy Minds","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120031-06","Innovation Health Leap Silver Healthy Minds","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719600_CSR94.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120027-00","Innovation Health Leap Silver Plus","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719594_Off.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120027-01","Innovation Health Leap Silver Plus","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719594_On.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120027-02","Innovation Health Leap Silver Plus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719594_AIAN0.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120027-03","Innovation Health Leap Silver Plus","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719594_AIANLTD.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120027-04","Innovation Health Leap Silver Plus","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719594_CSR73.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120027-05","Innovation Health Leap Silver Plus","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719594_CSR87.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120027-06","Innovation Health Leap Silver Plus","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719594_CSR94.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120029","Innovation Health Leap Gold Diabetes","12028VA012",,"VAN001","VAS001","VAF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120029-00","Innovation Health Leap Gold Diabetes","Standard Gold Off Exchange Plan","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719608_Off.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120029","Innovation Health Leap Gold Diabetes","12028VA012",,"VAN001","VAS001","VAF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120029-01","Innovation Health Leap Gold Diabetes","Standard Gold On Exchange Plan","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719608_On.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120029","Innovation Health Leap Gold Diabetes","12028VA012",,"VAN001","VAS001","VAF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120029-02","Innovation Health Leap Gold Diabetes","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719608_AIAN0.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","12028","SERFF","2016-08-21 07:17:17","Individual","No","46-0674828","12028VA0120029","Innovation Health Leap Gold Diabetes","12028VA012",,"VAN001","VAS001","VAF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","0.9959",,,"2017-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5853257683","12028VA0120029-03","Innovation Health Leap Gold Diabetes","Limited Cost Sharing Plan Variation","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_719608_AIANLTD.pdf","http://www.innovation-health.com/individuals-families-planbrochure-2017/"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130031","Gold Preferred 950/35/60","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","15668VA0130031-00","Gold Preferred 950/35/60","Standard Gold Off Exchange Plan",,"0.782465398311615","No","Yes","No","100%",,"$950","$20","$1,000","$200","$400","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","20.00%",,,,,"$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130031-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130031","Gold Preferred 950/35/60","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","15668VA0130031-01","Gold Preferred 950/35/60","Standard Gold On Exchange Plan",,"0.782465398311615","No","Yes","No","100%",,"$950","$20","$1,000","$200","$400","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","20.00%",,,,,"$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130031-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130031","Gold Preferred 950/35/60","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","15668VA0130031-02","Gold Preferred 950/35/60 Native American Zero Cost share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130031-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130048","Silver Standard 3500/30/65","15668VA013","7205839435","VAN001","VAS001","VAF009","New","PPO","Silver","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130048-02","Silver Standard 3500/30/65 Native American Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/15668va0130048-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130047","Silver Basic 2450","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130047-02","Silver Basic 2450 Native American Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130047","Silver Basic 2450","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130047-03","Silver Basic 2450 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.688062191009521","No","Yes","No","100%",,"$2,450","$20","$1,000","$200","$1,100","$1,600","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","30.00%",,,,,"$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20 M","20507VA117","7487657612","VAN001","VAS001","VAF013","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170002-01","OptimaFit Silver 4000 20 M","Standard Silver On Exchange Plan",,"0.681871116161346","No","Yes","No","100%",,"$4,000","$30","$600","$0","$300","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2310|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130048","Silver Standard 3500/30/65","15668VA013","7205839435","VAN001","VAS001","VAF009","New","PPO","Silver","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130048-03","Silver Standard 3500/30/65 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$200","$200","$2,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130048-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20 M","20507VA117","7487657612","VAN001","VAS001","VAF013","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170002-05","OptimaFit Gold 600 M","87% AV Level Silver Plan",,"0.861194133758545","No","Yes","No","100%",,"$600","$30","$700","$0","$80","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2315|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP3.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20 M","20507VA117","7487657612","VAN001","VAS001","VAF013","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170002-06","OptimaFit Platinum 150 M","94% AV Level Silver Plan",,"0.931139826774597","No","Yes","No","100%",,"$200","$20","$700","$0","$80","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2317|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP3.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20 M","20507VA117","7487657612","VAN001","VAS001","VAF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170006-00","OptimaFit Silver 2600 25 20","Standard Silver Off Exchange Plan","70.87%","0.687921464443207","No","Yes","No","100%",,"$2,600","$30","$900","$0","$500","$800","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2339|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20 M","20507VA117","7487657612","VAN001","VAS001","VAF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170006-01","OptimaFit Silver 2600 25 20 M","Standard Silver On Exchange Plan","70.87%","0.687921464443207","No","Yes","No","100%",,"$2,600","$30","$900","$0","$500","$800","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2311|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20 M","20507VA117","7487657612","VAN001","VAS001","VAF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170006-02","OptimaFit Silver 2600 25 20 ZCS","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2321|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20 M","20507VA117","7487657612","VAN001","VAS001","VAF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170006-03","OptimaFit Silver 2600 25 20 LCS","Limited Cost Sharing Plan Variation","70.87%","0.687921464443207","No","Yes","No","100%",,"$2,600","$30","$900","$0","$500","$800","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2325|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130031","Gold Preferred 950/35/60","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","15668VA0130031-03","Gold Preferred 950/35/60 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.782465398311615","No","Yes","No","100%",,"$950","$20","$1,000","$200","$400","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","20.00%",,,,,"$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130031-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130033","Gold Preferred 1250/35/50","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130033-00","Gold Preferred 1250/35/50","Standard Gold Off Exchange Plan",,"0.78126722574234","No","Yes","No","100%",,"$1,250","$20","$900","$200","$300","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"$9,300","$9300 per person","$18600 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25.00%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130033-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130033","Gold Preferred 1250/35/50","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130033-01","Gold Preferred 1250/35/50","Standard Gold On Exchange Plan",,"0.78126722574234","No","Yes","No","100%",,"$1,250","$20","$900","$200","$300","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"$9,300","$9300 per person","$18600 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25.00%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130033-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130033","Gold Preferred 1250/35/50","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130033-02","Gold Preferred 1250/35/50 Native American Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130033-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130033","Gold Preferred 1250/35/50","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130033-03","Gold Preferred 1250/35/50 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.78126722574234","No","Yes","No","100%",,"$1,250","$20","$900","$200","$300","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"$9,300","$9300 per person","$18600 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25.00%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130033-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2900/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130035-00","Silver Preferred 2900/40/60","Standard Silver Off Exchange Plan",,"0.695790588855743","No","Yes","No","100%",,"$2,900","$20","$600","$200","$400","$2,100","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2900/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130035-01","Silver Preferred 2900/40/60","Standard Silver On Exchange Plan",,"0.695790588855743","No","Yes","No","100%",,"$2,900","$20","$600","$200","$400","$2,100","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2900/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130035-02","Silver Preferred 2900/40/60 Native American Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2900/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130035-03","Silver Preferred 2900/40/60 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.695790588855743","No","Yes","No","100%",,"$2,900","$20","$600","$200","$400","$2,100","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2900/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130035-04","Silver Preferred 2900/40/60 (CSR 73%)","73% AV Level Silver Plan",,"0.721522271633148","No","Yes","No","100%",,"$2,900","$20","$600","$200","$400","$2,100","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-04-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2900/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130035-05","Silver Preferred 2900/40/60 (CSR 87%)","87% AV Level Silver Plan",,"0.860393822193146","No","Yes","No","100%",,"$700","$20","$730","$200","$300","$1,150","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-05-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2900/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130035-06","Silver Preferred 2900/40/60 (CSR 94%)","94% AV Level Silver Plan",,"0.930972933769226","No","Yes","No","100%",,"$400","$0","$350","$200","$250","$400","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-06-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3800/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130037-00","Silver Preferred 3800/40/60","Standard Silver Off Exchange Plan",,"0.688324213027954","No","Yes","No","100%",,"$3,800","$20","$400","$200","$400","$2,000","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3800/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130037-01","Silver Preferred 3800/40/60","Standard Silver On Exchange Plan",,"0.688324213027954","No","Yes","No","100%",,"$3,800","$20","$400","$200","$400","$2,000","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3800/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130037-02","Silver Preferred 3800/40/60 Native American Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3800/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130037-03","Silver Preferred 3800/40/60 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.688324213027954","No","Yes","No","100%",,"$3,800","$20","$400","$200","$400","$2,000","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3800/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130037-04","Silver Preferred 3800/40/60 (CSR 73%)","73% AV Level Silver Plan",,"0.721522271633148","No","Yes","No","100%",,"$2,900","$20","$600","$200","$400","$2,000","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-04-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3800/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130037-05","Silver Preferred 3800/40/60 (CSR 87%)","87% AV Level Silver Plan",,"0.860393822193146","No","Yes","No","100%",,"$700","$20","$730","$200","$400","$1,050","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-05-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3800/40/60","15668VA013","7205839435","VAN001","VAS001","VAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130037-06","Silver Preferred 3800/40/60 (CSR 94%)","94% AV Level Silver Plan",,"0.930972933769226","No","Yes","No","100%",,"$400","$20","$330","$200","$250","$500","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20.00%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","35.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-06-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130047","Silver Basic 2450","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130047-00","Silver Basic 2450","Standard Silver Off Exchange Plan",,"0.688062191009521","No","Yes","No","100%",,"$2,450","$20","$1,000","$200","$1,100","$1,600","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","30.00%",,,,,"$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130047","Silver Basic 2450","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130047-01","Silver Basic 2450","Standard Silver On Exchange Plan",,"0.688062191009521","No","Yes","No","100%",,"$2,450","$20","$1,000","$200","$1,100","$1,600","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","30.00%",,,,,"$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130047","Silver Basic 2450","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130047-04","Silver Basic 2450 (CSR 73%)","73% AV Level Silver Plan",,"0.721163988113403","No","Yes","No","100%",,"$2,450","$20","$1,000","$200","$1,100","$1,600","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","30.00%",,,,,"$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-04-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130047","Silver Basic 2450","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130047-05","Silver Basic 2450 (CSR 87%)","87% AV Level Silver Plan",,"0.860987961292267","No","Yes","No","100%",,"$700","$0","$700","$200","$700","$700","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","30.00%",,,,,"$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-05-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130047","Silver Basic 2450","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130047-06","Silver Basic 2450 (CSR 94%)","94% AV Level Silver Plan",,"0.930107772350311","No","Yes","No","100%",,"$250","$0","$350","$200","$250","$400","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-06-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130048","Silver Standard 3500/30/65","15668VA013","7205839435","VAN001","VAS001","VAF009","New","PPO","Silver","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130048-00","Silver Standard 3500/30/65","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$200","$200","$2,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130048-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130048","Silver Standard 3500/30/65","15668VA013","7205839435","VAN001","VAS001","VAF009","New","PPO","Silver","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130048-01","Silver Standard 3500/30/65","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$200","$200","$2,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130048-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130048","Silver Standard 3500/30/65","15668VA013","7205839435","VAN001","VAS001","VAF009","New","PPO","Silver","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130048-04","Silver Standard 3500/30/65 (CSR 73%)","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$600","$200","$200","$2,400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130048-04-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130048","Silver Standard 3500/30/65","15668VA013","7205839435","VAN001","VAS001","VAF009","New","PPO","Silver","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130048-05","Silver Standard 3500/30/65 (CSR 87%)","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$1,000","$200","$200","$1,300","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130048-05-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130048","Silver Standard 3500/30/65","15668VA013","7205839435","VAN001","VAS001","VAF009","New","PPO","Silver","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130048-06","Silver Standard 3500/30/65 (CSR 94%)","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$10","$300","$200","$200","$500","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130048-06-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130039","Bronze 5250","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130039-00","Bronze 5250","Standard Bronze Off Exchange Plan",,"0.618677973747253","Yes","Yes","No","100%",,"$5,250","$10","$300","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130039-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130039","Bronze 5250","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130039-01","Bronze 5250","Standard Bronze On Exchange Plan",,"0.618677973747253","Yes","Yes","No","100%",,"$5,250","$10","$300","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130039-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130039","Bronze 5250","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130039-02","Bronze 5250 Native American Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/15668va0130039-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130039","Bronze 5250","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130039-03","Bronze 5250 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.618677973747253","Yes","Yes","No","100%",,"$5,250","$10","$300","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130039-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130041","Bronze 6200","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130041-00","Bronze 6200","Standard Bronze Off Exchange Plan",,"0.614609777927399","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130041-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130041","Bronze 6200","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130041-01","Bronze 6200","Standard Bronze On Exchange Plan",,"0.614609777927399","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130041-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130041","Bronze 6200","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130041-02","Bronze 6200 Native American Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/15668va0130041-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130041","Bronze 6200","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130041-03","Bronze 6200 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.614609777927399","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130041-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130043","Bronze HSA 5000","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130043-00","Bronze HSA 5000","Standard Bronze Off Exchange Plan",,"0.6186403632164","Yes","Yes","No","100%",,"$5,000","$10","$600","$200","$5,000","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130043-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130043","Bronze HSA 5000","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130043-01","Bronze HSA 5000","Standard Bronze On Exchange Plan",,"0.61880099773407","Yes","Yes","No","100%",,"$5,000","$10","$600","$200","$5,000","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130043-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130043","Bronze HSA 5000","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130043-02","Bronze HSA 5000 Native American Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/15668va0130043-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130043","Bronze HSA 5000","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130043-03","Bronze HSA 5000 Native American Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.61880099773407","Yes","Yes","No","100%",,"$5,000","$10","$600","$200","$5,000","$100","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130043-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130045","Bronze HSA 6000","15668VA013","7205839435","VAN001","VAS001","VAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130045-00","Bronze HSA 6000","Standard Bronze Off Exchange Plan",,"0.614096581935883","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130045-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130045","Bronze HSA 6000","15668VA013","7205839435","VAN001","VAS001","VAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130045-01","Bronze HSA 6000","Standard Bronze On Exchange Plan",,"0.614096581935883","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130045-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130045","Bronze HSA 6000","15668VA013","7205839435","VAN001","VAS001","VAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130045-02","Bronze HSA 6000 Native American Zero Cost share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/15668va0130045-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130045","Bronze HSA 6000","15668VA013","7205839435","VAN001","VAS001","VAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130045-03","Bronze HSA 6000 Native American Limited Cost share","Limited Cost Sharing Plan Variation",,"0.614096581935883","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,200","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130045-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130029","Catastrophic 7150","15668VA013","7205839435","VAN001","VAS001","VAF008","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130029-00","Catastrophic 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$120","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130029-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130029","Catastrophic 7150","15668VA013","7205839435","VAN001","VAS001","VAF008","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130029-01","Catastrophic 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$120","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130029-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130050","Bronze Standard 6650","15668VA013","7205839435","VAN001","VAS001","VAF010","New","PPO","Bronze","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130050-00","Bronze Standard 6650","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,700","$30","$0","$200","$3,800","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130050-00-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130050","Bronze Standard 6650","15668VA013","7205839435","VAN001","VAS001","VAF010","New","PPO","Bronze","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130050-01","Bronze Standard 6650","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,700","$30","$0","$200","$3,800","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130050-01-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130050","Bronze Standard 6650","15668VA013","7205839435","VAN001","VAS001","VAF010","New","PPO","Bronze","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130050-02","Bronze Standard 6650","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/15668va0130050-02-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","15668","SERFF","2016-11-14 20:15:42","Individual","No","31-1592932","15668VA0130050","Bronze Standard 6650","15668VA013","7205839435","VAN001","VAS001","VAF010","New","PPO","Bronze","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-ppo-2017.html","15668VA0130050-03","Bronze Standard 6650","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$5,700","$30","$0","$200","$3,800","$1,100","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$28,600","$28600 per person","$57200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130050-03-2017.html","http://www.pchp.net/index.php/plan-brochure-ppo-2017.html"
"2017","VA","16064","SERFF","2016-08-21 07:17:17","Individual","Yes","54-0357120","16064VA1270005","Anthem Dental Family Value","16064VA127",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1270005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214305.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","54-0357120","16064VA1240003","Anthem Dental Family","16064VA124",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1240003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214303.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","54-0357120","16064VA1300003","Anthem Dental Family","16064VA130",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1300003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214303.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","Individual","Yes","54-0357120","16064VA1330005","Anthem Dental Family Value","16064VA133",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1330005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214305.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","Individual","Yes","54-0357120","16064VA1270003","Anthem Dental Family","16064VA127",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1270003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214303.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","54-0357120","16064VA1240004","Anthem Dental Family Enhanced","16064VA124",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $1,000",,"No","Allows Adult and Child-Only",,,,,"0.846","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1240004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214304.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","SHOP (Small Group)","Yes","54-0357120","16064VA1300004","Anthem Dental Family Enhanced","16064VA130",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $1,000",,"No","Allows Adult and Child-Only",,,,,"0.846","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1300004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214304.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","Individual","Yes","54-0357120","16064VA1330003","Anthem Dental Family","16064VA133",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1330003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214303.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","Individual","Yes","54-0357120","16064VA1270004","Anthem Dental Family Enhanced","16064VA127",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $1,000",,"No","Allows Adult and Child-Only",,,,,"0.846","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1270004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214304.pdf",
"2017","VA","16064","SERFF","2016-08-21 07:17:17","Individual","Yes","54-0357120","16064VA1330004","Anthem Dental Family Enhanced","16064VA133",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $1,000",,"No","Allows Adult and Child-Only",,,,,"0.846","Guaranteed Rate","2017-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1330004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214304.pdf",
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170001","OptimaFit Gold 1000 M","20507VA117","7487657612","VAN001","VAS001","VAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170001-00","OptimaFit Gold 1000","Standard Gold Off Exchange Plan",,"0.780394315719604","No","Yes","No","100%",,"$1,000","$30","$600","$0","$200","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2337|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170001","OptimaFit Gold 1000 M","20507VA117","7487657612","VAN001","VAS001","VAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170001-01","OptimaFit Gold 1000 M","Standard Gold On Exchange Plan",,"0.780394315719604","No","Yes","No","100%",,"$1,000","$30","$600","$0","$200","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2309|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170001","OptimaFit Gold 1000 M","20507VA117","7487657612","VAN001","VAS001","VAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170001-02","OptimaFit Gold 1000 ZCS","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2319|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170001","OptimaFit Gold 1000 M","20507VA117","7487657612","VAN001","VAS001","VAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170001-03","OptimaFit Gold 1000 LCS","Limited Cost Sharing Plan Variation",,"0.780394315719604","No","Yes","No","100%",,"$1,000","$30","$600","$0","$200","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2323|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20 M","20507VA117","7487657612","VAN001","VAS001","VAF013","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170002-00","OptimaFit Silver 4000 20","Standard Silver Off Exchange Plan",,"0.681871116161346","No","Yes","No","100%",,"$4,000","$30","$600","$0","$300","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2341|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20 M","20507VA117","7487657612","VAN001","VAS001","VAF013","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170002-02","OptimaFit Silver 4000 20 ZCS","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2320|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20 M","20507VA117","7487657612","VAN001","VAS001","VAF013","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170002-03","OptimaFit Silver 4000 20 LCS","Limited Cost Sharing Plan Variation",,"0.681871116161346","No","Yes","No","100%",,"$4,000","$30","$600","$0","$300","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2324|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20 M","20507VA117","7487657612","VAN001","VAS001","VAF013","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170002-04","OptimaFit Silver 2500 M","73% AV Level Silver Plan",,"0.737321496009827","No","Yes","No","100%",,"$2,500","$30","$900","$0","$80","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2313|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP3.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20 M","20507VA117","7487657612","VAN001","VAS001","VAF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170006-04","OptimaFit Silver 2000 25 M","73% AV Level Silver Plan","73.70%","0.736424267292023","No","Yes","No","100%",,"$2,000","$30","$1,000","$0","$400","$800","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2314|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP3.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20 M","20507VA117","7487657612","VAN001","VAS001","VAF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170006-05","OptimaFit Gold 800 20 M","87% AV Level Silver Plan","86.05%","0.859118640422821","No","Yes","No","100%",,"$800","$30","$600","$0","$400","$800","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2316|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP3.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20 M","20507VA117","7487657612","VAN001","VAS001","VAF014","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170006-06","OptimaFit Platinum 200 10 M","94% AV Level Silver Plan","93.01%","0.929910004138947","No","Yes","No","100%",,"$200","$20","$700","$150","$200","$500","$120","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2318|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP3.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170021","OptimaFit Bronze 6850 30 M","20507VA117","7487657612","VAN001","VAS001","VAF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170021-00","OptimaFit Bronze 6850 30","Standard Bronze Off Exchange Plan",,"0.601719379425049","No","Yes","No","100%",,"$6,900","$20","$60","$0","$800","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2343|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170021","OptimaFit Bronze 6850 30 M","20507VA117","7487657612","VAN001","VAS001","VAF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170021-01","OptimaFit Bronze 6850 30 M","Standard Bronze On Exchange Plan",,"0.601719379425049","No","Yes","No","100%",,"$6,900","$20","$60","$0","$800","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2312|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170021","OptimaFit Bronze 6850 30 M","20507VA117","7487657612","VAN001","VAS001","VAF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170021-02","OptimaFit Bronze 6850 30 ZCS","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2322|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170021","OptimaFit Bronze 6850 30 M","20507VA117","7487657612","VAN001","VAS001","VAF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170021-03","OptimaFit Bronze 6850 30 LCS","Limited Cost Sharing Plan Variation",,"0.601719379425049","No","Yes","No","100%",,"$6,900","$20","$60","$0","$800","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2326|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170011","OptimaFit Gold 1000 M Select","20507VA117","7487657612","VAN002","VAS002","VAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9967",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170011-00","OptimaFit Gold 1000 Select","Standard Gold Off Exchange Plan",,"0.780394315719604","No","Yes","No","100%",,"$1,000","$30","$600","$0","$80","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2327|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1SelectHR.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170011","OptimaFit Gold 1000 M Select","20507VA117","7487657612","VAN002","VAS002","VAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9967",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170011-01","OptimaFit Gold 1000 M Select","Standard Gold On Exchange Plan",,"0.780394315719604","No","Yes","No","100%",,"$1,000","$30","$600","$0","$80","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2327|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1SelectHR.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170011","OptimaFit Gold 1000 M Select","20507VA117","7487657612","VAN002","VAS002","VAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9967",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170011-02","OptimaFit Gold 1000 Select ZCS","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2331|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1SelectHR.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170011","OptimaFit Gold 1000 M Select","20507VA117","7487657612","VAN002","VAS002","VAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9967",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170011-03","OptimaFit Gold 1000 Select LCS","Limited Cost Sharing Plan Variation",,"0.780394315719604","No","Yes","No","100%",,"$1,000","$30","$600","$0","$80","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2332|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1SelectHR.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170028","OptimaFit Bronze 6850 30 M Select","20507VA117","7487657612","VAN002","VAS002","VAF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170028-00","OptimaFit Bronze 6850 30 Select","Standard Bronze Off Exchange Plan",,"0.601719379425049","No","Yes","No","100%",,"$6,900","$20","$60","$0","$800","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2334|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1SelectHR.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170028","OptimaFit Bronze 6850 30 M Select","20507VA117","7487657612","VAN002","VAS002","VAF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170028-01","OptimaFit Bronze 6850 30 M Select","Standard Bronze On Exchange Plan",,"0.601719379425049","No","Yes","No","100%",,"$6,900","$20","$60","$0","$800","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2334|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1SelectHR.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170028","OptimaFit Bronze 6850 30 M Select","20507VA117","7487657612","VAN002","VAS002","VAF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170028-02","OptimaFit Bronze 6850 30 Select ZCS","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2330|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1SelectHR.aspx"
"2017","VA","20507","SERFF","2017-03-15 12:23:29","Individual","No","54-1283337","20507VA1170028","OptimaFit Bronze 6850 30 M Select","20507VA117","7487657612","VAN002","VAS002","VAF008","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9957",,,"2017-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierClosedSGformulary.pdf","20507VA1170028-03","OptimaFit Bronze 6850 30 Select LCS","Limited Cost Sharing Plan Variation",,"0.601719379425049","No","Yes","No","100%",,"$6,900","$20","$60","$0","$800","$800","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=2329|False|1","http://www.optimahealth.com/exchange/pages/012017HIXBrochureIFP1SelectHR.aspx"
"2017","VA","24832","SERFF","2016-08-21 07:17:17","Individual","Yes","47-0397286","24832VA0020003","Renaissance Individual Dental PPO, EHB Certified","24832VA002",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","24832VA0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","24832","SERFF","2016-08-21 07:17:17","Individual","Yes","47-0397286","24832VA0020004","Renaissance Individual Dental PPO, EHB Certified","24832VA002",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","24832VA0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","24832","SERFF","2016-08-21 07:17:17","Individual","Yes","47-0397286","24832VA0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","24832VA004",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/24832","","24832VA0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/VA_EHB_High_2017","http://www.renaissancedental.com/VA_EHB_High_2017"
"2017","VA","24832","SERFF","2016-08-21 07:17:17","Individual","Yes","47-0397286","24832VA0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","24832VA004",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/24832","","24832VA0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/VA_EHB_Low_2017","http://www.renaissancedental.com/VA_EHB_Low_2017"
"2017","VA","24832","SERFF","2016-08-21 07:17:17","Individual","Yes","47-0397286","24832VA0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","24832VA005",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/24832","","24832VA0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/VA_Ped_High_2017","http://www.renaissancedental.com/VA_Ped_High_2017"
"2017","VA","24832","SERFF","2016-08-21 07:17:17","Individual","Yes","47-0397286","24832VA0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","24832VA005",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/24832","","24832VA0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/VA_Ped_Low_2017","http://www.renaissancedental.com/VA_Ped_Low_2017"
"2017","VA","24832","SERFF","2016-08-21 07:17:17","Individual","Yes","47-0397286","24832VA0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","24832VA006",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","24832VA0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","24832","SERFF","2016-08-21 07:17:17","Individual","Yes","47-0397286","24832VA0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","24832VA006",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","24832VA0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","Individual","Yes","54-0844477","31319VA0010004","Delta Dental Individual and Family Basic plus Major Plan","31319VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010004-00","Delta Dental Individual and Family Basic plus Major Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plus_Major_Plan.pdf",
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020011","Delta Dental Exchange Certified Pediatric Dental Plan - Basic","31319VA002",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020011-00","Delta Dental Exchange Certified Pediatric Dental Plan - Basic","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","Individual","Yes","54-0844477","31319VA0010004","Delta Dental Individual and Family Basic plus Major Plan","31319VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010004-01","Delta Dental Individual and Family Basic plus Major Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plus_Major_Plan.pdf",
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020012","Delta Dental Exchange Certified Pediatric Dental Plan - Basic","31319VA002",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020012-00","Delta Dental Exchange Certified Pediatric Dental Plan - Basic","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","Individual","Yes","54-0844477","31319VA0010003","Delta Dental Individual and Family Basic Plan","31319VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010003-00","Delta Dental Individual and Family Basic Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plan.pdf",
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020013","Delta Dental Exchange Certified Pediatric Dental Plan - Preferred","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020013-00","Delta Dental Exchange Certified Pediatric Dental Plan - Preferred","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020014","Delta Dental Exchange Certified Pediatric Dental Plan - Preferred","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020014-00","Delta Dental Exchange Certified Pediatric Dental Plan - Preferred","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","Individual","Yes","54-0844477","31319VA0010003","Delta Dental Individual and Family Basic Plan","31319VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010003-01","Delta Dental Individual and Family Basic Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plan.pdf",
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010005","Silver Basic 2500 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010005-00","Silver Basic 2500 HMO","Standard Silver Off Exchange Plan",,"0.685112655162811","No","Yes","No","100%",,"$2,500","$20","$1,000","$200","$1,100","$1,200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010005","Silver Basic 2500 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010005-01","Silver Basic 2500 HMO","Standard Silver On Exchange Plan",,"0.685112655162811","No","Yes","No","100%",,"$2,500","$20","$1,000","$200","$1,100","$1,200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010005","Silver Basic 2500 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010005-02","Silver Basic 2500 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010005","Silver Basic 2500 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010005-03","Silver Basic 2500 HMO","Limited Cost Sharing Plan Variation",,"0.685112655162811","No","Yes","No","100%",,"$2,500","$20","$1,000","$200","$1,100","$1,200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020015","Delta Dental Small Group Family Exchange Dental Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020015-00","Delta Dental Small Group Family Exchange Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020016","Delta Dental Small Group Family Exchange Dental Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020016-00","Delta Dental Small Group Family Exchange Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020017","Delta Dental Small Group Family Exchange Dental Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020017-00","Delta Dental Small Group Family Exchange Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020018","Delta Dental Small Group Family Exchange Dental Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020018-00","Delta Dental Small Group Family Exchange Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020019","Delta Dental Exchange Certified Pediatric Dental Benefit Amendment Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020019-00","Delta Dental Exchange Certified Pediatric Dental Benefit Amendment Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","31319","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","54-0844477","31319VA0020020","Delta Dental Exchange Certified Pediatric Dental Benefit Amendment Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020020-00","Delta Dental Exchange Certified Pediatric Dental Benefit Amendment Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","35801","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","35801VA0040002","EHB High PPO","35801VA004",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","35801VA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","VA","35801","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","35801VA0040001","EHB Low PPO","35801VA004",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","35801VA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","VA","35801","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","35801VA0030002","EHB High Passive","35801VA003",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","35801VA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010011","Silver Standard 3500/30/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010011-00","Silver Standard 3500/30/65 HMO","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$200","$200","$2,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010011-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010011","Silver Standard 3500/30/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010011-01","Silver Standard 3500/30/65 HMO","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$200","$200","$2,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010011-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010011","Silver Standard 3500/30/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010011-02","Silver Standard 3500/30/65 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0010011-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010011","Silver Standard 3500/30/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010011-03","Silver Standard 3500/30/65 HMO","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$500","$200","$200","$2,600","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010011-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","35801","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","93-0242990","35801VA0030001","EHB Low Passive","35801VA003",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","35801VA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010001","Gold Preferred 950/30/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010001-00","Gold Preferred 950/30/50 HMO","Standard Gold Off Exchange Plan",,"0.783630549907684","No","Yes","No","100%",,"$950","$20","$1,000","$200","$400","$1,700","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010001-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010001","Gold Preferred 950/30/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010001-01","Gold Preferred 950/30/50 HMO","Standard Gold On Exchange Plan",,"0.783630549907684","No","Yes","No","100%",,"$950","$20","$1,000","$200","$400","$1,700","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010001-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010001","Gold Preferred 950/30/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010001-02","Gold Preferred 950/30/50 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010001-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010001","Gold Preferred 950/30/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010001-03","Gold Preferred 950/30/50 HMO","Limited Cost Sharing Plan Variation",,"0.783630549907684","No","Yes","No","100%",,"$950","$20","$1,000","$200","$400","$1,700","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010001-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010002","Gold Preferred 1200/25/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010002-00","Gold Preferred 1200/25/50 HMO","Standard Gold Off Exchange Plan",,"0.781887829303741","No","Yes","No","100%",,"$1,200","$20","$900","$200","$400","$1,700","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010002-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010002","Gold Preferred 1200/25/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010002-01","Gold Preferred 1200/25/50 HMO","Standard Gold On Exchange Plan",,"0.781887829303741","No","Yes","No","100%",,"$1,200","$20","$900","$200","$400","$1,700","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010002-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010002","Gold Preferred 1200/25/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010002-02","Gold Preferred 1200/25/50 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010002-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010002","Gold Preferred 1200/25/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010002-03","Gold Preferred 1200/25/50 HMO","Limited Cost Sharing Plan Variation",,"0.781887829303741","No","Yes","No","100%",,"$1,200","$20","$900","$200","$400","$1,700","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010002-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010003","Silver Preferred 3200/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010003-00","Silver Preferred 3200/35/60 HMO","Standard Silver Off Exchange Plan",,"0.688875794410706","No","Yes","No","100%",,"$3,200","$20","$500","$200","$400","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010003","Silver Preferred 3200/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010003-01","Silver Preferred 3200/35/60 HMO","Standard Silver On Exchange Plan",,"0.688875794410706","No","Yes","No","100%",,"$3,200","$20","$500","$200","$400","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010003","Silver Preferred 3200/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010003-02","Silver Preferred 3200/35/60 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010003","Silver Preferred 3200/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010003-03","Silver Preferred 3200/35/60 HMO","Limited Cost Sharing Plan Variation",,"0.688875794410706","No","Yes","No","100%",,"$3,200","$20","$500","$200","$400","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010003","Silver Preferred 3200/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010003-04","Silver Preferred 3200/35/60 HMO","73% AV Level Silver Plan",,"0.720369040966034","No","Yes","No","100%",,"$3,000","$20","$500","$200","$400","$1,800","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-04-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010003","Silver Preferred 3200/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010003-05","Silver Preferred 3200/35/60 HMO","87% AV Level Silver Plan",,"0.861007511615753","No","Yes","No","100%",,"$1,150","$0","$550","$200","$400","$1,300","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-05-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010003","Silver Preferred 3200/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010003-06","Silver Preferred 3200/35/60 HMO","94% AV Level Silver Plan",,"0.93038409948349","No","Yes","No","100%",,"$400","$0","$350","$200","$400","$350","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-06-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3800/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010004-00","Silver Preferred 3800/40/65 HMO","Standard Silver Off Exchange Plan",,"0.685968518257141","No","Yes","No","100%",,"$3,800","$20","$400","$200","$400","$1,900","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3800/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010004-01","Silver Preferred 3800/40/65 HMO","Standard Silver On Exchange Plan",,"0.685968518257141","No","Yes","No","100%",,"$3,800","$20","$400","$200","$400","$1,900","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3800/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010004-02","Silver Preferred 3800/40/65 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3800/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010004-03","Silver Preferred 3800/40/65 HMO","Limited Cost Sharing Plan Variation",,"0.685968518257141","No","Yes","No","100%",,"$3,800","$20","$400","$200","$400","$1,900","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3800/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010004-04","Silver Preferred 3800/40/65 HMO","73% AV Level Silver Plan",,"0.720369040966034","No","Yes","No","100%",,"$3,000","$20","$600","$200","$400","$1,900","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-04-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3800/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010004-05","Silver Preferred 3800/40/65 HMO","87% AV Level Silver Plan",,"0.861007511615753","No","Yes","No","100%",,"$1,150","$0","$550","$200","$400","$1,300","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-05-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3800/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010004-06","Silver Preferred 3800/40/65 HMO","94% AV Level Silver Plan",,"0.93038409948349","No","Yes","No","100%",,"$400","$0","$350","$200","$400","$350","$0","$80","$0","$0","$0","$0","$375","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-06-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010005","Silver Basic 2500 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010005-04","Silver Basic 2500 HMO","73% AV Level Silver Plan",,"0.720434427261353","No","Yes","No","100%",,"$2,400","$20","$1,000","$200","$1,100","$1,200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-04-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010005","Silver Basic 2500 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010005-05","Silver Basic 2500 HMO","87% AV Level Silver Plan",,"0.861151933670044","No","Yes","No","100%",,"$700","$0","$700","$200","$700","$700","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-05-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010005","Silver Basic 2500 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010005-06","Silver Basic 2500 HMO","94% AV Level Silver Plan",,"0.930107772350311","No","Yes","No","100%",,"$250","$0","$350","$200","$250","$350","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-06-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010011","Silver Standard 3500/30/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010011-04","Silver Standard 3500/30/65 HMO","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$600","$200","$200","$2,400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010011-04-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010011","Silver Standard 3500/30/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010011-05","Silver Standard 3500/30/65 HMO","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$0","$1,300","$200","$200","$1,400","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010011-05-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010011","Silver Standard 3500/30/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010011-06","Silver Standard 3500/30/65 HMO","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$0","$1,000","$200","$200","$1,050","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010011-06-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010006","Bronze 5250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010006-00","Bronze 5250 HMO","Standard Bronze Off Exchange Plan",,"0.618677973747253","Yes","Yes","No","100%",,"$5,250","$0","$20","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010006-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010006","Bronze 5250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010006-01","Bronze 5250 HMO","Standard Bronze On Exchange Plan",,"0.618677973747253","Yes","Yes","No","100%",,"$5,250","$0","$20","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010006-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010006","Bronze 5250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010006-02","Bronze 5250 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0010006-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010006","Bronze 5250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010006-03","Bronze 5250 HMO","Limited Cost Sharing Plan Variation",,"0.618677973747253","Yes","Yes","No","100%",,"$5,250","$0","$20","$200","$4,900","$200","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010006-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010007","Bronze 6200 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010007-00","Bronze 6200 HMO","Standard Bronze Off Exchange Plan",,"0.614609777927399","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$140","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010007-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010007","Bronze 6200 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010007-01","Bronze 6200 HMO","Standard Bronze On Exchange Plan",,"0.614609777927399","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$140","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010007-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010007","Bronze 6200 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010007-02","Bronze 6200 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0010007-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010007","Bronze 6200 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010007-03","Bronze 6200 HMO","Limited Cost Sharing Plan Variation",,"0.614609777927399","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$140","$0","$80","$0","$0","$0","$0","$375","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010007-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010008","Catastrophic 7150 HMO","37204VA001","7407850644","VAN001","VAS001","VAF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010008-00","Catastrophic 7150 HMO","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$120","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010008-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010008","Catastrophic 7150 HMO","37204VA001","7407850644","VAN001","VAS001","VAF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010008-01","Catastrophic 7150 HMO","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,900","$120","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010008-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010009","Bronze HSA 5000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010009-00","Bronze HSA 5000 HMO","Standard Bronze Off Exchange Plan",,"0.61880099773407","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$30","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010009-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010009","Bronze HSA 5000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010009-01","Bronze HSA 5000 HMO","Standard Bronze On Exchange Plan",,"0.61880099773407","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$30","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010009-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010009","Bronze HSA 5000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010009-02","Bronze HSA 5000 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0010009-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010009","Bronze HSA 5000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010009-03","Bronze HSA 5000 HMO","Limited Cost Sharing Plan Variation",,"0.61880099773407","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$30","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010009-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010010","Bronze HSA 6000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010010-00","Bronze HSA 6000 HMO","Standard Bronze Off Exchange Plan",,"0.614096581935883","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010010-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010010","Bronze HSA 6000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010010-01","Bronze HSA 6000 HMO","Standard Bronze On Exchange Plan",,"0.614096581935883","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010010-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010010","Bronze HSA 6000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010010-02","Bronze HSA 6000 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0010010-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010010","Bronze HSA 6000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010010-03","Bronze HSA 6000 HMO","Limited Cost Sharing Plan Variation",,"0.614096581935883","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,100","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010010-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010012","Bronze Standard 6650 HMO","37204VA001","7407850644","VAN001","VAS001","VAF008","New","HMO","Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010012-00","Bronze Standard 6650 HMO","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,700","$30","$0","$200","$3,800","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010012-00-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010012","Bronze Standard 6650 HMO","37204VA001","7407850644","VAN001","VAS001","VAF008","New","HMO","Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010012-01","Bronze Standard 6650 HMO","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$5,700","$30","$0","$200","$3,800","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010012-01-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010012","Bronze Standard 6650 HMO","37204VA001","7407850644","VAN001","VAS001","VAF008","New","HMO","Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010012-02","Bronze Standard 6650 HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0010012-02-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","37204","SERFF","2016-11-14 20:15:42","Individual","No","47-3163409","37204VA0010012","Bronze Standard 6650 HMO","37204VA001","7407850644","VAN001","VAS001","VAF008","New","HMO","Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Diabetes","0.9992",,,"2017-01-01","2017-12-31","No",,"No",,"No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2017.html","37204VA0010012-03","Bronze Standard 6650 HMO","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$5,700","$30","$0","$200","$3,800","$1,200","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010012-03-2017.html","http://www.pchp.net/index.php/plan-brochure-hmo-2017.html"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040003","UHC Compass HSA Silver 2800","38599VA004",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040003-00","UHC Compass HSA Silver 2800","Standard Silver Off Exchange Plan","68.70%",,"Yes","Yes","No","100%",,"$2,800","$1,500","$0","$200","$2,800","$700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","per person not applicable","$5600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0503&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040003","UHC Compass HSA Silver 2800","38599VA004",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040003-01","UHC Compass HSA Silver 2800","Standard Silver On Exchange Plan","68.70%",,"Yes","Yes","No","100%",,"$2,800","$1,500","$0","$200","$2,800","$700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","per person not applicable","$5600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0503&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040003","UHC Compass HSA Silver 2800","38599VA004",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040003-02","UHC Compass HSA Silver 2800","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0504&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040003","UHC Compass HSA Silver 2800","38599VA004",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040003-03","UHC Compass HSA Silver 2800","Limited Cost Sharing Plan Variation","68.70%",,"Yes","Yes","No","100%",,"$2,800","$1,500","$0","$200","$2,800","$700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","per person not applicable","$5600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0505&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040003","UHC Compass HSA Silver 2800","38599VA004",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040003-04","UHC Compass HSA Silver 2800","73% AV Level Silver Plan","72.40%",,"Yes","Yes","No","100%",,"$2,100","$1,500","$0","$200","$2,100","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","per person not applicable","$4200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0506&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040003","UHC Compass HSA Silver 2800","38599VA004",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040003-05","UHC Compass HSA Silver 2800","87% AV Level Silver Plan","86.80%",,"Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","per person not applicable","$1100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0507&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040003","UHC Compass HSA Silver 2800","38599VA004",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040003-06","UHC Compass HSA Silver 2800","94% AV Level Silver Plan","94.00%",,"Yes","Yes","No","100%",,"$0","$800","$0","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0508&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040005","UHC Compass HSA Bronze 6550","38599VA004",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040005-00","UHC Compass HSA Bronze 6550","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0515&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040005","UHC Compass HSA Bronze 6550","38599VA004",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040005-01","UHC Compass HSA Bronze 6550","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0515&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040005","UHC Compass HSA Bronze 6550","38599VA004",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040005-02","UHC Compass HSA Bronze 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0516&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040005","UHC Compass HSA Bronze 6550","38599VA004",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040005-03","UHC Compass HSA Bronze 6550","Limited Cost Sharing Plan Variation",,"0.612314343452454","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0517&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040002","UHC Compass Gold 1000","38599VA004",,"VAN001","VAS002","VAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040002-00","UHC Compass Gold 1000","Standard Gold Off Exchange Plan","81.00%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0500&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040002","UHC Compass Gold 1000","38599VA004",,"VAN001","VAS002","VAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040002-01","UHC Compass Gold 1000","Standard Gold On Exchange Plan","81.00%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0500&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040002","UHC Compass Gold 1000","38599VA004",,"VAN001","VAS002","VAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040002-02","UHC Compass Gold 1000","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0501&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040002","UHC Compass Gold 1000","38599VA004",,"VAN001","VAS002","VAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040002-03","UHC Compass Gold 1000","Limited Cost Sharing Plan Variation","81.00%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0502&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040004","UHC Compass Silver 5200","38599VA004",,"VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040004-00","UHC Compass Silver 5200","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,"$5,200","$10","$0","$200","$300","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0509&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020001","Cigna Connect HSA 5000","41921VA002","7730182962","VAN001","VAS001","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020001-00","Cigna Connect HSA 5000","Standard Bronze Off Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","Yes","59-1031071","41921VA0030001","Cigna Dental Pediatric","41921VA003","7730182962","VAN002","VAS003",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Services","Yes",,"","41921VA0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2017/sob/cigna-dental-pediatric-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020001","Cigna Connect HSA 5000","41921VA002","7730182962","VAN001","VAS001","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020001-01","Cigna Connect HSA 5000","Standard Bronze On Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020001","Cigna Connect HSA 5000","41921VA002","7730182962","VAN001","VAS001","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020001-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020001","Cigna Connect HSA 5000","41921VA002","7730182962","VAN001","VAS001","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020001-03","Cigna Connect HSA 5000-1","Limited Cost Sharing Plan Variation",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-1-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020002","Cigna Connect 5750","41921VA002","7730182962","VAN001","VAS001","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020002-00","Cigna Connect 5750","Standard Bronze Off Exchange Plan",,"0.59673935174942","Yes","Yes","No","100%",,"$5,750","$0","$830","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-5750-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-5750-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020002","Cigna Connect 5750","41921VA002","7730182962","VAN001","VAS001","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020002-01","Cigna Connect 5750","Standard Bronze On Exchange Plan",,"0.59673935174942","Yes","Yes","No","100%",,"$5,750","$0","$830","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-5750-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-5750-richmond-va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040004","UHC Compass Silver 5200","38599VA004",,"VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040004-01","UHC Compass Silver 5200","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,"$5,200","$10","$0","$200","$300","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0509&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040004","UHC Compass Silver 5200","38599VA004",,"VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040004-02","UHC Compass Silver 5200","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0510&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040004","UHC Compass Silver 5200","38599VA004",,"VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040004-03","UHC Compass Silver 5200","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","No","100%",,"$5,200","$10","$0","$200","$300","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0511&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020010","Cigna Connect HSA 5000","41921VA002","7730182962","VAN001","VAS002","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020010-00","Cigna Connect HSA 5000","Standard Bronze Off Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-northern-va","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020010","Cigna Connect HSA 5000","41921VA002","7730182962","VAN001","VAS002","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020010-01","Cigna Connect HSA 5000","Standard Bronze On Exchange Plan",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-northern-va","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020010","Cigna Connect HSA 5000","41921VA002","7730182962","VAN001","VAS002","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020010-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020010","Cigna Connect HSA 5000","41921VA002","7730182962","VAN001","VAS002","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020010-03","Cigna Connect HSA 5000-1","Limited Cost Sharing Plan Variation",,"0.615946888923645","Yes","Yes","No","100%",,"$5,000","$0","$1,200","$30","$5,000","$0","$10","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/2017/sbc/cigna-connect-hsa-5000-1-northern-va","http://www.cigna.com/2017/sob/cigna-connect-hsa-5000-1-northern-va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040004","UHC Compass Silver 5200","38599VA004",,"VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040004-04","UHC Compass Silver 5200","73% AV Level Silver Plan","72.00%",,"No","Yes","No","100%",,"$4,200","$10","$0","$200","$300","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,200","$4200 per person","$8400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0512&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040004","UHC Compass Silver 5200","38599VA004",,"VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040004-05","UHC Compass Silver 5200","87% AV Level Silver Plan","86.10%",,"No","Yes","No","100%",,"$800","$10","$0","$200","$300","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0513&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040004","UHC Compass Silver 5200","38599VA004",,"VAN001","VAS001","VAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040004-06","UHC Compass Silver 5200","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,"$0","$10","$0","$200","$0","$900","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0514&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040006","UHC Compass Bronze 7100","38599VA004",,"VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040006-00","UHC Compass Bronze 7100","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0518&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040006","UHC Compass Bronze 7100","38599VA004",,"VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040006-01","UHC Compass Bronze 7100","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0518&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040006","UHC Compass Bronze 7100","38599VA004",,"VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040006-02","UHC Compass Bronze 7100","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0519&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","38599","SERFF","2016-10-19 03:51:02","Individual","No","52-1130183","38599VA0040006","UHC Compass Bronze 7100","38599VA004",,"VAN001","VAS001","VAF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,"2017-01-01",,"Yes","Emergency and Non Emergency","No",,"No",,"http://www.uhc.com/iex/doc?id=va0522&st=va","38599VA0040006-03","UHC Compass Bronze 7100","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$700","$0","$40","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0520&st=va","http://www.uhc.com/iex/doc?id=va0521&st=va"
"2017","VA","40198","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","40198VA0020002","DentaQuest EPO  Pediatric High","40198VA002",,"VAN003","VAS002",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020002-00","DentaQuest EPO  Pediatric High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2017","VA","40198","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","40198VA0020002","DentaQuest EPO  Pediatric High","40198VA002",,"VAN003","VAS002",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020002-01","DentaQuest EPO  Pediatric High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2017","VA","40198","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","40198VA0020003","DentaQuest EPO Family High","40198VA002",,"VAN003","VAS002",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2017","VA","40198","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","40198VA0020003","DentaQuest EPO Family High","40198VA002",,"VAN003","VAS002",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2017","VA","40198","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","40198VA0020004","DentaQuest EPO Family Low","40198VA002",,"VAN003","VAS002",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2017","VA","40198","SERFF","2016-08-19 03:49:17","Individual","Yes","59-0397210","40198VA0020004","DentaQuest EPO Family Low","40198VA002",,"VAN003","VAS002",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240007","HealthyBlue PPO Gold $1,000","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99731188457807",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240007-00","HealthyBlue PPO Gold $1,000","Standard Gold Off Exchange Plan","79.16%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HFNVBN7BRXXVBN7NN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","SHOP (Small Group)","Yes","53-0078070","40308VA0330002","BlueDental Preferred High","40308VA033",,"VAN011","VAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Frequency and age limitations may apply based on type of service received. Annual maximum benefit is $1,000 per member.",,"No","Allows Adult and Child-Only",,,,,"0.231153003004074","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","No",,"","40308VA0330002-00","BlueDental Preferred High","Standard High Off Exchange Plan","83.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.carefirst.com/bluedentalpreferredhighoptionva"
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","Yes","53-0078070","40308VA0320001","BlueDental Preferred High","40308VA032",,"VAN010","VAS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Annual maximum benefit is $1,000 per member age 19 and over. Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"6.70831667638216E-02","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320001-01","BlueDental Preferred High","Standard High On Exchange Plan","83.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.carefirst.com/bluedentalpreferredhighoptionva"
"2017","VA","40308","SERFF","2016-11-18 20:15:51","SHOP (Small Group)","NO","53-0078070","40308VA0270007","BluePreferred PPO 100%/80%","40308VA027",,"VAN001","VAS001","VAF007","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998486152363606",,,"2017-01-01","2017-12-31","Yes","All covered services","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","40308VA0270007-00","BluePreferred PPO 100%/80%","Standard Platinum Off Exchange Plan","91.98%",,"Yes","Yes","No","100%",,"$0","$265","$0","$30","$0","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APPVB78ARXXVBB8DN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","SHOP (Small Group)","NO","53-0078070","40308VA0270007","BluePreferred PPO 100%/80%","40308VA027",,"VAN001","VAS001","VAF007","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998486152363606",,,"2017-01-01","2017-12-31","Yes","All covered services","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","40308VA0270007-01","BluePreferred PPO 100%/80%","Standard Platinum On Exchange Plan","91.98%",,"Yes","Yes","No","100%",,"$0","$265","$0","$30","$0","$560","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APPVB78ARXXVBB8DN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","SHOP (Small Group)","Yes","53-0078070","40308VA0340002","BlueDental Traditional","40308VA034",,"VAN011","VAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Frequency and age limitations may apply based on type of service received. Annual maximum benefit is $1,500 per member.",,"No","Allows Adult and Child-Only",,,,,"0.215696055129333","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","No",,"","40308VA0340002-00","BlueDental Traditional","Standard High Off Exchange Plan","83.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","$180 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,," www.carefirst.com/bluedentaltraditionalva"
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240007","HealthyBlue PPO Gold $1,000","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99731188457807",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240007-01","HealthyBlue PPO Gold $1,000","Standard Gold On Exchange Plan","79.16%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HFNVBN7BRXXVBN7NN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","Yes","53-0078070","40308VA0320002","BlueDental Preferred Low","40308VA032",,"VAN010","VAS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Annual maximum benefit is $1,000 per member age 19 and over. Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"5.26697738524025E-02","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320002-01","BlueDental Preferred Low","Standard Low On Exchange Plan","68.39%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$200","$200 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.carefirst.com/bluedentalpreferredlowoptionva"
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","Yes","53-0078070","40308VA0320003","BlueDental Preferred High","40308VA032",,"VAN010","VAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Annual maximum benefit is $1,000 per member age 19 and over. Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"6.70831667638216E-02","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320003-00","BlueDental Preferred High","Standard High Off Exchange Plan","83.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.carefirst.com/bluedentalpreferredhighoptionva"
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240007","HealthyBlue PPO Gold $1,000","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99731188457807",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240007-02","HealthyBlue PPO Gold $1,000","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HFNVBN7DRXXVBN71N012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","SHOP (Small Group)","NO","53-0078070","40308VA0270027","BluePreferred PPO 1000 90%/70%","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998486318624995",,,"2017-01-01","2017-12-31","Yes","All covered services","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","40308VA0270027-00","BluePreferred PPO 1000 90%/70%","Standard Gold Off Exchange Plan","80.61%",,"Yes","Yes","No","100%",,"$1,000","$15","$350","$30","$1,000","$360","$44","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","0.00%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APHVB77ARXCVBC7BN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","SHOP (Small Group)","NO","53-0078070","40308VA0270027","BluePreferred PPO 1000 90%/70%","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998486318624995",,,"2017-01-01","2017-12-31","Yes","All covered services","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","40308VA0270027-01","BluePreferred PPO 1000 90%/70%","Standard Gold On Exchange Plan","80.61%",,"Yes","Yes","No","100%",,"$1,000","$15","$350","$30","$1,000","$360","$44","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","0.00%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APHVB77ARXCVBC7BN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240007","HealthyBlue PPO Gold $1,000","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99731188457807",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240007-03","HealthyBlue PPO Gold $1,000","Limited Cost Sharing Plan Variation","79.16%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HFNVBN7CRXXVBN7NN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","Yes","53-0078070","40308VA0320004","BlueDental Preferred Low","40308VA032",,"VAN010","VAS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Annual maximum benefit is $1,000 per member age 19 and over. Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"5.26697738524025E-02","Guaranteed Rate","2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320004-00","BlueDental Preferred Low","Standard Low Off Exchange Plan","68.39%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$200","$200 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.carefirst.com/bluedentalpreferredlowoptionva"
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240008","BluePreferred HSA Silver $2,000","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997322935562938",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240008-00","BluePreferred PPO HSA Silver $2,000","Standard Silver Off Exchange Plan","68.87%",,"Yes","Yes","No","100%",,"$2,000","$0","$968","$30","$1,350","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://content.carefirst.com/sbc/APHVBN6ERXCVBN6MN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","SHOP (Small Group)","NO","53-0078070","40308VA0270028","BluePreferred PPO HSA/HRA Silver 2000 80%/60%","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998486110012234",,,"2017-01-01","2017-12-31","Yes","All covered services","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","40308VA0270028-00","BluePreferred PPO HSA/HRA Silver 2000 80%/60%","Standard Silver Off Exchange Plan","71.13%",,"Yes","Yes","No","100%",,"$2,000","$15","$50","$30","$2,000","$220","$68","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APHVB76CRXCVBC6CN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","SHOP (Small Group)","NO","53-0078070","40308VA0270028","BluePreferred PPO HSA/HRA Silver 2000 80%/60%","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998486110012234",,,"2017-01-01","2017-12-31","Yes","All covered services","Yes","All covered services","Yes",,"http://www.carefirst.com/acarx","40308VA0270028-01","BluePreferred PPO HSA/HRA Silver 2000 80%/60%","Standard Silver On Exchange Plan","71.13%",,"Yes","Yes","No","100%",,"$2,000","$15","$50","$30","$2,000","$220","$68","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APHVB76CRXCVBC6CN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240008","BluePreferred HSA Silver $2,000","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997322935562938",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240008-01","BluePreferred PPO HSA Silver $2,000","Standard Silver On Exchange Plan","68.87%",,"Yes","Yes","No","100%",,"$2,000","$0","$968","$30","$1,350","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://content.carefirst.com/sbc/APHVBN6FRXCVBN6MN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240008","BluePreferred HSA Silver $2,000","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997322935562938",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240008-02","BluePreferred PPO Silver $2,000 NA0","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://content.carefirst.com/sbc/APPVBN6GRXXVBN65N012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240008","BluePreferred HSA Silver $2,000","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997322935562938",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240008-03","BluePreferred PPO Silver $2,000 NAL","Limited Cost Sharing Plan Variation","68.87%",,"Yes","Yes","No","100%",,"$2,000","$0","$968","$30","$1,350","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/APHVBN6GRXCVBN6PN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240008","BluePreferred HSA Silver $2,000","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997322935562938",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240008-04","BluePreferred PPO Silver $2,000 A","73% AV Level Silver Plan","73.46%",,"Yes","Yes","No","100%",,"$1,250","$15","$1,193","$30","$1,250","$505","$297","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","30.00%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/APHVBN6HRXCVBN6NN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240008","BluePreferred HSA Silver $2,000","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997322935562938",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240008-05","BluePreferred PPO Silver $2,000 B","87% AV Level Silver Plan","87.62%",,"Yes","Yes","No","100%",,"$0","$170","$1,350","$30","$0","$610","$366","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$600","$1200 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/APPVBN6ERXXVBN6NN012017.pdf",
"2017","VA","40308","SERFF","2016-11-18 20:15:51","Individual","No","53-0078070","40308VA0240008","BluePreferred HSA Silver $2,000","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997322935562938",,,"2017-01-01","2017-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://www.carefirst.com/acarx","40308VA0240008-06","BluePreferred PPO Silver $2,000 C","94% AV Level Silver Plan","94.70%",,"Yes","Yes","No","100%",,"$0","$0","$450","$30","$0","$0","$366","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$600","$1200 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/APPVBN6FRXXVBN6PN012017.pdf",
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020002","Cigna Connect 5750","41921VA002","7730182962","VAN001","VAS001","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020002","Cigna Connect 5750","41921VA002","7730182962","VAN001","VAS001","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020002-03","Cigna Connect 5750-1","Limited Cost Sharing Plan Variation",,"0.59673935174942","Yes","Yes","No","100%",,"$5,750","$0","$830","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-5750-1-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-5750-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020011","Cigna Connect 5750","41921VA002","7730182962","VAN001","VAS002","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020011-00","Cigna Connect 5750","Standard Bronze Off Exchange Plan",,"0.59673935174942","Yes","Yes","No","100%",,"$5,750","$0","$830","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-5750-northern-va","http://www.cigna.com/2017/sob/cigna-connect-5750-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020011","Cigna Connect 5750","41921VA002","7730182962","VAN001","VAS002","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020011-01","Cigna Connect 5750","Standard Bronze On Exchange Plan",,"0.59673935174942","Yes","Yes","No","100%",,"$5,750","$0","$830","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-5750-northern-va","http://www.cigna.com/2017/sob/cigna-connect-5750-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020011","Cigna Connect 5750","41921VA002","7730182962","VAN001","VAS002","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020011-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020011","Cigna Connect 5750","41921VA002","7730182962","VAN001","VAS002","VAF001","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020011-03","Cigna Connect 5750-1","Limited Cost Sharing Plan Variation",,"0.59673935174942","Yes","Yes","No","100%",,"$5,750","$0","$830","$30","$5,030","$0","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-5750-1-northern-va","http://www.cigna.com/2017/sob/cigna-connect-5750-1-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020007","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS001","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020007-00","Cigna Connect 2000","Standard Silver Off Exchange Plan","71.51%","0.719399929046631","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$760","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-2000-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020007","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS001","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020007-01","Cigna Connect 2000","Standard Silver On Exchange Plan","71.51%","0.719399929046631","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$760","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-2000-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020007","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS001","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020007-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020007","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS001","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020007-03","Cigna Connect 2000-1","Limited Cost Sharing Plan Variation","71.51%","0.719399929046631","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$760","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-1-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-2000-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020007","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS001","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020007-04","Cigna Connect 1800-2","73% AV Level Silver Plan","73.76%","0.741716146469116","Yes","Yes","No","100%",,"$1,800","$70","$1,630","$30","$140","$760","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1800-2-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-1800-2-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020007","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS001","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020007-05","Cigna Connect 650-3","87% AV Level Silver Plan","86.61%","0.87182891368866","Yes","Yes","No","100%",,"$650","$30","$660","$30","$140","$360","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-650-3-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-650-3-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020007","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS001","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020007-06","Cigna Connect 75-4","94% AV Level Silver Plan","93.47%","0.937910914421082","Yes","Yes","No","100%",,"$80","$30","$360","$30","$80","$320","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-75-4-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-75-4-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020016","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS002","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020016-00","Cigna Connect 2000","Standard Silver Off Exchange Plan","71.51%","0.719399929046631","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$760","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-northern-va","http://www.cigna.com/2017/sob/cigna-connect-2000-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020016","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS002","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020016-01","Cigna Connect 2000","Standard Silver On Exchange Plan","71.51%","0.719399929046631","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$760","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-northern-va","http://www.cigna.com/2017/sob/cigna-connect-2000-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020016","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS002","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020016-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020016","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS002","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020016-03","Cigna Connect 2000-1","Limited Cost Sharing Plan Variation","71.51%","0.719399929046631","Yes","Yes","No","100%",,"$2,000","$70","$1,570","$30","$140","$760","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2000-1-northern-va","http://www.cigna.com/2017/sob/cigna-connect-2000-1-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020016","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS002","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020016-04","Cigna Connect 1800-2","73% AV Level Silver Plan","73.76%","0.741716146469116","Yes","Yes","No","100%",,"$1,800","$70","$1,630","$30","$140","$760","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1800-2-northern-va","http://www.cigna.com/2017/sob/cigna-connect-1800-2-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020016","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS002","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020016-05","Cigna Connect 650-3","87% AV Level Silver Plan","86.61%","0.87182891368866","Yes","Yes","No","100%",,"$650","$30","$660","$30","$140","$360","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-650-3-northern-va","http://www.cigna.com/2017/sob/cigna-connect-650-3-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020016","Cigna Connect 2000","41921VA002","7730182962","VAN001","VAS002","VAF005","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020016-06","Cigna Connect 75-4","94% AV Level Silver Plan","93.47%","0.937910914421082","Yes","Yes","No","100%",,"$80","$30","$360","$30","$80","$320","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-75-4-northern-va","http://www.cigna.com/2017/sob/cigna-connect-75-4-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020005","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS001","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020005-00","Cigna Connect 2500","Standard Silver Off Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-2500-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020005","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS001","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020005-01","Cigna Connect 2500","Standard Silver On Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-2500-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020005","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS001","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020005-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020005","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS001","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020005-03","Cigna Connect 2500-1","Limited Cost Sharing Plan Variation","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-1-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-2500-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020005","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS001","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020005-04","Cigna Connect 1900-2","73% AV Level Silver Plan","72.07%","0.720824360847473","Yes","Yes","No","100%",,"$1,900","$0","$1,100","$30","$1,900","$0","$630","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1900-2-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-1900-2-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020005","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS001","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020005-05","Cigna Connect 550-3","87% AV Level Silver Plan","86.14%","0.861583888530731","Yes","Yes","No","100%",,"$550","$0","$1,030","$30","$550","$0","$670","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-550-3-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-550-3-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020005","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS001","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020005-06","Cigna Connect 140-4","94% AV Level Silver Plan","93.06%","0.930877983570099","Yes","Yes","No","100%",,"$140","$0","$730","$30","$140","$0","$490","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$140","$140 per person","$280 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-140-4-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-140-4-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020014","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS002","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020014-00","Cigna Connect 2500","Standard Silver Off Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-northern-va","http://www.cigna.com/2017/sob/cigna-connect-2500-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020014","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS002","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020014-01","Cigna Connect 2500","Standard Silver On Exchange Plan","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-northern-va","http://www.cigna.com/2017/sob/cigna-connect-2500-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020014","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS002","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020014-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020014","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS002","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020014-03","Cigna Connect 2500-1","Limited Cost Sharing Plan Variation","68.07%","0.680769741535187","Yes","Yes","No","100%",,"$2,500","$0","$980","$30","$2,500","$0","$510","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-2500-1-northern-va","http://www.cigna.com/2017/sob/cigna-connect-2500-1-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020014","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS002","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020014-04","Cigna Connect 1900-2","73% AV Level Silver Plan","72.07%","0.720824360847473","Yes","Yes","No","100%",,"$1,900","$0","$1,100","$30","$1,900","$0","$630","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1900-2-northern-va","http://www.cigna.com/2017/sob/cigna-connect-1900-2-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020014","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS002","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020014-05","Cigna Connect 550-3","87% AV Level Silver Plan","86.14%","0.861583888530731","Yes","Yes","No","100%",,"$550","$0","$1,030","$30","$550","$0","$670","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-550-3-northern-va","http://www.cigna.com/2017/sob/cigna-connect-550-3-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020014","Cigna Connect 2500","41921VA002","7730182962","VAN001","VAS002","VAF003","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020014-06","Cigna Connect 140-4","94% AV Level Silver Plan","93.06%","0.930877983570099","Yes","Yes","No","100%",,"$140","$0","$730","$30","$140","$0","$490","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$140","$140 per person","$280 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-140-4-northern-va","http://www.cigna.com/2017/sob/cigna-connect-140-4-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-00","Cigna Connect 4500","Standard Silver Off Exchange Plan","68.03%","0.687342762947083","Yes","Yes","No","100%",,"$4,500","$40","$410","$30","$140","$440","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-4500-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-01","Cigna Connect 4500","Standard Silver On Exchange Plan","68.03%","0.687342762947083","Yes","Yes","No","100%",,"$4,500","$40","$410","$30","$140","$440","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-4500-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-03","Cigna Connect 4500-1","Limited Cost Sharing Plan Variation","68.03%","0.687342762947083","Yes","Yes","No","100%",,"$4,500","$40","$410","$30","$140","$440","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-1-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-4500-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-04","Cigna Connect 3200-2","73% AV Level Silver Plan","72.09%","0.727907538414001","Yes","Yes","No","100%",,"$3,200","$40","$610","$30","$140","$440","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3200-2-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-3200-2-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-05","Cigna Connect 800-3","87% AV Level Silver Plan","86.44%","0.866618037223816","Yes","Yes","No","100%",,"$800","$40","$640","$30","$140","$400","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-800-3-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-800-3-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.11%","0.93289190530777","Yes","Yes","No","100%",,"$100","$30","$710","$30","$100","$360","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-100-4-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020009","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS001","VAF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020009-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.39%","0.783746182918549","Yes","Yes","No","100%",,"$1,200","$30","$930","$30","$1,200","$240","$450","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-1200-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020009","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS001","VAF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020009-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.39%","0.783746182918549","Yes","Yes","No","100%",,"$1,200","$30","$930","$30","$1,200","$240","$450","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-1200-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020009","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS001","VAF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020009-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020009","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS001","VAF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020009-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.39%","0.783746182918549","Yes","Yes","No","100%",,"$1,200","$30","$930","$30","$1,200","$240","$450","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-1-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-1200-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-00","Cigna Connect 4500","Standard Silver Off Exchange Plan","68.03%","0.687342762947083","Yes","Yes","No","100%",,"$4,500","$40","$410","$30","$140","$440","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-northern-va","http://www.cigna.com/2017/sob/cigna-connect-4500-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-01","Cigna Connect 4500","Standard Silver On Exchange Plan","68.03%","0.687342762947083","Yes","Yes","No","100%",,"$4,500","$40","$410","$30","$140","$440","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-northern-va","http://www.cigna.com/2017/sob/cigna-connect-4500-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-03","Cigna Connect 4500-1","Limited Cost Sharing Plan Variation","68.03%","0.687342762947083","Yes","Yes","No","100%",,"$4,500","$40","$410","$30","$140","$440","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-4500-1-northern-va","http://www.cigna.com/2017/sob/cigna-connect-4500-1-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-04","Cigna Connect 3200-2","73% AV Level Silver Plan","72.09%","0.727907538414001","Yes","Yes","No","100%",,"$3,200","$40","$610","$30","$140","$440","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-3200-2-northern-va","http://www.cigna.com/2017/sob/cigna-connect-3200-2-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-05","Cigna Connect 800-3","87% AV Level Silver Plan","86.44%","0.866618037223816","Yes","Yes","No","100%",,"$800","$40","$640","$30","$140","$400","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-800-3-northern-va","http://www.cigna.com/2017/sob/cigna-connect-800-3-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF004","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.11%","0.93289190530777","Yes","Yes","No","100%",,"$100","$30","$710","$30","$100","$360","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-100-4-northern-va","http://www.cigna.com/2017/sob/cigna-connect-100-4-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020018","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS002","VAF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020018-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.39%","0.783746182918549","Yes","Yes","No","100%",,"$1,200","$30","$930","$30","$1,200","$240","$450","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-northern-va","http://www.cigna.com/2017/sob/cigna-connect-1200-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020018","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS002","VAF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020018-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.39%","0.783746182918549","Yes","Yes","No","100%",,"$1,200","$30","$930","$30","$1,200","$240","$450","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-northern-va","http://www.cigna.com/2017/sob/cigna-connect-1200-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020018","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS002","VAF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020018-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020018","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS002","VAF006","New","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020018-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.39%","0.783746182918549","Yes","Yes","No","100%",,"$1,200","$30","$930","$30","$1,200","$240","$450","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-1200-1-northern-va","http://www.cigna.com/2017/sob/cigna-connect-1200-1-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020004","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS001","VAF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020004-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","61.98%","0.628298878669739","No","Yes","No","100%",,"$6,400","$90","$410","$30","$140","$950","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-6400-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020004","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS001","VAF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020004-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","61.98%","0.628298878669739","No","Yes","No","100%",,"$6,400","$90","$410","$30","$140","$950","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-6400-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020004","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS001","VAF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020004-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020004","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS001","VAF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020004-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","61.98%","0.628298878669739","No","Yes","No","100%",,"$6,400","$90","$410","$30","$140","$950","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-1-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-6400-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020013","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS002","VAF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020013-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","61.98%","0.628298878669739","No","Yes","No","100%",,"$6,400","$90","$410","$30","$140","$950","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-northern-va","http://www.cigna.com/2017/sob/cigna-connect-6400-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020013","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS002","VAF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020013-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","61.98%","0.628298878669739","No","Yes","No","100%",,"$6,400","$90","$410","$30","$140","$950","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-northern-va","http://www.cigna.com/2017/sob/cigna-connect-6400-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020013","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS002","VAF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020013-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020013","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS002","VAF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020013-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","61.98%","0.628298878669739","No","Yes","No","100%",,"$6,400","$90","$410","$30","$140","$950","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cigna.com/2017/sbc/cigna-connect-6400-1-northern-va","http://www.cigna.com/2017/sob/cigna-connect-6400-1-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020003","Cigna US-VA Connect 6650","41921VA002",,"VAN001","VAS001","VAF007","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020003-00","Cigna US-VA Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-6650-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-6650-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020003","Cigna US-VA Connect 6650","41921VA002",,"VAN001","VAS001","VAF007","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020003-01","Cigna US-VA Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-6650-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-6650-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020003","Cigna US-VA Connect 6650","41921VA002",,"VAN001","VAS001","VAF007","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020003-02","Cigna US-VA Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020003","Cigna US-VA Connect 6650","41921VA002",,"VAN001","VAS001","VAF007","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020003-03","Cigna US-VA Connect 6650-1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-6650-1-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-6650-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020012","Cigna US-VA Connect 6650","41921VA002",,"VAN001","VAS002","VAF007","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020012-00","Cigna US-VA Connect 6650","Standard Bronze Off Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-6650-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-6650-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020012","Cigna US-VA Connect 6650","41921VA002",,"VAN001","VAS002","VAF007","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020012-01","Cigna US-VA Connect 6650","Standard Bronze On Exchange Plan","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-6650-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-6650-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020012","Cigna US-VA Connect 6650","41921VA002",,"VAN001","VAS002","VAF007","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020012-02","Cigna US-VA Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020012","Cigna US-VA Connect 6650","41921VA002",,"VAN001","VAS002","VAF007","New","EPO","Bronze","Design 1","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020012-03","Cigna US-VA Connect 6650-1","Limited Cost Sharing Plan Variation","61.92%","0.61881411075592","Yes","Yes","No","100%",,"$6,650","$70","$340","$30","$4,700","$140","$0","$280","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-6650-1-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-6650-1-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020008","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS001","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020008-00","Cigna US-VA Connect 3500","Standard Silver Off Exchange Plan","70.79%",,"Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-3500-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-3500-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020008","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS001","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020008-01","Cigna US-VA Connect 3500","Standard Silver On Exchange Plan","70.79%",,"Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-3500-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-3500-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020008","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS001","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020008-02","Cigna US-VA Connect-0","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-richmond-va","http://www.cigna.com/2017/sob/cigna-connect-0-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020008","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS001","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020008-03","Cigna US-VA Connect 3500-1","Limited Cost Sharing Plan Variation","70.79%",,"Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-3500-1-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-3500-1-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020008","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS001","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020008-04","Cigna US-VA Connect 3000-2","73% AV Level Silver Plan","73.61%",,"Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-3000-2-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-3000-2-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020008","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS001","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020008-05","Cigna US-VA Connect 700-3","87% AV Level Silver Plan","87.50%",,"Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-700-3-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-700-3-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020008","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS001","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020008-06","Cigna US-VA Connect 250-4","94% AV Level Silver Plan","94.31%",,"Yes","Yes","No","100%",,"$250","$20","$350","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-250-4-richmond-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-250-4-richmond-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020017","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS002","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020017-00","Cigna US-VA Connect 3500","Standard Silver Off Exchange Plan","70.79%",,"Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-3500-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-3500-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020017","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS002","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020017-01","Cigna US-VA Connect 3500","Standard Silver On Exchange Plan","70.79%",,"Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-3500-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-3500-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020017","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS002","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020017-02","Cigna US-VA Connect-0","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-connect-0-northern-va","http://www.cigna.com/2017/sob/cigna-connect-0-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020017","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS002","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020017-03","Cigna US-VA Connect 3500-1","Limited Cost Sharing Plan Variation","70.79%",,"Yes","Yes","No","100%",,"$3,500","$90","$750","$30","$140","$910","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-3500-1-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-3500-1-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020017","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS002","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020017-04","Cigna US-VA Connect 3000-2","73% AV Level Silver Plan","73.61%",,"Yes","Yes","No","100%",,"$3,000","$80","$850","$30","$140","$800","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-3000-2-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-3000-2-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020017","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS002","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020017-05","Cigna US-VA Connect 700-3","87% AV Level Silver Plan","87.50%",,"Yes","Yes","No","100%",,"$700","$20","$1,280","$30","$140","$290","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-700-3-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-700-3-northern-va"
"2017","VA","41921","SERFF","2016-08-24 05:44:16","Individual","No","59-1031071","41921VA0020017","Cigna US-VA Connect 3500","41921VA002",,"VAN001","VAS002","VAF008","New","EPO","Silver","Design 2","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020017-06","Cigna US-VA Connect 250-4","94% AV Level Silver Plan","94.31%",,"Yes","Yes","No","100%",,"$250","$20","$350","$30","$140","$180","$0","$280","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2017/sbc/cigna-us-va-connect-250-4-northern-va","http://www.cigna.com/2017/sob/cigna-us-va-connect-250-4-northern-va"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","42808VA0200004","Guardian Pediatric Advantage","42808VA020",,"VAN001","VAS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","42808VA0200004-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","42808VA0260002","Guardian Essentials for Families and Individuals","42808VA026",,"VAN002","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","42808VA0260002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","42808VA0260002","Guardian Essentials for Families and Individuals","42808VA026",,"VAN002","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","42808VA0260002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","42808VA0210004","Guardian Pediatric Essentials","42808VA021",,"VAN001","VAS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","42808VA0210004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","42808VA0230005","Guardian Family Advantage","42808VA023",,"VAN001","VAS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","42808VA0230005-00","Guardian Family Advantage","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","42808VA0270001","Guardian Select for Families and Individuals","42808VA027",,"VAN002","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","42808VA0270001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","42808VA0270001","Guardian Select for Families and Individuals","42808VA027",,"VAN002","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","42808VA0270001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","42808VA0230006","Guardian Family Advantage","42808VA023",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","42808VA0230006-01","Guardian Family Advantage","Standard High On Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","42808VA0250005","Guardian Family Essentials","42808VA025",,"VAN001","VAS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","42808VA0250005-00","Guardian Family Essentials","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5123390","42808VA0250006","Guardian Family Essentials","42808VA025",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","42808VA0250006-01","Guardian Family Essentials","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","42808VA0280001","Guardian Basics for Families and Individuals","42808VA028",,"VAN002","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","42808VA0280001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","VA","42808","SERFF","2016-08-20 11:23:22","Individual","Yes","13-5123390","42808VA0280001","Guardian Basics for Families and Individuals","42808VA028",,"VAN002","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/payments","","42808VA0280001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans/","https://dentalexchange.guardianlife.com/learn-more/our-plans/"
"2017","VA","51207","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","51207VA0040002","EHB High PPO","51207VA004",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","51207VA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","VA","51207","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","51207VA0040001","EHB Low PPO","51207VA004",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","51207VA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720028","Anthem HealthKeepers Gold X 1300","88380VA072",,"VAN001","VAS001","VAF008","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720028-00","Anthem HealthKeepers Gold X 1300","Standard Gold Off Exchange Plan","78.04%","0.778083086013794","Yes","Yes","Yes","70%","30%","$1,300","$80","$2,300","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","20.00%","$1,300","$1300 per person","$3900 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETW","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730061","Anthem HealthKeepers Silver X POS 2000 0 5000","88380VA073",,"VAN002","VAS001","VAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730061-00","Anthem HealthKeepers Silver X POS 2000 0 5000","Standard Silver Off Exchange Plan","71.63%","0","Yes","Yes","No","100%",,"$2,000","$1,300","$0","$0","$2,000","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.sbc.anthem.com/dps/ccd200G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730061","Anthem HealthKeepers Silver X POS 2000 0 5000","88380VA073",,"VAN002","VAS001","VAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730061-01","Anthem HealthKeepers Silver X POS 2000 0 5000","Standard Silver On Exchange Plan","71.63%","0","Yes","Yes","No","100%",,"$2,000","$1,300","$0","$0","$2,000","$1,400","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.sbc.anthem.com/dps/ccd200G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245214.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720028","Anthem HealthKeepers Gold X 1300","88380VA072",,"VAN001","VAS001","VAF008","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720028-01","Anthem HealthKeepers Gold X 1300","Standard Gold On Exchange Plan","78.04%","0.778083086013794","Yes","Yes","Yes","70%","30%","$1,300","$80","$2,300","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","20.00%","$1,300","$1300 per person","$3900 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETX","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720028","Anthem HealthKeepers Gold X 1300","88380VA072",,"VAN001","VAS001","VAF008","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720028-02","Anthem HealthKeepers Gold X 1300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ETY","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","51207","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","51207VA0030002","EHB High Passive","51207VA003",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","51207VA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","VA","51207","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-0883760","51207VA0030001","EHB Low Passive","51207VA003",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","51207VA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","VA","53311","SERFF","2016-08-24 05:44:16","Individual","Yes","36-3757528","53311VA0010001","TruAssure Basic Adult or Child Dental Plan","53311VA001",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","53311VA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=VA","https://www.truassure.com/brochure?state=VA"
"2017","VA","53311","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-3757528","53311VA0030001","TruAssure Dental Small Group Basic Plan","53311VA003",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","53311VA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","53311","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","36-3757528","53311VA0040001","TruAssure Dental Small Group Preferred Plan","53311VA004",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","53311VA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","53311","SERFF","2016-08-24 05:44:16","Individual","Yes","36-3757528","53311VA0010001","TruAssure Basic Adult or Child Dental Plan","53311VA001",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","53311VA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=VA","https://www.truassure.com/brochure?state=VA"
"2017","VA","53311","SERFF","2016-08-24 05:44:16","Individual","Yes","36-3757528","53311VA0020001","TruAssure Preferred Adult or Child Dental Plan","53311VA002",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","53311VA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=VA","https://www.truassure.com/brochure?state=VA"
"2017","VA","53311","SERFF","2016-08-24 05:44:16","Individual","Yes","36-3757528","53311VA0020001","TruAssure Preferred Adult or Child Dental Plan","53311VA002",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","53311VA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=VA","https://www.truassure.com/brochure?state=VA"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","54965VA0050004","Choice PPO Basic","54965VA005","7962405180","VAN002","VAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only.  Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050004-00","Choice PPO Basic","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLSMGFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030005","Elite PPO Basic Kids","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030005-00","Elite PPO Basic Kids","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030005","Elite PPO Basic Kids","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030005-01","Elite PPO Basic Kids","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","54965VA0050004","Choice PPO Basic","54965VA005","7962405180","VAN002","VAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only.  Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050004-01","Choice PPO Basic","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLSMGFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","54965VA0050005","Choice PPO Premium","54965VA005","7962405180","VAN002","VAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only.  Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050005-00","Choice PPO Premium","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHSMGFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030003","Elite PPO Premium Kids","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030003-00","Elite PPO Premium Kids","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030003","Elite PPO Premium Kids","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030003-01","Elite PPO Premium Kids","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","54965VA0050005","Choice PPO Premium","54965VA005","7962405180","VAN002","VAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only.  Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050005-01","Choice PPO Premium","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHSMGFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0020001","Select Plan Basic Kids","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020001-00","Select Plan Basic Kids","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBLINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0020001","Select Plan Basic Kids","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020001-01","Select Plan Basic Kids","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBLINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","54965VA0060002","Elite ePPO","54965VA006","7962405180","VAN003","VAS003",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Must choose participating dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0060002-00","Elite ePPO","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHSMGFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0020005","Select Plan Premium Kids","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020005-00","Select Plan Premium Kids","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0020005","Select Plan Premium Kids","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020005-01","Select Plan Premium Kids","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","54965VA0060002","Elite ePPO","54965VA006","7962405180","VAN003","VAS003",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Must choose participating dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0060002-01","Elite ePPO","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHSMGFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","54965VA0040004","Select Plan Premium","54965VA004","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0040004-00","Select Plan Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHSMGFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030004","Elite PPO Basic","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030004-00","Elite PPO Basic","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLINDFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030004","Elite PPO Basic","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030004-01","Elite PPO Basic","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBLINDFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","SHOP (Small Group)","Yes","54-1808292","54965VA0040004","Select Plan Premium","54965VA004","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0040004-01","Select Plan Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHSMGFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030006","Elite PPO Premium","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030006-00","Elite PPO Premium","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHINDFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030006","Elite PPO Premium","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030006-01","Elite PPO Premium","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17SBHINDFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0020002","Select Plan Basic","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020002-00","Select Plan Basic","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBLINDFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0020002","Select Plan Basic","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020002-01","Select Plan Basic","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBLINDFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0020006","Select Plan Premium","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020006-00","Select Plan Premium","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHINDFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0020006","Select Plan Premium","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020006-01","Select Plan Premium","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17DBHINDFAMEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0070001","Elite ePPO","54965VA007","7962405180","VAN003","VAS003",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0070001-00","Elite ePPO","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPLINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0070001","Elite ePPO","54965VA007","7962405180","VAN003","VAS003",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0070001-01","Elite ePPO","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPLINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0070002","Elite ePPO","54965VA007","7962405180","VAN003","VAS003",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0070002-00","Elite ePPO","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0070002","Elite ePPO","54965VA007","7962405180","VAN003","VAS003",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0070002-01","Elite ePPO","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHINDPEDEHB.PDF"
"2017","VA","54965","SERFF","2016-08-24 05:44:16","Individual","Yes","54-1808292","54965VA0030007","Elite PPO Plus","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030007-00","Elite PPO Plus","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","66599","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","66599VA0040002","EHB High PPO","66599VA004",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","VA","66599","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","66599VA0040001","EHB Low PPO","66599VA004",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","VA","66599","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","66599VA0030002","EHB High Passive","66599VA003",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","VA","66599","SERFF","2016-08-19 03:49:17","SHOP (Small Group)","Yes","47-0098400","66599VA0030001","EHB Low Passive","66599VA003",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","69103VA0040001","DentaTrust - PPO Pediatric High Option","69103VA004","7083617077","VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040001-00","DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbVA.dentalcareplus.com","http://hixindsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","69103VA0050003","DentaSpan Family High Option","69103VA005","7083617077","VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0050003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbVA.dentalcareplus.com","http://hixsgsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","69103VA0050003","DentaSpan Family High Option","69103VA005","7083617077","VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0050003-01","DentaSpan Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbVA.dentalcareplus.com","http://hixsgsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","69103VA0040001","DentaTrust - PPO Pediatric High Option","69103VA004","7083617077","VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040001-01","DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbVA.dentalcareplus.com","http://hixindsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","69103VA0050004","DentaSpan Family Low Option","69103VA005","7083617077","VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0050004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbVA.dentalcareplus.com","http://hixsgsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","69103VA0040002","DentaTrust - PPO Pediatric Low Option","69103VA004","7083617077","VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040002-00","DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbVA.dentalcareplus.com","http://hixindsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","69103VA0040002","DentaTrust - PPO Pediatric Low Option","69103VA004","7083617077","VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040002-01","DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbVA.dentalcareplus.com","http://hixindsbVA.dentalcareplus.com"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720031","Anthem HealthKeepers Bronze X 6350","88380VA072",,"VAN001","VAS001","VAF010","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720031-03","Anthem HealthKeepers Bronze X 6350","Limited Cost Sharing Plan Variation","59.55%","0.595490574836731","Yes","Yes","Yes","70%","30%","$6,350","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%","$6,350","$6350 per person","$12700 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EU8","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","69103VA0050004","DentaSpan Family Low Option","69103VA005","7083617077","VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0050004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbVA.dentalcareplus.com","http://hixsgsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","69103VA0060003","DentaSpan Family High Option- Off Exchange","69103VA006","7083617077","VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0060003-00","DentaSpan Family High Option- Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbVA.dentalcareplus.com","http://hixsgsbVA.dentalcareplus.com"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-00","Anthem HealthKeepers Silver X 3500","Standard Silver Off Exchange Plan","68.47%","0.683447599411011","Yes","Yes","Yes","70%","30%","$3,500","$100","$1,000","$0","$500","$2,100","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%","$3,500","$3500 per person","$7000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFG","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730037","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS002","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9915",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730037-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730037","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS002","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9915",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730037-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-01","Anthem HealthKeepers Silver X 3500","Standard Silver On Exchange Plan","68.47%","0.683447599411011","Yes","Yes","Yes","70%","30%","$3,500","$100","$1,000","$0","$500","$2,100","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%","$3,500","$3500 per person","$7000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA4","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-02","Anthem HealthKeepers Silver X 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA5","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730038","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS005","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9912",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730038-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730038","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS005","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9912",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730038-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","69103VA0060004","DentaSpan Family Low Option- Off Exchange","69103VA006","7083617077","VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0060004-00","DentaSpan Family Low Option- Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbVA.dentalcareplus.com","http://hixsgsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","69103VA0040003","DentaTrust - PPO Family High Option","69103VA004","7083617077","VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040003-00","DentaTrust - PPO Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbVA.dentalcareplus.com","http://hixindsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","69103VA0060001","DentaSpan Pediatric High Option- Off Exchange","69103VA006","7083617077","VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0060001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbVA.dentalcareplus.com","http://hixsgsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","69103VA0040003","DentaTrust - PPO Family High Option","69103VA004","7083617077","VAN001","VAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040003-01","DentaTrust - PPO Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbVA.dentalcareplus.com","http://hixindsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","31-1185262","69103VA0060002","DentaSpan Pediatric Low Option- Off Exchange","69103VA006","7083617077","VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0060002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixsgsbVA.dentalcareplus.com","http://hixsgsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","69103VA0040004","DentaTrust - PPO Family Low Option","69103VA004","7083617077","VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040004-00","DentaTrust - PPO Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbVA.dentalcareplus.com","http://hixindsbVA.dentalcareplus.com"
"2017","VA","69103","SERFF","2016-08-20 11:23:22","Individual","Yes","31-1185262","69103VA0040004","DentaTrust - PPO Family Low Option","69103VA004","7083617077","VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040004-01","DentaTrust - PPO Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixindsbVA.dentalcareplus.com","http://hixindsbVA.dentalcareplus.com"
"2017","VA","72006","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","72006VA0160001","EHB Basic Dental Plan (Low)","72006VA016",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but when paired with one of MetLife’s group certificates, the amount paid by the Plan upon claims adjudication will be greater of either the traditional group certificate or the EHB certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","72006VA0160001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","VA","72006","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","72006VA0180001","Family Basic Dental Plan (Low)","72006VA018",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.91","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","72006VA0180001-01","Family Basic Dental Plan (Low)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49131"
"2017","VA","72006","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","13-5581829","72006VA0190001","Family Enhanced Dental Plan (High)","72006VA019",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.88","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","72006VA0190001-01","Family Enhanced Dental Plan (High)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49133"
"2017","VA","86443","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","46-0682197","86443VA0060003","IH Signature Silver HMO 2500 70 HSA T","86443VA006",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5850649067","86443VA0060003-00","IH Signature Silver HMO 2500 70 HSA T","Standard Silver Off Exchange Plan","71.39%","0.733307898044586","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$60","$2,500","$700","$200","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$7000 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_SG_718719_Off.pdf",
"2017","VA","86443","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","46-0682197","86443VA0060003","IH Signature Silver HMO 2500 70 HSA T","86443VA006",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5850649067","86443VA0060003-01","IH Signature Silver HMO 2500 70 HSA T","Standard Silver On Exchange Plan","71.39%","0.733307898044586","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$60","$2,500","$700","$200","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$7000 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_SG_718719_On.pdf",
"2017","VA","86443","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","46-0682197","86443VA0060001","IH Signature Gold HMO 1000 100","86443VA006",,"VAN001","VAS001","VAF021","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5850649067","86443VA0060001-00","IH Signature Gold HMO 1000 100","Standard Gold Off Exchange Plan","81.37%","0","No","Yes","No","100%",,"$1,000","$100","$0","$60","$0","$1,200","$0","$20","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_SG_718715_Off.pdf",
"2017","VA","86443","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","46-0682197","86443VA0060001","IH Signature Gold HMO 1000 100","86443VA006",,"VAN001","VAS001","VAF021","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5850649067","86443VA0060001-01","IH Signature Gold HMO 1000 100","Standard Gold On Exchange Plan","81.37%","0","No","Yes","No","100%",,"$1,000","$100","$0","$60","$0","$1,200","$0","$20","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_SG_718715_On.pdf",
"2017","VA","86443","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","46-0682197","86443VA0060002","IH Signature Silver HMO 2000 100","86443VA006",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5850649067","86443VA0060002-00","IH Signature Silver HMO 2000 100","Standard Silver Off Exchange Plan","71.85%","0","No","Yes","No","100%",,"$2,000","$900","$0","$60","$0","$1,500","$0","$20","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_SG_718717_Off.pdf",
"2017","VA","86443","SERFF","2017-04-26 20:15:34","SHOP (Small Group)","No","46-0682197","86443VA0060002","IH Signature Silver HMO 2000 100","86443VA006",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy, Weight Loss Programs","0.9983",,,"2017-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5850649067","86443VA0060002-01","IH Signature Silver HMO 2000 100","Standard Silver On Exchange Plan","71.85%","0","No","Yes","No","100%",,"$2,000","$900","$0","$60","$0","$1,500","$0","$20","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://innovation-health.s3.amazonaws.com/SBC_2017_IHVA_SG_718717_On.pdf",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720016","Anthem HealthKeepers Bronze X 6200 for HSA","88380VA072",,"VAN001","VAS001","VAF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720016-00","Anthem HealthKeepers Bronze X 6200 for HSA","Standard Bronze Off Exchange Plan","61.28%","0.612807929515839","Yes","Yes","Yes","70%","30%","$6,200","$0","$300","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","25.00%","$6,200","$6200 per person","$12400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GBL","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730063","Anthem HealthKeepers Gold X OAPOS 3000 0 4000","88380VA073",,"VAN003","VAS001","VAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Traditional Network","Yes",,"https://www.anthem.com/VA/Nationaltier4","88380VA0730063-00","Anthem HealthKeepers Gold X OAPOS 3000 0 4000","Standard Gold Off Exchange Plan","78.87%","0.756185412406921","No","Yes","No","100%",,"$3,000","$80","$0","$0","$700","$1,600","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd201V",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730063","Anthem HealthKeepers Gold X OAPOS 3000 0 4000","88380VA073",,"VAN003","VAS001","VAF002","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Traditional Network","Yes",,"https://www.anthem.com/VA/Nationaltier4","88380VA0730063-01","Anthem HealthKeepers Gold X OAPOS 3000 0 4000","Standard Gold On Exchange Plan","78.87%","0.756185412406921","No","Yes","No","100%",,"$3,000","$80","$0","$0","$700","$1,600","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd201V","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245211.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720016","Anthem HealthKeepers Bronze X 6200 for HSA","88380VA072",,"VAN001","VAS001","VAF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720016-01","Anthem HealthKeepers Bronze X 6200 for HSA","Standard Bronze On Exchange Plan","61.28%","0.612807929515839","Yes","Yes","Yes","70%","30%","$6,200","$0","$300","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","25.00%","$6,200","$6200 per person","$12400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G9S","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720016","Anthem HealthKeepers Bronze X 6200 for HSA","88380VA072",,"VAN001","VAS001","VAF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720016-02","Anthem HealthKeepers Bronze X 6200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9T","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720016","Anthem HealthKeepers Bronze X 6200 for HSA","88380VA072",,"VAN001","VAS001","VAF013","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720016-03","Anthem HealthKeepers Bronze X 6200 for HSA","Limited Cost Sharing Plan Variation","61.28%","0.612807929515839","Yes","Yes","Yes","70%","30%","$6,200","$0","$300","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","25.00%","$6,200","$6200 per person","$12400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G9S","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 4900 for HSA","88380VA072",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-00","Anthem HealthKeepers Bronze X 4900 for HSA","Standard Bronze Off Exchange Plan","61.98%","0.619777977466583","Yes","Yes","Yes","70%","30%","$4,900","$0","$900","$0","$4,900","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","35.00%","$4,900","$4900 per person","$9800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GBR","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 4900 for HSA","88380VA072",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-01","Anthem HealthKeepers Bronze X 4900 for HSA","Standard Bronze On Exchange Plan","61.98%","0.619777977466583","Yes","Yes","Yes","70%","30%","$4,900","$0","$900","$0","$4,900","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","35.00%","$4,900","$4900 per person","$9800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GA2","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 4900 for HSA","88380VA072",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-02","Anthem HealthKeepers Bronze X 4900 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA3","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 4900 for HSA","88380VA072",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-03","Anthem HealthKeepers Bronze X 4900 for HSA","Limited Cost Sharing Plan Variation","61.98%","0.619777977466583","Yes","Yes","Yes","70%","30%","$4,900","$0","$900","$0","$4,900","$0","$100","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","35.00%","$4,900","$4900 per person","$9800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GA2","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720027","Anthem HealthKeepers Bronze X 5750 for HSA","88380VA072",,"VAN001","VAS022","VAF014","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720027-00","Anthem HealthKeepers Bronze X 5750 for HSA","Standard Bronze Off Exchange Plan","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X52","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720027","Anthem HealthKeepers Bronze X 5750 for HSA","88380VA072",,"VAN001","VAS022","VAF014","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720027-01","Anthem HealthKeepers Bronze X 5750 for HSA","Standard Bronze On Exchange Plan","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4Z","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720027","Anthem HealthKeepers Bronze X 5750 for HSA","88380VA072",,"VAN001","VAS022","VAF014","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720027-02","Anthem HealthKeepers Bronze X 5750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X50","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720027","Anthem HealthKeepers Bronze X 5750 for HSA","88380VA072",,"VAN001","VAS022","VAF014","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720027-03","Anthem HealthKeepers Bronze X 5750 for HSA","Limited Cost Sharing Plan Variation","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4Z","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720031","Anthem HealthKeepers Bronze X 6350","88380VA072",,"VAN001","VAS001","VAF010","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720031-00","Anthem HealthKeepers Bronze X 6350","Standard Bronze Off Exchange Plan","59.55%","0.595490574836731","Yes","Yes","Yes","70%","30%","$6,350","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%","$6,350","$6350 per person","$12700 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUA","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730062","Anthem HealthKeepers Silver X OAPOS 4500E 0 6000","88380VA073",,"VAN003","VAS001","VAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Traditional Network","Yes",,"https://www.anthem.com/VA/Nationaltier4","88380VA0730062-00","Anthem HealthKeepers Silver X OAPOS 4500E 0 6000","Standard Silver Off Exchange Plan","69.62%","0.661345422267914","No","Yes","No","100%",,"$4,500","$100","$0","$0","$1,200","$1,600","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd21AP",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730062","Anthem HealthKeepers Silver X OAPOS 4500E 0 6000","88380VA073",,"VAN003","VAS001","VAF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2017-01-01","2017-12-31","Yes","Full Access","Yes","Traditional Network","Yes",,"https://www.anthem.com/VA/Nationaltier4","88380VA0730062-01","Anthem HealthKeepers Silver X OAPOS 4500E 0 6000","Standard Silver On Exchange Plan","69.62%","0.661345422267914","No","Yes","No","100%",,"$4,500","$100","$0","$0","$1,200","$1,600","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd21AP","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245213.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720031","Anthem HealthKeepers Bronze X 6350","88380VA072",,"VAN001","VAS001","VAF010","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720031-01","Anthem HealthKeepers Bronze X 6350","Standard Bronze On Exchange Plan","59.55%","0.595490574836731","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%","$6,350","$6350 per person","$12700 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EU8","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720031","Anthem HealthKeepers Bronze X 6350","88380VA072",,"VAN001","VAS001","VAF010","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720031-02","Anthem HealthKeepers Bronze X 6350 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$6,350","$0","$400","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EU9","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720028","Anthem HealthKeepers Gold X 1300","88380VA072",,"VAN001","VAS001","VAF008","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720028-03","Anthem HealthKeepers Gold X 1300","Limited Cost Sharing Plan Variation","78.04%","0.778083086013794","Yes","Yes","Yes","70%","30%","$1,300","$80","$2,300","$0","$500","$1,600","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","20.00%","$1,300","$1300 per person","$3900 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ETX","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-03","Anthem HealthKeepers Silver X 3500","Limited Cost Sharing Plan Variation","68.47%","0.683447599411011","Yes","Yes","Yes","70%","30%","$3,500","$100","$1,000","$0","$500","$2,100","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%","$3,500","$3500 per person","$7000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA4","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-04","Anthem HealthKeepers Silver X 3500 S04","73% AV Level Silver Plan","73.97%","0.738165736198425","Yes","Yes","Yes","70%","30%","$2,400","$80","$1,500","$0","$500","$1,700","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","15.00%","$2,400","$2400 per person","$4800 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA6","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730039","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS006","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9915",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730039-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730039","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS006","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9915",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730039-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-05","Anthem HealthKeepers Silver X 3500 S05","87% AV Level Silver Plan","87.95%","0.879309356212616","Yes","Yes","Yes","70%","30%","$900","$40","$600","$0","$500","$1,100","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","$1,550","$1550 per person","$3100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15.00%","$900","$900 per person","$1800 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA7","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-06","Anthem HealthKeepers Silver X 3500 S06","94% AV Level Silver Plan","94.81%","0.948239624500275","Yes","Yes","Yes","70%","30%","$200","$40","$400","$0","$200","$400","$10","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15.00%","$200","$200 per person","$400 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA8","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730040","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS009","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9912",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730040-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730040","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS009","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9912",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730040-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5000","88380VA072",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-00","Anthem HealthKeepers Silver X 5000","Standard Silver Off Exchange Plan","68.15%","0.681164264678955","Yes","Yes","Yes","70%","30%","$5,000","$60","$600","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","25.00%","$5,000","$5000 per person","$10000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUG","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5000","88380VA072",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-01","Anthem HealthKeepers Silver X 5000","Standard Silver On Exchange Plan","68.15%","0.681164264678955","Yes","Yes","Yes","70%","30%","$5,000","$60","$600","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","25.00%","$5,000","$5000 per person","$10000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUB","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730041","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS012","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9915",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730041-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730041","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS012","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9915",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730041-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5000","88380VA072",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-02","Anthem HealthKeepers Silver X 5000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EUC","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5000","88380VA072",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-03","Anthem HealthKeepers Silver X 5000","Limited Cost Sharing Plan Variation","68.15%","0.681164264678955","Yes","Yes","Yes","70%","30%","$5,000","$60","$600","$0","$500","$1,500","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","25.00%","$5,000","$5000 per person","$10000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUB","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730069","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS013","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9915",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730069-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730069","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS013","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9915",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730069-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730042","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS013","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9906",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730042-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730042","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS013","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9906",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730042-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5000","88380VA072",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-04","Anthem HealthKeepers Silver X 5000 S04","73% AV Level Silver Plan","72.18%","0.721347093582153","Yes","Yes","Yes","70%","30%","$3,750","$60","$1,200","$0","$500","$1,400","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUD","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5000","88380VA072",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-05","Anthem HealthKeepers Silver X 5000 S05","87% AV Level Silver Plan","86.27%","0.862448990345001","Yes","Yes","Yes","70%","30%","$850","$40","$1,000","$0","$500","$1,400","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","25.00%","$850","$850 per person","$1700 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUE","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730043","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS015","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9911",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730043-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730043","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS015","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9911",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730043-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5000","88380VA072",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-06","Anthem HealthKeepers Silver X 5000 S06","94% AV Level Silver Plan","93.23%","0.932537615299225","Yes","Yes","Yes","70%","30%","$250","$40","$500","$0","$250","$500","$10","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUF","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730044","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS016","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9906",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730044-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730044","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS016","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9906",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730044-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730045","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS017","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730045-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730045","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS017","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730045-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730046","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS018","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9906",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730046-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730046","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS018","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9906",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730046-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730047","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS019","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9912",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730047-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730047","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS019","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9912",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730047-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730048","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS020","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730048-00","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze Off Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730048","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","88380VA073",,"VAN001","VAS020","VAF004","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730048-01","Anthem HealthKeepers Bronze Pathway X POS 6550E 0 6550 Plus w HSA","Standard Bronze On Exchange Plan",,"0.60807877779007","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,200","$0","$0","$200","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd218G","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245215.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5900","88380VA072",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-00","Anthem HealthKeepers Bronze X 5900","Standard Bronze Off Exchange Plan","61.37%","0.613716959953308","Yes","Yes","Yes","70%","30%","$5,900","$0","$500","$0","$4,500","$200","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","35.00%","$5,900","$5900 per person","$11800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBM","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730064","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS002","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730064-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730064","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS002","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730064-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5900","88380VA072",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-01","Anthem HealthKeepers Bronze X 5900","Standard Bronze On Exchange Plan","61.37%","0.613716959953308","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$4,500","$200","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","35.00%","$5,900","$5900 per person","$11800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9U","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5900","88380VA072",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-02","Anthem HealthKeepers Bronze X 5900 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$5,900","$0","$500","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9V","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730065","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS005","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9921",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730065-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730065","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS005","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9921",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730065-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5900","88380VA072",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-03","Anthem HealthKeepers Bronze X 5900","Limited Cost Sharing Plan Variation","61.37%","0.613716959953308","Yes","Yes","Yes","70%","30%","$5,900","$0","$500","$0","$4,500","$200","$0","$200","$999","$999","$999","$999",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","35.00%","$5,900","$5900 per person","$11800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9U","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730066","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS006","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730066-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730066","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS006","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730066-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730067","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS009","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9921",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730067-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730067","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS009","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9921",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730067-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730068","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS012","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9917",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730068-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730068","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS012","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9917",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730068-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730070","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS015","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9919",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730070-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730070","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS015","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9919",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730070-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730071","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS016","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9916",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730071-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730071","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS016","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9916",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730071-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730072","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS017","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9916",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730072-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730035","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS019","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730035-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730035","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS019","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730035-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730034","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS018","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730034-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730036","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS020","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9928",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730036-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730072","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS017","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9916",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730072-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730073","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS018","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9916",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730073-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730073","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS018","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9916",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730073-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730074","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS019","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9921",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730074-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730074","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS019","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9921",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730074-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730075","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS020","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9916",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730075-00","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold Off Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730075","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","88380VA073",,"VAN001","VAS020","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9916",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730075-01","Anthem HealthKeepers Gold Pathway X POS 1000 20 2900 Plus","Standard Gold On Exchange Plan","81.56%","0.826802730560303","No","Yes","No","100%",,"$1,000","$100","$1,200","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd202M","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245210.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730013","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS002","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730013-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730013","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS002","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730013-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730014","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS005","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730014-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730014","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS005","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730014-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730015","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS006","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730015-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730015","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS006","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730015-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730016","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS009","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730016-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730016","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS009","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730016-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730017","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS012","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730017-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730017","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS012","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730017-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730018","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS013","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730018-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730018","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS013","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730018-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730019","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS015","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9938",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730019-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730019","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS015","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9938",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730019-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730020","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS016","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730020-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730020","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS016","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730020-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730021","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS017","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730021-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730021","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS017","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730021-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730022","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS018","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730022-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730022","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS018","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730022-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730023","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS019","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730023-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730023","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS019","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9939",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730023-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730024","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS020","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730024-00","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold Off Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730024","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","88380VA073",,"VAN001","VAS020","VAF005","Existing","POS","Gold","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730024-01","Anthem HealthKeepers Gold Pathway X POS 500 20 5000 Plus","Standard Gold On Exchange Plan","81.65%","0.823871672153473","No","Yes","No","100%",,"$500","$100","$1,300","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217T","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245209.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730025","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS002","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9929",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730025-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 5150","88380VA072",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-00","Anthem HealthKeepers Bronze X 5150","Standard Bronze Off Exchange Plan","61.93%","0.619266152381897","Yes","Yes","Yes","70%","30%","$6,200","$0","$300","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","35.00%","$5,150","$5150 per person","$10300 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBN","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 5150","88380VA072",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-01","Anthem HealthKeepers Bronze X 5150","Standard Bronze On Exchange Plan","61.93%","0.619266152381897","Yes","Yes","Yes","70%","30%","$6,200","$0","$300","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","35.00%","$5,150","$5150 per person","$10300 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9W","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730025","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS002","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9929",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730025-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730026","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS005","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730026-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 5150","88380VA072",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-02","Anthem HealthKeepers Bronze X 5150 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9X","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 5150","88380VA072",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-03","Anthem HealthKeepers Bronze X 5150","Limited Cost Sharing Plan Variation","61.93%","0.619266152381897","Yes","Yes","Yes","70%","30%","$6,200","$0","$300","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","35.00%","$5,150","$5150 per person","$10300 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9W","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730026","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS005","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730026-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730027","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS006","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9929",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730027-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-00","Anthem HealthKeepers Silver X 2800","Standard Silver Off Exchange Plan","69.03%","0.688784182071686","Yes","Yes","Yes","70%","30%","$2,800","$100","$1,600","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFH","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-01","Anthem HealthKeepers Silver X 2800","Standard Silver On Exchange Plan","69.03%","0.688784182071686","Yes","Yes","Yes","70%","30%","$2,800","$100","$1,600","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA9","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730027","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS006","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9929",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730027-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730028","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS009","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730028-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-02","Anthem HealthKeepers Silver X 2800 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAA","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-03","Anthem HealthKeepers Silver X 2800","Limited Cost Sharing Plan Variation","69.03%","0.688784182071686","Yes","Yes","Yes","70%","30%","$2,800","$100","$1,600","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA9","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730028","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS009","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9926",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730028-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730029","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS012","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9928",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730029-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-04","Anthem HealthKeepers Silver X 2800 S04","73% AV Level Silver Plan","73.59%","0.735056161880493","Yes","Yes","Yes","70%","30%","$2,600","$100","$1,700","$0","$500","$1,800","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAB","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-05","Anthem HealthKeepers Silver X 2800 S05","87% AV Level Silver Plan","87.90%","0.878866314888","Yes","Yes","Yes","70%","30%","$750","$40","$800","$0","$500","$1,100","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","$1,550","$1550 per person","$3100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAC","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730029","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS012","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9928",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730029-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730030","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS013","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730030-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-06","Anthem HealthKeepers Silver X 2800 S06","94% AV Level Silver Plan","94.59%","0.946115255355835","Yes","Yes","Yes","70%","30%","$200","$40","$400","$0","$200","$400","$20","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAD","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730030","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS013","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730030-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730031","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS015","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9931",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730031-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730031","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS015","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9931",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730031-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730032","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS016","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730032-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730032","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS016","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730032-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730033","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS017","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9928",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730033-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730033","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS017","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9928",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730033-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730034","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS018","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9927",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730034-00","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver Off Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z",
"2017","VA","88380","SERFF","2017-04-25 20:15:31","SHOP (Small Group)","No","54-1356687","88380VA0730036","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","88380VA073",,"VAN001","VAS020","VAF005","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","All except Primary Care Physicians, OBGYNs and Emergency Care.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9928",,,"2017-01-01","2017-12-31","Yes","Urgent/Emergency Coverage Only","Yes","Traditional Network","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730036-01","Anthem HealthKeepers Silver Pathway X POS 2000 30 6750 Plus","Standard Silver On Exchange Plan","70.92%","0.730912208557129","No","Yes","No","100%",,"$2,000","$100","$1,500","$0","$400","$1,700","$0","$200","$0","$0","$0","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd217Z","https://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e245212.pdf"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720019","Anthem HealthKeepers Bronze X 4500","88380VA072",,"VAN001","VAS022","VAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720019-00","Anthem HealthKeepers Bronze X 4500","Standard Bronze Off Exchange Plan","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBP","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720019","Anthem HealthKeepers Bronze X 4500","88380VA072",,"VAN001","VAS022","VAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720019-01","Anthem HealthKeepers Bronze X 4500","Standard Bronze On Exchange Plan","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9Y","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720019","Anthem HealthKeepers Bronze X 4500","88380VA072",,"VAN001","VAS022","VAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720019-02","Anthem HealthKeepers Bronze X 4500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9Z","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720019","Anthem HealthKeepers Bronze X 4500","88380VA072",,"VAN001","VAS022","VAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720019-03","Anthem HealthKeepers Bronze X 4500","Limited Cost Sharing Plan Variation","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9Y","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2300","88380VA072",,"VAN001","VAS022","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-00","Anthem HealthKeepers Silver X 2300","Standard Silver Off Exchange Plan","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFK","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2300","88380VA072",,"VAN001","VAS022","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-01","Anthem HealthKeepers Silver X 2300","Standard Silver On Exchange Plan","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAK","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2300","88380VA072",,"VAN001","VAS022","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-02","Anthem HealthKeepers Silver X 2300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAL","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2300","88380VA072",,"VAN001","VAS022","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-03","Anthem HealthKeepers Silver X 2300","Limited Cost Sharing Plan Variation","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAK","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2300","88380VA072",,"VAN001","VAS022","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-04","Anthem HealthKeepers Silver X 2300 S04","73% AV Level Silver Plan","73.67%","0.753176271915436","Yes","Yes","Yes","70%","30%","$1,850","$100","$2,000","$0","$500","$1,700","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAM","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2300","88380VA072",,"VAN001","VAS022","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-05","Anthem HealthKeepers Silver X 2300 S05","87% AV Level Silver Plan","87.95%","0.888113260269165","Yes","Yes","Yes","70%","30%","$750","$40","$600","$0","$500","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAN","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2300","88380VA072",,"VAN001","VAS022","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-06","Anthem HealthKeepers Silver X 2300 S06","94% AV Level Silver Plan","94.48%","0.945339679718018","Yes","Yes","Yes","70%","30%","$200","$40","$400","$0","$200","$400","$20","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAP","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890007","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS021","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890007-00","Anthem HealthKeepers Bronze X POS 5750 for HSA","Standard Bronze Off Exchange Plan","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X56","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890007","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS021","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890007-01","Anthem HealthKeepers Bronze X POS 5750 for HSA","Standard Bronze On Exchange Plan","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890007","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS021","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890007-02","Anthem HealthKeepers Bronze X POS 5750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X54","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890007","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS021","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890007-03","Anthem HealthKeepers Bronze X POS 5750 for HSA","Limited Cost Sharing Plan Variation","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890008","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS007","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890008-00","Anthem HealthKeepers Bronze X POS 5750 for HSA","Standard Bronze Off Exchange Plan","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X56","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890008","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS007","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890008-01","Anthem HealthKeepers Bronze X POS 5750 for HSA","Standard Bronze On Exchange Plan","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890008","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS007","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890008-02","Anthem HealthKeepers Bronze X POS 5750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X54","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890008","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS007","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890008-03","Anthem HealthKeepers Bronze X POS 5750 for HSA","Limited Cost Sharing Plan Variation","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890009","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS018","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890009-00","Anthem HealthKeepers Bronze X POS 5750 for HSA","Standard Bronze Off Exchange Plan","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X56","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890009","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS018","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890009-01","Anthem HealthKeepers Bronze X POS 5750 for HSA","Standard Bronze On Exchange Plan","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890009","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS018","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890009-02","Anthem HealthKeepers Bronze X POS 5750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X54","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890009","Anthem HealthKeepers Bronze X POS 5750 for HSA","88380VA089",,"VAN001","VAS018","VAF003","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890009-03","Anthem HealthKeepers Bronze X POS 5750 for HSA","Limited Cost Sharing Plan Variation","61.90%","0.6185023188591","Yes","Yes","Yes","70%","30%","$5,750","$0","$20","$0","$5,200","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","0.00%","$5,750","$5750 per person","$11500 per group","0.00%","$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890001","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS007","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890001-00","Anthem HealthKeepers Bronze X POS 4500","Standard Bronze Off Exchange Plan","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBQ","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890001","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS007","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890001-01","Anthem HealthKeepers Bronze X POS 4500","Standard Bronze On Exchange Plan","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890001","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS007","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890001-02","Anthem HealthKeepers Bronze X POS 4500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA1","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890001","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS007","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890001-03","Anthem HealthKeepers Bronze X POS 4500","Limited Cost Sharing Plan Variation","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS007","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-00","Anthem HealthKeepers Silver X POS 2300","Standard Silver Off Exchange Plan","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFL","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS007","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-01","Anthem HealthKeepers Silver X POS 2300","Standard Silver On Exchange Plan","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS007","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-02","Anthem HealthKeepers Silver X POS 2300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAR","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS007","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-03","Anthem HealthKeepers Silver X POS 2300","Limited Cost Sharing Plan Variation","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS007","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-04","Anthem HealthKeepers Silver X POS 2300 S04","73% AV Level Silver Plan","73.67%","0.753176271915436","Yes","Yes","Yes","70%","30%","$1,850","$100","$2,000","$0","$500","$1,700","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAS","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS007","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-05","Anthem HealthKeepers Silver X POS 2300 S05","87% AV Level Silver Plan","87.95%","0.888113260269165","Yes","Yes","Yes","70%","30%","$750","$40","$600","$0","$500","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAT","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS007","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-06","Anthem HealthKeepers Silver X POS 2300 S06","94% AV Level Silver Plan","94.48%","0.945339679718018","Yes","Yes","Yes","70%","30%","$200","$40","$400","$0","$200","$400","$20","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAU","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890004","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS018","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890004-00","Anthem HealthKeepers Bronze X POS 4500","Standard Bronze Off Exchange Plan","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBQ","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890004","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS018","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890004-01","Anthem HealthKeepers Bronze X POS 4500","Standard Bronze On Exchange Plan","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890004","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS018","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890004-02","Anthem HealthKeepers Bronze X POS 4500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA1","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890004","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS018","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890004-03","Anthem HealthKeepers Bronze X POS 4500","Limited Cost Sharing Plan Variation","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS018","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-00","Anthem HealthKeepers Silver X POS 2300","Standard Silver Off Exchange Plan","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFL","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS018","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-01","Anthem HealthKeepers Silver X POS 2300","Standard Silver On Exchange Plan","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS018","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-02","Anthem HealthKeepers Silver X POS 2300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAR","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS018","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-03","Anthem HealthKeepers Silver X POS 2300","Limited Cost Sharing Plan Variation","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS018","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-04","Anthem HealthKeepers Silver X POS 2300 S04","73% AV Level Silver Plan","73.67%","0.753176271915436","Yes","Yes","Yes","70%","30%","$1,850","$100","$2,000","$0","$500","$1,700","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAS","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS018","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-05","Anthem HealthKeepers Silver X POS 2300 S05","87% AV Level Silver Plan","87.95%","0.888113260269165","Yes","Yes","Yes","70%","30%","$750","$40","$600","$0","$500","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAT","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS018","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-06","Anthem HealthKeepers Silver X POS 2300 S06","94% AV Level Silver Plan","94.48%","0.945339679718018","Yes","Yes","Yes","70%","30%","$200","$40","$400","$0","$200","$400","$20","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAU","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890010","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS021","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890010-00","Anthem HealthKeepers Bronze X POS 4500","Standard Bronze Off Exchange Plan","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBQ","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890010","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS021","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890010-01","Anthem HealthKeepers Bronze X POS 4500","Standard Bronze On Exchange Plan","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890010","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS021","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890010-02","Anthem HealthKeepers Bronze X POS 4500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA1","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890010","Anthem HealthKeepers Bronze X POS 4500","88380VA089",,"VAN001","VAS021","VAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890010-03","Anthem HealthKeepers Bronze X POS 4500","Limited Cost Sharing Plan Variation","61.83%","0.638008892536163","Yes","Yes","Yes","70%","30%","$4,500","$100","$900","$0","$3,300","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS021","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-00","Anthem HealthKeepers Silver X POS 2300","Standard Silver Off Exchange Plan","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFL","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS021","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-01","Anthem HealthKeepers Silver X POS 2300","Standard Silver On Exchange Plan","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS021","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-02","Anthem HealthKeepers Silver X POS 2300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200","$999","$999","$999","$999",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAR","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS021","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-03","Anthem HealthKeepers Silver X POS 2300","Limited Cost Sharing Plan Variation","68.72%","0.705177664756775","Yes","Yes","Yes","70%","30%","$2,300","$100","$1,800","$0","$500","$2,000","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%","$2,300","$2300 per person","$4600 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS021","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-04","Anthem HealthKeepers Silver X POS 2300 S04","73% AV Level Silver Plan","73.67%","0.753176271915436","Yes","Yes","Yes","70%","30%","$1,850","$100","$2,000","$0","$500","$1,700","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAS","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS021","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-05","Anthem HealthKeepers Silver X POS 2300 S05","87% AV Level Silver Plan","87.95%","0.888113260269165","Yes","Yes","Yes","70%","30%","$750","$40","$600","$0","$500","$900","$0","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAT","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2300","88380VA089",,"VAN001","VAS021","VAF002","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","Yes","Traditional Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-06","Anthem HealthKeepers Silver X POS 2300 S06","94% AV Level Silver Plan","94.48%","0.945339679718018","Yes","Yes","Yes","70%","30%","$200","$40","$400","$0","$200","$400","$20","$200","$999","$999","$999","$999",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%","$200","$200 per person","$400 per group","20.00%","$6,900","$6900 per person","$13800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAU","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720015","Anthem HealthKeepers Catastrophic X 7150","88380VA072",,"VAN001","VAS001","VAF015","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720015-00","Anthem HealthKeepers Catastrophic X 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBK","http://editiondigital.net/view/IU65/2017/OFF_HIX_VA_KIT_2017"
"2017","VA","88380","SERFF","2017-04-25 20:15:31","Individual","No","54-1356687","88380VA0720015","Anthem HealthKeepers Catastrophic X 7150","88380VA072",,"VAN001","VAS001","VAF015","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2017-01-01","2017-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720015-01","Anthem HealthKeepers Catastrophic X 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$4,500","$200","$0","$200","$999","$999","$999","$999",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9R","http://editiondigital.net/view/IU65/2017/ON_HIX_VA_KIT_2017"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060008","Aetna Leap Basic","93187VA006",,"VAN001","VAS001","VAF008","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060008-00","Aetna Leap Basic","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720365_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060008","Aetna Leap Basic","93187VA006",,"VAN001","VAS001","VAF008","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060008-01","Aetna Leap Basic","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720365_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060008","Aetna Leap Basic","93187VA006",,"VAN001","VAS001","VAF008","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060008-02","Aetna Leap Basic","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720365_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060008","Aetna Leap Basic","93187VA006",,"VAN001","VAS001","VAF008","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060008-03","Aetna Leap Basic","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720365_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060029","Aetna Leap Basic Bon Secours","93187VA006",,"VAN005","VAS005","VAF029","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060029-00","Aetna Leap Basic Bon Secours","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719817_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060029","Aetna Leap Basic Bon Secours","93187VA006",,"VAN005","VAS005","VAF029","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060029-01","Aetna Leap Basic Bon Secours","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719817_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060029","Aetna Leap Basic Bon Secours","93187VA006",,"VAN005","VAS005","VAF029","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060029-02","Aetna Leap Basic Bon Secours","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719817_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060029","Aetna Leap Basic Bon Secours","93187VA006",,"VAN005","VAS005","VAF029","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060029-03","Aetna Leap Basic Bon Secours","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719817_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060001","Aetna Leap Basic Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060001-00","Aetna Leap Basic Coastal VA HP","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720291_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060001","Aetna Leap Basic Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060001-01","Aetna Leap Basic Coastal VA HP","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720291_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060001","Aetna Leap Basic Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060001-02","Aetna Leap Basic Coastal VA HP","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720291_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060001","Aetna Leap Basic Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF001","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060001-03","Aetna Leap Basic Coastal VA HP","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720291_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060018","Aetna Leap Diabetes Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060018-02","Aetna Leap Diabetes Roanoke Valley","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720317_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060022","Aetna Leap Basic Gateway Health","93187VA006",,"VAN002","VAS002","VAF022","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060022-00","Aetna Leap Basic Gateway Health","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720402_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060018","Aetna Leap Diabetes Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060018-04","Aetna Leap Diabetes Roanoke Valley","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720317_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060018","Aetna Leap Diabetes Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060018-05","Aetna Leap Diabetes Roanoke Valley","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720317_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060018","Aetna Leap Diabetes Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060018-06","Aetna Leap Diabetes Roanoke Valley","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720317_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060012","Aetna Leap Everyday","93187VA006",,"VAN001","VAS001","VAF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060012-00","Aetna Leap Everyday","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720334_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060012","Aetna Leap Everyday","93187VA006",,"VAN001","VAS001","VAF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060012-01","Aetna Leap Everyday","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720334_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060012","Aetna Leap Everyday","93187VA006",,"VAN001","VAS001","VAF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060012-02","Aetna Leap Everyday","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720334_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060012","Aetna Leap Everyday","93187VA006",,"VAN001","VAS001","VAF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060012-03","Aetna Leap Everyday","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720334_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060022","Aetna Leap Basic Gateway Health","93187VA006",,"VAN002","VAS002","VAF022","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060022-01","Aetna Leap Basic Gateway Health","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720402_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060022","Aetna Leap Basic Gateway Health","93187VA006",,"VAN002","VAS002","VAF022","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060022-02","Aetna Leap Basic Gateway Health","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720402_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060022","Aetna Leap Basic Gateway Health","93187VA006",,"VAN002","VAS002","VAF022","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060022-03","Aetna Leap Basic Gateway Health","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720402_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060015","Aetna Leap Basic Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF015","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060015-00","Aetna Leap Basic Roanoke Valley","Standard Bronze Off Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720328_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060015","Aetna Leap Basic Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF015","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060015-01","Aetna Leap Basic Roanoke Valley","Standard Bronze On Exchange Plan","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720328_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060015","Aetna Leap Basic Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF015","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060015-02","Aetna Leap Basic Roanoke Valley","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720328_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060015","Aetna Leap Basic Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF015","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060015-03","Aetna Leap Basic Roanoke Valley","Limited Cost Sharing Plan Variation","61.94%","0.619440615177155","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720328_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060011","Aetna Leap Diabetes","93187VA006",,"VAN001","VAS001","VAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060011-00","Aetna Leap Diabetes","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720354_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060011","Aetna Leap Diabetes","93187VA006",,"VAN001","VAS001","VAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060011-01","Aetna Leap Diabetes","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720354_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060011","Aetna Leap Diabetes","93187VA006",,"VAN001","VAS001","VAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060011-02","Aetna Leap Diabetes","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720354_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060011","Aetna Leap Diabetes","93187VA006",,"VAN001","VAS001","VAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060011-03","Aetna Leap Diabetes","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720354_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060011","Aetna Leap Diabetes","93187VA006",,"VAN001","VAS001","VAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060011-04","Aetna Leap Diabetes","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720354_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060011","Aetna Leap Diabetes","93187VA006",,"VAN001","VAS001","VAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060011-05","Aetna Leap Diabetes","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720354_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060011","Aetna Leap Diabetes","93187VA006",,"VAN001","VAS001","VAF011","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060011-06","Aetna Leap Diabetes","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720354_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060004","Aetna Leap Diabetes Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060004-00","Aetna Leap Diabetes Coastal VA HP","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720280_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060004","Aetna Leap Diabetes Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060004-01","Aetna Leap Diabetes Coastal VA HP","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720280_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060004","Aetna Leap Diabetes Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060004-02","Aetna Leap Diabetes Coastal VA HP","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720280_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060004","Aetna Leap Diabetes Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060004-03","Aetna Leap Diabetes Coastal VA HP","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720280_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060004","Aetna Leap Diabetes Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060004-04","Aetna Leap Diabetes Coastal VA HP","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720280_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060004","Aetna Leap Diabetes Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060004-05","Aetna Leap Diabetes Coastal VA HP","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720280_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060004","Aetna Leap Diabetes Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060004-06","Aetna Leap Diabetes Coastal VA HP","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720280_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060025","Aetna Leap Diabetes Gateway Health","93187VA006",,"VAN002","VAS002","VAF025","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060025-00","Aetna Leap Diabetes Gateway Health","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720391_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060025","Aetna Leap Diabetes Gateway Health","93187VA006",,"VAN002","VAS002","VAF025","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060025-01","Aetna Leap Diabetes Gateway Health","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720391_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060025","Aetna Leap Diabetes Gateway Health","93187VA006",,"VAN002","VAS002","VAF025","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060025-02","Aetna Leap Diabetes Gateway Health","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720391_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060025","Aetna Leap Diabetes Gateway Health","93187VA006",,"VAN002","VAS002","VAF025","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060025-03","Aetna Leap Diabetes Gateway Health","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720391_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060025","Aetna Leap Diabetes Gateway Health","93187VA006",,"VAN002","VAS002","VAF025","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060025-04","Aetna Leap Diabetes Gateway Health","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720391_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060025","Aetna Leap Diabetes Gateway Health","93187VA006",,"VAN002","VAS002","VAF025","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060025-05","Aetna Leap Diabetes Gateway Health","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720391_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060025","Aetna Leap Diabetes Gateway Health","93187VA006",,"VAN002","VAS002","VAF025","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060025-06","Aetna Leap Diabetes Gateway Health","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720391_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060018","Aetna Leap Diabetes Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060018-00","Aetna Leap Diabetes Roanoke Valley","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720317_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060018","Aetna Leap Diabetes Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060018-01","Aetna Leap Diabetes Roanoke Valley","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720317_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060018","Aetna Leap Diabetes Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060018-03","Aetna Leap Diabetes Roanoke Valley","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720317_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060012","Aetna Leap Everyday","93187VA006",,"VAN001","VAS001","VAF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060012-04","Aetna Leap Everyday","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720334_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060012","Aetna Leap Everyday","93187VA006",,"VAN001","VAS001","VAF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060012-05","Aetna Leap Everyday","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720334_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060012","Aetna Leap Everyday","93187VA006",,"VAN001","VAS001","VAF012","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060012-06","Aetna Leap Everyday","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720334_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060005","Aetna Leap Everyday Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060005-00","Aetna Leap Everyday Coastal VA HP","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720180_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060005","Aetna Leap Everyday Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060005-01","Aetna Leap Everyday Coastal VA HP","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720180_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060005","Aetna Leap Everyday Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060005-02","Aetna Leap Everyday Coastal VA HP","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720180_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060005","Aetna Leap Everyday Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060005-03","Aetna Leap Everyday Coastal VA HP","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720180_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060005","Aetna Leap Everyday Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060005-04","Aetna Leap Everyday Coastal VA HP","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720180_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060005","Aetna Leap Everyday Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060005-05","Aetna Leap Everyday Coastal VA HP","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720180_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060005","Aetna Leap Everyday Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060005-06","Aetna Leap Everyday Coastal VA HP","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720180_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060026","Aetna Leap Everyday Gateway Health","93187VA006",,"VAN002","VAS002","VAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060026-00","Aetna Leap Everyday Gateway Health","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720371_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060026","Aetna Leap Everyday Gateway Health","93187VA006",,"VAN002","VAS002","VAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060026-01","Aetna Leap Everyday Gateway Health","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720371_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060026","Aetna Leap Everyday Gateway Health","93187VA006",,"VAN002","VAS002","VAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060026-02","Aetna Leap Everyday Gateway Health","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720371_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060026","Aetna Leap Everyday Gateway Health","93187VA006",,"VAN002","VAS002","VAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060026-03","Aetna Leap Everyday Gateway Health","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720371_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060026","Aetna Leap Everyday Gateway Health","93187VA006",,"VAN002","VAS002","VAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060026-04","Aetna Leap Everyday Gateway Health","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720371_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060019","Aetna Leap Everyday Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF019","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060019-01","Aetna Leap Everyday Roanoke Valley","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720297_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060026","Aetna Leap Everyday Gateway Health","93187VA006",,"VAN002","VAS002","VAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060026-05","Aetna Leap Everyday Gateway Health","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720371_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060019","Aetna Leap Everyday Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF019","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060019-03","Aetna Leap Everyday Roanoke Valley","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720297_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060019","Aetna Leap Everyday Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF019","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060019-04","Aetna Leap Everyday Roanoke Valley","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720297_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060019","Aetna Leap Everyday Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF019","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060019-05","Aetna Leap Everyday Roanoke Valley","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720297_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060019","Aetna Leap Everyday Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF019","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060019-06","Aetna Leap Everyday Roanoke Valley","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720297_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060014","Aetna Leap Healthy Minds","93187VA006",,"VAN001","VAS001","VAF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060014-00","Aetna Leap Healthy Minds","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720347_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060014","Aetna Leap Healthy Minds","93187VA006",,"VAN001","VAS001","VAF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060014-01","Aetna Leap Healthy Minds","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720347_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060014","Aetna Leap Healthy Minds","93187VA006",,"VAN001","VAS001","VAF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060014-02","Aetna Leap Healthy Minds","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720347_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060026","Aetna Leap Everyday Gateway Health","93187VA006",,"VAN002","VAS002","VAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060026-06","Aetna Leap Everyday Gateway Health","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720371_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060013","Aetna Leap Everyday Plus","93187VA006",,"VAN001","VAS001","VAF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060013-00","Aetna Leap Everyday Plus","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720440_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060013","Aetna Leap Everyday Plus","93187VA006",,"VAN001","VAS001","VAF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060013-01","Aetna Leap Everyday Plus","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720440_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060013","Aetna Leap Everyday Plus","93187VA006",,"VAN001","VAS001","VAF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060013-02","Aetna Leap Everyday Plus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720440_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060013","Aetna Leap Everyday Plus","93187VA006",,"VAN001","VAS001","VAF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060013-03","Aetna Leap Everyday Plus","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720440_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060013","Aetna Leap Everyday Plus","93187VA006",,"VAN001","VAS001","VAF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060013-04","Aetna Leap Everyday Plus","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720440_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060013","Aetna Leap Everyday Plus","93187VA006",,"VAN001","VAS001","VAF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060013-05","Aetna Leap Everyday Plus","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720440_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060013","Aetna Leap Everyday Plus","93187VA006",,"VAN001","VAS001","VAF013","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060013-06","Aetna Leap Everyday Plus","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720440_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060006","Aetna Leap Everyday Plus Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060006-00","Aetna Leap Everyday Plus Coastal VA HP","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720430_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060006","Aetna Leap Everyday Plus Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060006-01","Aetna Leap Everyday Plus Coastal VA HP","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720430_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060006","Aetna Leap Everyday Plus Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060006-02","Aetna Leap Everyday Plus Coastal VA HP","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720430_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060006","Aetna Leap Everyday Plus Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060006-03","Aetna Leap Everyday Plus Coastal VA HP","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720430_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060006","Aetna Leap Everyday Plus Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060006-04","Aetna Leap Everyday Plus Coastal VA HP","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720430_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060006","Aetna Leap Everyday Plus Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060006-05","Aetna Leap Everyday Plus Coastal VA HP","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720430_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060006","Aetna Leap Everyday Plus Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060006-06","Aetna Leap Everyday Plus Coastal VA HP","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720430_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060027","Aetna Leap Everyday Plus Gateway Health","93187VA006",,"VAN002","VAS002","VAF027","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060027-00","Aetna Leap Everyday Plus Gateway Health","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720439_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060027","Aetna Leap Everyday Plus Gateway Health","93187VA006",,"VAN002","VAS002","VAF027","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060027-01","Aetna Leap Everyday Plus Gateway Health","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720439_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060027","Aetna Leap Everyday Plus Gateway Health","93187VA006",,"VAN002","VAS002","VAF027","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060027-02","Aetna Leap Everyday Plus Gateway Health","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720439_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060027","Aetna Leap Everyday Plus Gateway Health","93187VA006",,"VAN002","VAS002","VAF027","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060027-03","Aetna Leap Everyday Plus Gateway Health","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720439_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060027","Aetna Leap Everyday Plus Gateway Health","93187VA006",,"VAN002","VAS002","VAF027","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060027-04","Aetna Leap Everyday Plus Gateway Health","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720439_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060027","Aetna Leap Everyday Plus Gateway Health","93187VA006",,"VAN002","VAS002","VAF027","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060027-05","Aetna Leap Everyday Plus Gateway Health","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720439_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060027","Aetna Leap Everyday Plus Gateway Health","93187VA006",,"VAN002","VAS002","VAF027","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060027-06","Aetna Leap Everyday Plus Gateway Health","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720439_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060020","Aetna Leap Everyday Plus Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF020","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060020-00","Aetna Leap Everyday Plus Roanoke Valley","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720438_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060020","Aetna Leap Everyday Plus Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF020","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060020-01","Aetna Leap Everyday Plus Roanoke Valley","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720438_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060020","Aetna Leap Everyday Plus Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF020","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060020-02","Aetna Leap Everyday Plus Roanoke Valley","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720438_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060020","Aetna Leap Everyday Plus Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF020","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060020-03","Aetna Leap Everyday Plus Roanoke Valley","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720438_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060020","Aetna Leap Everyday Plus Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF020","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060020-04","Aetna Leap Everyday Plus Roanoke Valley","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720438_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060020","Aetna Leap Everyday Plus Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF020","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060020-05","Aetna Leap Everyday Plus Roanoke Valley","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720438_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060020","Aetna Leap Everyday Plus Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF020","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060020-06","Aetna Leap Everyday Plus Roanoke Valley","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720438_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060019","Aetna Leap Everyday Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF019","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060019-00","Aetna Leap Everyday Roanoke Valley","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720297_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060019","Aetna Leap Everyday Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF019","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060019-02","Aetna Leap Everyday Roanoke Valley","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720297_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060014","Aetna Leap Healthy Minds","93187VA006",,"VAN001","VAS001","VAF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060014-03","Aetna Leap Healthy Minds","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720347_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060014","Aetna Leap Healthy Minds","93187VA006",,"VAN001","VAS001","VAF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060014-04","Aetna Leap Healthy Minds","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720347_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060014","Aetna Leap Healthy Minds","93187VA006",,"VAN001","VAS001","VAF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060014-05","Aetna Leap Healthy Minds","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720347_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060014","Aetna Leap Healthy Minds","93187VA006",,"VAN001","VAS001","VAF014","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060014-06","Aetna Leap Healthy Minds","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720347_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060007","Aetna Leap Healthy Minds Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060007-00","Aetna Leap Healthy Minds Coastal VA HP","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720273_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060007","Aetna Leap Healthy Minds Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060007-01","Aetna Leap Healthy Minds Coastal VA HP","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720273_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060007","Aetna Leap Healthy Minds Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060007-02","Aetna Leap Healthy Minds Coastal VA HP","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720273_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060007","Aetna Leap Healthy Minds Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060007-03","Aetna Leap Healthy Minds Coastal VA HP","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720273_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060007","Aetna Leap Healthy Minds Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060007-04","Aetna Leap Healthy Minds Coastal VA HP","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720273_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060007","Aetna Leap Healthy Minds Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060007-05","Aetna Leap Healthy Minds Coastal VA HP","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720273_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060007","Aetna Leap Healthy Minds Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060007-06","Aetna Leap Healthy Minds Coastal VA HP","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720273_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060028","Aetna Leap Healthy Minds Gateway Health","93187VA006",,"VAN002","VAS002","VAF028","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060028-00","Aetna Leap Healthy Minds Gateway Health","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720384_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060028","Aetna Leap Healthy Minds Gateway Health","93187VA006",,"VAN002","VAS002","VAF028","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060028-01","Aetna Leap Healthy Minds Gateway Health","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720384_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060028","Aetna Leap Healthy Minds Gateway Health","93187VA006",,"VAN002","VAS002","VAF028","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060028-02","Aetna Leap Healthy Minds Gateway Health","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720384_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060028","Aetna Leap Healthy Minds Gateway Health","93187VA006",,"VAN002","VAS002","VAF028","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060028-03","Aetna Leap Healthy Minds Gateway Health","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720384_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060028","Aetna Leap Healthy Minds Gateway Health","93187VA006",,"VAN002","VAS002","VAF028","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060028-04","Aetna Leap Healthy Minds Gateway Health","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720384_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060028","Aetna Leap Healthy Minds Gateway Health","93187VA006",,"VAN002","VAS002","VAF028","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060028-05","Aetna Leap Healthy Minds Gateway Health","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720384_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060028","Aetna Leap Healthy Minds Gateway Health","93187VA006",,"VAN002","VAS002","VAF028","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060028-06","Aetna Leap Healthy Minds Gateway Health","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720384_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060021","Aetna Leap Healthy Minds Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060021-00","Aetna Leap Healthy Minds Roanoke Valley","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720310_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060021","Aetna Leap Healthy Minds Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060021-01","Aetna Leap Healthy Minds Roanoke Valley","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720310_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060021","Aetna Leap Healthy Minds Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060021-02","Aetna Leap Healthy Minds Roanoke Valley","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720310_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060021","Aetna Leap Healthy Minds Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060021-03","Aetna Leap Healthy Minds Roanoke Valley","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720310_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060021","Aetna Leap Healthy Minds Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060021-04","Aetna Leap Healthy Minds Roanoke Valley","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720310_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060021","Aetna Leap Healthy Minds Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060021-05","Aetna Leap Healthy Minds Roanoke Valley","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720310_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060021","Aetna Leap Healthy Minds Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060021-06","Aetna Leap Healthy Minds Roanoke Valley","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720310_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060035","Aetna Leap Healthy Minds Bon Secours","93187VA006",,"VAN005","VAS005","VAF035","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060035-01","Aetna Leap Healthy Minds Bon Secours","Standard Silver On Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719826_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060034","Aetna Leap Everyday Plus Bon Secours","93187VA006",,"VAN005","VAS005","VAF034","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060034-06","Aetna Leap Everyday Plus Bon Secours","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720185_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-00","KP VA Silver 1800/30/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.716359615325928","No","Yes","No","100%",,"$1,800","$20","$800","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_1800_30_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500003","KP VA Platinum 1350/20/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF003","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500003-00","KP VA Platinum 1350/20/HSA/HRA/Dental/Ped Dental","Standard Platinum Off Exchange Plan","88.04%","0.880224764347076","Yes","Yes","No","100%",,"$1,400","$200","$0","$200","$1,400","$300","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$5400 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Platinum_1350_20_HSA_HRA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500003","KP VA Platinum 1350/20/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF003","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500003-01","KP VA Platinum 1350/20/HSA/HRA/Dental/Ped Dental","Standard Platinum On Exchange Plan","88.04%","0.880224764347076","Yes","Yes","No","100%",,"$1,400","$200","$0","$200","$1,400","$300","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$5400 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Platinum_1350_20_HSA_HRA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530012","KP VA STD Silver 3500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-01","KP VA STD Silver 3500/30/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$1,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_STD_Silver_3500_30_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530012","KP VA STD Silver 3500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-00","KP VA STD Silver 3500/30/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$1,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_STD_Silver_3500_30_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060035","Aetna Leap Healthy Minds Bon Secours","93187VA006",,"VAN005","VAS005","VAF035","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060035-02","Aetna Leap Healthy Minds Bon Secours","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719826_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060035","Aetna Leap Healthy Minds Bon Secours","93187VA006",,"VAN005","VAS005","VAF035","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060035-03","Aetna Leap Healthy Minds Bon Secours","Limited Cost Sharing Plan Variation","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719826_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060035","Aetna Leap Healthy Minds Bon Secours","93187VA006",,"VAN005","VAS005","VAF035","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060035-04","Aetna Leap Healthy Minds Bon Secours","73% AV Level Silver Plan","73.08%","0.728109896183014","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,975","$4975 per person","$9950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719826_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060035","Aetna Leap Healthy Minds Bon Secours","93187VA006",,"VAN005","VAS005","VAF035","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060035-05","Aetna Leap Healthy Minds Bon Secours","87% AV Level Silver Plan","86.23%","0.860678732395172","Yes","Yes","No","100%",,"$1,900","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719826_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060035","Aetna Leap Healthy Minds Bon Secours","93187VA006",,"VAN005","VAS005","VAF035","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060035-06","Aetna Leap Healthy Minds Bon Secours","94% AV Level Silver Plan","93.18%","0.931061446666718","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719826_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-00","KP VA Gold 1000/20/Dental/Ped Dental","Standard Gold Off Exchange Plan",,"0.803272664546967","No","Yes","No","100%",,"$1,000","$20","$700","$200","$1,000","$800","$50","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Gold_1000_20_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060024","Aetna Leap Diabetes Gold Gateway Health","93187VA006",,"VAN002","VAS002","VAF024","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060024-00","Aetna Leap Diabetes Gold Gateway Health","Standard Gold Off Exchange Plan","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720398_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060024","Aetna Leap Diabetes Gold Gateway Health","93187VA006",,"VAN002","VAS002","VAF024","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060024-01","Aetna Leap Diabetes Gold Gateway Health","Standard Gold On Exchange Plan","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720398_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060024","Aetna Leap Diabetes Gold Gateway Health","93187VA006",,"VAN002","VAS002","VAF024","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060024-02","Aetna Leap Diabetes Gold Gateway Health","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720398_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060024","Aetna Leap Diabetes Gold Gateway Health","93187VA006",,"VAN002","VAS002","VAF024","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060024-03","Aetna Leap Diabetes Gold Gateway Health","Limited Cost Sharing Plan Variation","78.00%","0.77504026889801","Yes","Yes","No","100%",,"$2,800","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,835","$2835 per person","$5670 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720398_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060032","Aetna Leap Diabetes Bon Secours","93187VA006",,"VAN005","VAS005","VAF032","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060032-00","Aetna Leap Diabetes Bon Secours","Standard Silver Off Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719831_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060032","Aetna Leap Diabetes Bon Secours","93187VA006",,"VAN005","VAS005","VAF032","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060032-01","Aetna Leap Diabetes Bon Secours","Standard Silver On Exchange Plan","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719831_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060032","Aetna Leap Diabetes Bon Secours","93187VA006",,"VAN005","VAS005","VAF032","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060032-02","Aetna Leap Diabetes Bon Secours","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719831_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060032","Aetna Leap Diabetes Bon Secours","93187VA006",,"VAN005","VAS005","VAF032","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060032-03","Aetna Leap Diabetes Bon Secours","Limited Cost Sharing Plan Variation","71.72%","0.716066181659698","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719831_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060032","Aetna Leap Diabetes Bon Secours","93187VA006",,"VAN005","VAS005","VAF032","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060032-04","Aetna Leap Diabetes Bon Secours","73% AV Level Silver Plan","73.73%","0.736078679561615","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,515","$5515 per person","$11030 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719831_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060032","Aetna Leap Diabetes Bon Secours","93187VA006",,"VAN005","VAS005","VAF032","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060032-05","Aetna Leap Diabetes Bon Secours","87% AV Level Silver Plan","86.41%","0.862975418567657","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,900","$80","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719831_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060032","Aetna Leap Diabetes Bon Secours","93187VA006",,"VAN005","VAS005","VAF032","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060032-06","Aetna Leap Diabetes Bon Secours","94% AV Level Silver Plan","93.16%","0.931011736392975","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719831_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060033","Aetna Leap Everyday Bon Secours","93187VA006",,"VAN005","VAS005","VAF033","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060033-00","Aetna Leap Everyday Bon Secours","Standard Silver Off Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719815_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060033","Aetna Leap Everyday Bon Secours","93187VA006",,"VAN005","VAS005","VAF033","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060033-01","Aetna Leap Everyday Bon Secours","Standard Silver On Exchange Plan","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719815_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060033","Aetna Leap Everyday Bon Secours","93187VA006",,"VAN005","VAS005","VAF033","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060033-02","Aetna Leap Everyday Bon Secours","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719815_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060033","Aetna Leap Everyday Bon Secours","93187VA006",,"VAN005","VAS005","VAF033","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060033-03","Aetna Leap Everyday Bon Secours","Limited Cost Sharing Plan Variation","68.07%","0.682660698890686","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,075","$6075 per person","$12150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719815_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060033","Aetna Leap Everyday Bon Secours","93187VA006",,"VAN005","VAS005","VAF033","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060033-04","Aetna Leap Everyday Bon Secours","73% AV Level Silver Plan","72.03%","0.722017109394073","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,875","$4875 per person","$9750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719815_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060033","Aetna Leap Everyday Bon Secours","93187VA006",,"VAN005","VAS005","VAF033","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060033-05","Aetna Leap Everyday Bon Secours","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719815_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060033","Aetna Leap Everyday Bon Secours","93187VA006",,"VAN005","VAS005","VAF033","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060033-06","Aetna Leap Everyday Bon Secours","94% AV Level Silver Plan","93.11%","0.931309461593628","Yes","Yes","No","100%",,"$800","$0","$0","$200","$800","$10","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719815_CSR94.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060034","Aetna Leap Everyday Plus Bon Secours","93187VA006",,"VAN005","VAS005","VAF034","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060034-00","Aetna Leap Everyday Plus Bon Secours","Standard Silver Off Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720185_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060034","Aetna Leap Everyday Plus Bon Secours","93187VA006",,"VAN005","VAS005","VAF034","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060034-01","Aetna Leap Everyday Plus Bon Secours","Standard Silver On Exchange Plan","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720185_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060034","Aetna Leap Everyday Plus Bon Secours","93187VA006",,"VAN005","VAS005","VAF034","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060034-02","Aetna Leap Everyday Plus Bon Secours","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720185_AIAN0.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060034","Aetna Leap Everyday Plus Bon Secours","93187VA006",,"VAN005","VAS005","VAF034","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060034-03","Aetna Leap Everyday Plus Bon Secours","Limited Cost Sharing Plan Variation","71.72%","0.718998074531555","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720185_AIANLTD.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060034","Aetna Leap Everyday Plus Bon Secours","93187VA006",,"VAN005","VAS005","VAF034","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060034-04","Aetna Leap Everyday Plus Bon Secours","73% AV Level Silver Plan","73.72%","0.738910853862762","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,490","$4490 per person","$8980 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720185_CSR73.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060034","Aetna Leap Everyday Plus Bon Secours","93187VA006",,"VAN005","VAS005","VAF034","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060034-05","Aetna Leap Everyday Plus Bon Secours","87% AV Level Silver Plan","86.06%","0.861319661140442","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,800","$70","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,825","$1825 per person","$3650 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720185_CSR87.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060035","Aetna Leap Healthy Minds Bon Secours","93187VA006",,"VAN005","VAS005","VAF035","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes","1",,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060035-00","Aetna Leap Healthy Minds Bon Secours","Standard Silver Off Exchange Plan","71.08%","0.70792430639267","Yes","Yes","No","100%",,"$5,200","$10","$0","$200","$2,400","$200","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719826_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060009","Aetna Leap Catastrophic","93187VA006",,"VAN001","VAS001","VAF009","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060009-00","Aetna Leap Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720369_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060009","Aetna Leap Catastrophic","93187VA006",,"VAN001","VAS001","VAF009","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060009-01","Aetna Leap Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720369_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060030","Aetna Leap Catastrophic Bon Secours","93187VA006",,"VAN005","VAS005","VAF030","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060030-00","Aetna Leap Catastrophic Bon Secours","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719818_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060030","Aetna Leap Catastrophic Bon Secours","93187VA006",,"VAN005","VAS005","VAF030","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060030-01","Aetna Leap Catastrophic Bon Secours","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_719818_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060002","Aetna Leap Catastrophic Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF002","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060002-00","Aetna Leap Catastrophic Coastal VA HP","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720295_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060002","Aetna Leap Catastrophic Coastal VA HP","93187VA006",,"VAN003","VAS003","VAF002","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060002-01","Aetna Leap Catastrophic Coastal VA HP","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720295_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060023","Aetna Leap Catastrophic Gateway Health","93187VA006",,"VAN002","VAS002","VAF023","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060023-00","Aetna Leap Catastrophic Gateway Health","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720406_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060023","Aetna Leap Catastrophic Gateway Health","93187VA006",,"VAN002","VAS002","VAF023","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060023-01","Aetna Leap Catastrophic Gateway Health","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720406_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060016","Aetna Leap Catastrophic Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF016","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060016-00","Aetna Leap Catastrophic Roanoke Valley","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720332_Off.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","93187","SERFF","2016-08-25 03:47:19","Individual","No","23-2169745","93187VA0060016","Aetna Leap Catastrophic Roanoke Valley","93187VA006",,"VAN004","VAS004","VAF016","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,,,"2017-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5763819421","93187VA0060016-01","Aetna Leap Catastrophic Roanoke Valley","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2017/CB/VA/SBC_2017_VA_720332_On.pdf","https://www.aetna.com/individuals-families/cb/plan-brochure/2017/Brochure_2017_VA.html"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500001","KP VA Platinum 0/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500001-00","KP VA Platinum 0/20/Dental/Ped Dental","Standard Platinum Off Exchange Plan","91.96%","0.918966233730316","Yes","Yes","No","100%",,"$0","$200","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Platinum_0_20_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-00","KP VA Platinum 0/20/Dental/Ped Dental","Standard Platinum Off Exchange Plan","91.03%","0.909604728221893","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$700","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Platinum_0_20_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-01","KP VA Platinum 0/20/Dental/Ped Dental","Standard Platinum On Exchange Plan","91.03%","0.909604728221893","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$700","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Platinum_0_20_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500001","KP VA Platinum 0/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500001-01","KP VA Platinum 0/20/Dental/Ped Dental","Standard Platinum On Exchange Plan","91.96%","0.918966233730316","Yes","Yes","No","100%",,"$0","$200","$0","$200","$0","$500","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Platinum_0_20_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-02","KP VA Platinum 0/20/Dental/Ped Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Platinum_0_20_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500004","KP VA Gold 0/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500004-00","KP VA Gold 0/20/Dental/Ped Dental","Standard Gold Off Exchange Plan","81.95%","0.818832457065582","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$1,200","$0","$80","$0","$0","$0","$0","$300","3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_0_20_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500004","KP VA Gold 0/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500004-01","KP VA Gold 0/20/Dental/Ped Dental","Standard Gold On Exchange Plan","81.95%","0.818832457065582","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$1,200","$0","$80","$0","$0","$0","$0","$300","3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_0_20_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-03","KP VA Platinum 0/20/Dental/Ped Dental","Limited Cost Sharing Plan Variation","91.03%","0.909604728221893","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$700","$0","$80","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Platinum_0_20_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500002","KP VA Platinum 500/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF002","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500002-00","KP VA Platinum 500/20/Dental/Ped Dental","Standard Platinum Off Exchange Plan","88.14%","0.880597710609436","No","Yes","No","100%",,"$500","$100","$0","$200","$500","$600","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Platinum_500_20_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-00","KP VA Gold 0/20/Dental/Ped Dental","Standard Gold Off Exchange Plan",,"0.814003705978394","Yes","Yes","No","100%",,"$0","$20","$1,300","$200","$0","$700","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Gold_0_20_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-01","KP VA Gold 0/20/Dental/Ped Dental","Standard Gold On Exchange Plan",,"0.814003705978394","Yes","Yes","No","100%",,"$0","$20","$1,300","$200","$0","$700","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Gold_0_20_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500002","KP VA Platinum 500/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF002","Existing","HMO","Platinum","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500002-01","KP VA Platinum 500/20/Dental/Ped Dental","Standard Platinum On Exchange Plan","88.14%","0.880597710609436","No","Yes","No","100%",,"$500","$100","$0","$200","$500","$600","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Platinum_500_20_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500015","KP VA Gold 500/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF005","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500015-00","KP VA Gold 500/20/Dental/Ped Dental","Standard Gold Off Exchange Plan","80.59%","0.805048048496246","No","Yes","No","100%",,"$500","$500","$0","$200","$500","$1,200","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_500_20_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-02","KP VA Gold 0/20/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Gold_0_20_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-03","KP VA Gold 0/20/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.814003705978394","Yes","Yes","No","100%",,"$0","$20","$1,300","$200","$0","$700","$400","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Gold_0_20_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500015","KP VA Gold 500/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF005","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500015-01","KP VA Gold 500/20/Dental/Ped Dental","Standard Gold On Exchange Plan","80.59%","0.805048048496246","No","Yes","No","100%",,"$500","$500","$0","$200","$500","$1,200","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_500_20_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-01","KP VA Gold 1000/20/Dental/Ped Dental","Standard Gold On Exchange Plan",,"0.803272664546967","No","Yes","No","100%",,"$1,000","$20","$700","$200","$1,000","$800","$50","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Gold_1000_20_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-02","KP VA Gold 1000/20/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Gold_1000_20_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-03","KP VA Gold 1000/20/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.803272664546967","No","Yes","No","100%",,"$1,000","$20","$700","$200","$1,000","$800","$50","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Gold_1000_20_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530012","KP VA STD Silver 3500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-02","KP VA STD Silver 3500/30/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_STD_Silver_3500_30_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500005","KP VA Gold 1000/30/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF006","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500005-00","KP VA Gold 1000/30/Dental/Ped Dental","Standard Gold Off Exchange Plan",,"0.797836780548096","No","Yes","No","100%",,"$1,000","$20","$300","$200","$1,000","$1,300","$30","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_1000_30_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500005","KP VA Gold 1000/30/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF006","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500005-01","KP VA Gold 1000/30/Dental/Ped Dental","Standard Gold On Exchange Plan",,"0.797836780548096","No","Yes","No","100%",,"$1,000","$20","$300","$200","$1,000","$1,300","$30","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_1000_30_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-01","KP VA Silver 1800/30/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.716359615325928","No","Yes","No","100%",,"$1,800","$20","$800","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_1800_30_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-02","KP VA Silver 1800/30/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_1800_30_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500012","KP VA Bronze 5250/50/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF010","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500012-00","KP VA Bronze 5250/50/Dental/Ped Dental","Standard Bronze Off Exchange Plan",,"0.616342604160309","No","Yes","No","100%",,"$4,500","$20","$0","$200","$1,700","$1,600","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Bronze_5250_50_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500012","KP VA Bronze 5250/50/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF010","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500012-01","KP VA Bronze 5250/50/Dental/Ped Dental","Standard Bronze On Exchange Plan",,"0.616342604160309","No","Yes","No","100%",,"$4,500","$20","$0","$200","$1,700","$1,600","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Bronze_5250_50_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-03","KP VA Silver 1800/30/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.716359615325928","No","Yes","No","100%",,"$1,800","$20","$800","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_1800_30_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-04","KP VA Silver 1550/30/CSR/Dental/Ped","73% AV Level Silver Plan",,"0.737350285053253","No","Yes","No","100%",,"$1,600","$20","$900","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,550","$1550 per person","$3100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_1550_30_CSR_Dental_Ped.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-05","KP VA Silver 100/10/CSR/Dental/Ped Dental","87% AV Level Silver Plan",,"0.876449465751648","No","Yes","No","100%",,"$100","$20","$1,300","$200","$100","$700","$400","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_100_10_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-06","KP VA Silver 0/5/CSR/Dental/Ped Dental","94% AV Level Silver Plan",,"0.949097096920013","No","Yes","No","100%",,"$0","$10","$400","$200","$0","$300","$100","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_0_5_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-00","KP VA Silver 2800/30/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.693759262561798","No","Yes","No","100%",,"$2,800","$20","$500","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2800_30_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-01","KP VA Silver 2800/30/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.693759262561798","No","Yes","No","100%",,"$2,800","$20","$500","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2800_30_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-02","KP VA Silver 2800/30/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2800_30_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-03","KP VA Silver 2800/30/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.693759262561798","No","Yes","No","100%",,"$2,800","$20","$500","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2800_30_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-04","KP VA Silver 1550/30/CSR/Dental/Ped","73% AV Level Silver Plan",,"0.737350285053253","No","Yes","No","100%",,"$1,600","$20","$900","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,550","$1550 per person","$3100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_1550_30_CSR_Dental_Ped.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-05","KP VA Silver 100/10/CSR/Dental/Ped Dental","87% AV Level Silver Plan",,"0.876449465751648","No","Yes","No","100%",,"$100","$20","$1,300","$200","$100","$700","$400","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_100_10_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2800/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-06","KP VA Silver 0/5/CSR/Dental/Ped Dental","94% AV Level Silver Plan",,"0.949097096920013","No","Yes","No","100%",,"$0","$10","$400","$200","$0","$300","$100","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_0_5_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-00","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.694180071353912","Yes","Yes","No","100%",,"$2,800","$20","$300","$200","$2,800","$300","$200","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2750_20_HSA_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500008","KP VA Silver 1350/30/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500008-00","KP VA Silver 1350/30/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.715969622135162","No","Yes","No","100%",,"$1,400","$20","$800","$200","$1,400","$1,100","$10","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_1350_30_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500008","KP VA Silver 1350/30/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500008-01","KP VA Silver 1350/30/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.715969622135162","No","Yes","No","100%",,"$1,400","$20","$800","$200","$1,400","$1,100","$10","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_1350_30_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-01","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.694180071353912","Yes","Yes","No","100%",,"$2,800","$20","$300","$200","$2,800","$300","$200","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2750_20_HSA_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-02","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2750_20_HSA_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500009","KP VA Silver 2250/30/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500009-00","KP VA Silver 2250/30/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.699220895767212","No","Yes","No","100%",,"$2,300","$20","$600","$200","$1,400","$1,100","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_2250_30_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500009","KP VA Silver 2250/30/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500009-01","KP VA Silver 2250/30/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.699220895767212","No","Yes","No","100%",,"$2,300","$20","$600","$200","$1,400","$1,100","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_2250_30_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-03","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.694180071353912","Yes","Yes","No","100%",,"$2,800","$20","$300","$200","$2,800","$300","$200","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2750_20_HSA_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-04","KP VA Silver 1700/20%/CSR/HDHP/Dental/Ped Dental","73% AV Level Silver Plan",,"0.733644247055054","Yes","Yes","No","100%",,"$1,700","$20","$600","$200","$1,700","$500","$300","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_1700_20_CSR_HDHP_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-05","KP VA Silver 500/10%/CSR/HDHP/Dental/Ped Dental","87% AV Level Silver Plan",,"0.875036001205444","Yes","Yes","No","100%",,"$500","$20","$400","$200","$500","$400","$200","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_500_10_CSR_HDHP_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-06","KP VA Silver 100/5%/CSR/HDHP/Dental/Ped Dental","94% AV Level Silver Plan",,"0.947706818580627","Yes","Yes","No","100%",,"$100","$10","$200","$200","$100","$200","$100","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_100_5_CSR_HDHP_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500016","KP VA Silver 4000/30/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500016-00","KP VA Silver 4000/30/HSA/HRA/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.682942867279053","Yes","Yes","No","100%",,"$4,000","$20","$100","$200","$4,000","$300","$80","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$400.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_4000_30_HSA_HRA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500016","KP VA Silver 4000/30/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF009","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500016-01","KP VA Silver 4000/30/HSA/HRA/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.682942867279053","Yes","Yes","No","100%",,"$4,000","$20","$100","$200","$4,000","$300","$80","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$400.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_4000_30_HSA_HRA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530012","KP VA STD Silver 3500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-03","KP VA STD Silver 3500/30/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$200","$200","$1,400","$1,000","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_STD_Silver_3500_30_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530012","KP VA STD Silver 3500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-04","KP VA STD Silver 3000/30/CSR/Dental/Ped Dental","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$300","$200","$1,400","$800","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_STD_Silver_3000_30_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530012","KP VA STD Silver 3500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-05","KP VA STD Silver 700/10/CSR/Dental/Ped Dental","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$10","$800","$200","$700","$300","$100","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_STD_Silver_700_10_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530012","KP VA STD Silver 3500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-06","KP VA STD Silver 250/5/CSR/Dental/Ped Dental","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$300","$10","$200","$200","$300","$200","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_STD_Silver_250_5_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-00","KP VA Silver 6000/30/Dental/Ped Dental","Standard Silver Off Exchange Plan","68.12%","0.688154578208923","Yes","Yes","No","100%",,"$4,500","$20","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_6000_30_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500007","KP VA Gold 1700/30/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500007-00","KP VA Gold 1700/30/HSA/HRA/Dental/Ped Dental","Standard Gold Off Exchange Plan",,"0.786113083362579","Yes","Yes","No","100%",,"$1,700","$20","$800","$200","$1,700","$800","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_1700_30_HSA_HRA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500007","KP VA Gold 1700/30/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500007-01","KP VA Gold 1700/30/HSA/HRA/Dental/Ped Dental","Standard Gold On Exchange Plan",,"0.786113083362579","Yes","Yes","No","100%",,"$1,700","$20","$800","$200","$1,700","$800","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_1700_30_HSA_HRA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530009","KP VA Catastrophic 7150/0/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530009-01","KP VA Catastrophic 7150/0/Dental/Ped Dental","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Catastrophic_7150_0_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","97762","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","97762VA0010001","Dentegra Dental PPO Pediatric Basic Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010001-17"
"2017","VA","97762","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","97762VA0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","97762VA002",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0020001-17"
"2017","VA","97762","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","97762VA0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","97762VA002",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0020007-17"
"2017","VA","97762","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","97762VA0010007","Dentegra Dental PPO Family Basic Plan","97762VA001",,"VAN001","VAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010007-17"
"2017","VA","97762","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","97762VA0010008","Dentegra Dental PPO Family Preferred Plan","97762VA001",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010008-17"
"2017","VA","97762","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","97762VA0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","97762VA002",,"VAN001","VAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0020008-17"
"2017","WV","17919","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","47-0397286","17919WV0030001","Renaissance Group Dental PPO, EHB Certified","17919WV003",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","17919WV0030001-00","Renaissance Group Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WV","17919","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","47-0397286","17919WV0030002","Renaissance Group Dental PPO, EHB Certified","17919WV003",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","17919WV0030002-00","Renaissance Group Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-00","my Connect Blue WV PPO 750S","Standard Silver Off Exchange Plan","68.65%","0","No","Yes","Yes","63%","37%","$750","$1,400","$0","$0","$750","$1,000","$300","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%","$4,000","$4000 per person","$8000 per group","40.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530009","KP VA Catastrophic 7150/0/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530009-00","KP VA Catastrophic 7150/0/Dental/Ped Dental","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Catastrophic_7150_0_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-01","my Connect Blue WV PPO 750S","Standard Silver On Exchange Plan","68.65%","0","No","Yes","Yes","63%","37%","$750","$1,400","$0","$0","$750","$1,000","$300","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%","$4,000","$4000 per person","$8000 per group","40.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111261482/I_2111261482_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-01","KP VA Silver 6000/30/Dental/Ped Dental","Standard Silver On Exchange Plan","68.12%","0.688154578208923","Yes","Yes","No","100%",,"$4,500","$20","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_6000_30_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-02","KP VA Silver 6000/30/Dental/Ped Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_6000_30_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-03","KP VA Silver 6000/30/Dental/Ped Dental","Limited Cost Sharing Plan Variation","68.12%","0.688154578208923","Yes","Yes","No","100%",,"$4,500","$20","$0","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_6000_30_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-04","KP VA Silver 2000/30/CSR/Dental/Ped Dental","73% AV Level Silver Plan","73.51%","0.737672865390778","Yes","Yes","No","100%",,"$2,000","$20","$700","$200","$1,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_2000_30_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-05","KP VA Silver 300/15/CSR/Dental/Ped Dental","87% AV Level Silver Plan","86.01%","0.860182046890259","Yes","Yes","No","100%",,"$300","$20","$1,000","$200","$300","$700","$200","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_300_15_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-06","KP VA Silver 100/5/CSR/Dental/Ped Dental","94% AV Level Silver Plan","93.08%","0.930653512477875","Yes","Yes","No","100%",,"$100","$10","$400","$200","$100","$300","$100","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Silver_100_5_CSR_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500010","KP VA Silver 1500/30/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500010-00","KP VA Silver 1500/30/HSA/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.712363958358765","Yes","Yes","No","100%",,"$1,500","$20","$700","$200","$1,500","$800","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_1500_30_HSA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 5000/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-00","KP VA Bronze 5000/50/Dental/Ped Dental","Standard Bronze Off Exchange Plan",,"0.616715610027313","No","Yes","No","100%",,"$4,500","$20","$0","$200","$2,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_5000_50_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 5000/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-01","KP VA Bronze 5000/50/Dental/Ped Dental","Standard Bronze On Exchange Plan",,"0.616715610027313","No","Yes","No","100%",,"$4,500","$20","$0","$200","$2,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_5000_50_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500010","KP VA Silver 1500/30/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500010-01","KP VA Silver 1500/30/HSA/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.712363958358765","Yes","Yes","No","100%",,"$1,500","$20","$700","$200","$1,500","$800","$300","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_1500_30_HSA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500011","KP VA Silver 2500/30/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500011-00","KP VA Silver 2500/30/HSA/HRA/Dental/Ped Dental","Standard Silver Off Exchange Plan",,"0.718862235546112","Yes","Yes","No","100%",,"$2,500","$20","$400","$200","$2,500","$600","$200","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$300.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_2500_30_HSA_HRA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 5000/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-02","KP VA Bronze 5000/50/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_5000_50_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 5000/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-03","KP VA Bronze 5000/50/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.616715610027313","No","Yes","No","100%",,"$4,500","$20","$0","$200","$2,300","$1,100","$0","$80","$0","$0","$0","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_5000_50_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500011","KP VA Silver 2500/30/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500011-01","KP VA Silver 2500/30/HSA/HRA/Dental/Ped Dental","Standard Silver On Exchange Plan",,"0.718862235546112","Yes","Yes","No","100%",,"$2,500","$20","$400","$200","$2,500","$600","$200","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$300.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Silver_2500_30_HSA_HRA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530011","KP VA Bronze 6500/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530011-00","KP VA Bronze 6500/50/Dental/Ped Dental","Standard Bronze Off Exchange Plan",,"0.610209167003632","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_6500_50_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500013","KP VA Bronze 6550/0%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500013-00","KP VA Bronze 6550/0%/HSA/Dental/Ped Dental","Standard Bronze Off Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Bronze_6550_0_HSA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500013","KP VA Bronze 6550/0%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500013-01","KP VA Bronze 6550/0%/HSA/Dental/Ped Dental","Standard Bronze On Exchange Plan",,"0.612314343452454","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Bronze_6550_0_HSA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530011","KP VA Bronze 6500/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530011-01","KP VA Bronze 6500/50/Dental/Ped Dental","Standard Bronze On Exchange Plan",,"0.610209167003632","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_6500_50_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530011","KP VA Bronze 6500/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530011-02","KP VA Bronze 6500/50/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_6500_50_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500006","KP VA Gold 1350/0%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500006-00","KP VA Gold 1350/0%/HSA/Dental/Ped Dental","Standard Gold Off Exchange Plan",,"0.814364075660706","Yes","Yes","No","100%",,"$1,400","$20","$0","$200","$1,400","$700","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_1350_0_HSA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500006","KP VA Gold 1350/0%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500006-01","KP VA Gold 1350/0%/HSA/Dental/Ped Dental","Standard Gold On Exchange Plan",,"0.814364075660706","Yes","Yes","No","100%",,"$1,400","$20","$0","$200","$1,400","$700","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Gold_1350_0_HSA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530011","KP VA Bronze 6500/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF008","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530011-03","KP VA Bronze 6500/50/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.610209167003632","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_6500_50_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 6200/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF010","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530008-00","KP VA Bronze 6200/20%/HSA/Dental/Ped Dental","Standard Bronze Off Exchange Plan",,"0.614887058734894","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_6200_20_HSA_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500014","KP VA Bronze 5750/50/40%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500014-00","KP VA Bronze 5750/50/40%/HSA/Dental/Ped Dental","Standard Bronze Off Exchange Plan",,"0.619697630405426","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Bronze_5750_50_40_HSA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","SHOP (Small Group)","No","52-0954463","95185VA0500014","KP VA Bronze 5750/50/40%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9847",,,"2017-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500014-01","KP VA Bronze 5750/50/40%/HSA/Dental/Ped Dental","Standard Bronze On Exchange Plan",,"0.619697630405426","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2017/KP_VA_Bronze_5750_50_40_HSA_Dental_Ped_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2017/KP_VA_SG_PlanSummaryVA_2017.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 6200/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF010","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530008-01","KP VA Bronze 6200/20%/HSA/Dental/Ped Dental","Standard Bronze On Exchange Plan",,"0.614887058734894","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_6200_20_HSA_Dental_Ped_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 6200/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF010","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530008-02","KP VA Bronze 6200/20%/HSA/Dental/Ped Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_6200_20_HSA_Dental_Ped_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","VA","95185","SERFF","2017-01-24 20:15:29","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 6200/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF010","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9839",,,"2017-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530008-03","KP VA Bronze 6200/20%/HSA/Dental/Ped Dental","Limited Cost Sharing Plan Variation",,"0.614887058734894","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2017-ON-Exchange/KP_VA_Bronze_6200_20_HSA_Dental_Ped_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2017/va2017planbrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0430021","Health Savings Blue PPO 3000","31274WV043",,"WVN001","WVS001","WVF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0430021-00","Health Savings Blue PPO 3000","Standard Silver Off Exchange Plan",,"0.698439478874207","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0320001","Major Events Blue PPO 7150","31274WV032",,"WVN001","WVS001","WVF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0320001-00","Major Events Blue PPO 7150","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0320001","Major Events Blue PPO 7150","31274WV032",,"WVN001","WVS001","WVF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0320001-01","Major Events Blue PPO 7150","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111252704/I_2111252704_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0430021","Health Savings Blue PPO 3000","31274WV043",,"WVN001","WVS001","WVF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0430021-01","Health Savings Blue PPO 3000","Standard Silver On Exchange Plan",,"0.698439478874207","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$0","$200","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2096718470/SE_2096718470_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WV"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0430012","Health Savings Blue PPO 5500","31274WV043",,"WVN001","WVS001","WVF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0430012-00","Health Savings Blue PPO 5500","Standard Bronze Off Exchange Plan",,"0.616105139255524","Yes","Yes","No","100%",,"$5,500","$0","$500","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0430012","Health Savings Blue PPO 5500","31274WV043",,"WVN001","WVS001","WVF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0430012-01","Health Savings Blue PPO 5500","Standard Bronze On Exchange Plan",,"0.616105139255524","Yes","Yes","No","100%",,"$5,500","$0","$500","$0","$5,300","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110146302/SE_2110146302_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WV"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0420031","Shared Cost Blue PPO 1000","31274WV042",,"WVN001","WVS001","WVF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0420031-00","Shared Cost Blue PPO 1000","Standard Gold Off Exchange Plan",,"0.804805755615234","No","Yes","No","100%",,"$1,000","$10","$1,300","$0","$1,000","$300","$100","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480001","my Connect Blue WV PPO 1000G","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480001-00","my Connect Blue WV PPO 1000G","Standard Gold Off Exchange Plan","78.33%","0","No","Yes","Yes","63%","37%","$1,000","$500","$0","$0","$1,000","$600","$60","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480001","my Connect Blue WV PPO 1000G","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480001-01","my Connect Blue WV PPO 1000G","Standard Gold On Exchange Plan","78.33%","0","No","Yes","Yes","63%","37%","$1,000","$500","$0","$0","$1,000","$600","$60","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111102709/I_2111102709_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0420031","Shared Cost Blue PPO 1000","31274WV042",,"WVN001","WVS001","WVF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0420031-01","Shared Cost Blue PPO 1000","Standard Gold On Exchange Plan",,"0.804805755615234","No","Yes","No","100%",,"$1,000","$10","$1,300","$0","$1,000","$300","$100","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2096683633%2FSE_2096683633_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WV"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0440022","Shared Cost Blue PPO 2500","31274WV044",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0440022-00","Shared Cost Blue PPO 2500","Standard Silver Off Exchange Plan",,"0.715831160545349","No","Yes","No","100%",,"$2,500","$200","$1,200","$0","$1,700","$400","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480001","my Connect Blue WV PPO 1000G","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480001-02","my Connect Blue WV PPO 1000G","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111102842/I_2111102842_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480001","my Connect Blue WV PPO 1000G","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480001-03","my Connect Blue WV PPO 1000G","Limited Cost Sharing Plan Variation","78.33%","0","No","Yes","Yes","63%","37%","$1,000","$500","$0","$0","$1,000","$600","$60","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$1,500","$1500 per person","$3000 per group","30.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111102869/I_2111102869_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0440022","Shared Cost Blue PPO 2500","31274WV044",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0440022-01","Shared Cost Blue PPO 2500","Standard Silver On Exchange Plan",,"0.715831160545349","No","Yes","No","100%",,"$2,500","$200","$1,200","$0","$1,700","$400","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111417302/SE_2111417302_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WV"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480002","my Connect Blue WV PPO 1500G","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480002-00","my Connect Blue WV PPO 1500G","Standard Gold Off Exchange Plan","78.38%","0.767897665500641","No","Yes","Yes","63%","37%","$1,500","$10","$1,200","$0","$1,500","$600","$50","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0420011","Shared Cost Blue PPO 4000","31274WV042",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0420011-00","Shared Cost Blue PPO 4000","Standard Silver Off Exchange Plan",,"0.70358407497406","No","Yes","No","100%",,"$4,000","$10","$700","$0","$1,700","$400","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0420011","Shared Cost Blue PPO 4000","31274WV042",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0420011-01","Shared Cost Blue PPO 4000","Standard Silver On Exchange Plan",,"0.70358407497406","No","Yes","No","100%",,"$4,000","$10","$700","$0","$1,700","$400","$0","$0","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2097230930/SE_2097230930_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WV"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480002","my Connect Blue WV PPO 1500G","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480002-01","my Connect Blue WV PPO 1500G","Standard Gold On Exchange Plan","78.38%","0.767897665500641","No","Yes","Yes","63%","37%","$1,500","$10","$1,200","$0","$1,500","$600","$50","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111006131/I_2111006131_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480002","my Connect Blue WV PPO 1500G","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480002-02","my Connect Blue WV PPO 1500G","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111010923/I_2111010923_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0420012","Shared Cost Blue PPO 7150","31274WV042",,"WVN001","WVS001","WVF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0420012-00","Shared Cost Blue PPO 7150","Standard Bronze Off Exchange Plan","61.92%","0.64568042755127","No","Yes","No","100%",,"$7,150","$0","$0","$0","$4,600","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","SHOP (Small Group)","No","55-0624615","31274WV0420012","Shared Cost Blue PPO 7150","31274WV042",,"WVN001","WVS001","WVF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4906449921","31274WV0420012-01","Shared Cost Blue PPO 7150","Standard Bronze On Exchange Plan","61.92%","0.64568042755127","No","Yes","No","100%",,"$7,150","$0","$0","$0","$4,600","$500","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2109820936/SE_2109820936_20170101_SBC.pdf","https://shop.highmark.com/sales/#!/brochures/marketplace/WV"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480002","my Connect Blue WV PPO 1500G","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480002-03","my Connect Blue WV PPO 1500G","Limited Cost Sharing Plan Variation","78.38%","0.767897665500641","No","Yes","Yes","63%","37%","$1,500","$10","$1,200","$0","$1,500","$600","$50","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111011068/I_2111011068_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-02","my Connect Blue WV PPO 750S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111261483/I_2111261483_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010001","CareSource Gold","50328WV001",,"WVN001","WVS001","WVF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010001-01","CareSource Gold","Standard Gold On Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-gold-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010001","CareSource Gold","50328WV001",,"WVN001","WVS001","WVF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010001-02","CareSource Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-goldzero-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010001","CareSource Gold","50328WV001",,"WVN001","WVS001","WVF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010001-03","CareSource Gold Limited","Limited Cost Sharing Plan Variation",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-goldltd-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010007","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010007-00","CareSource Silver","Standard Silver Off Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010007","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010007-01","CareSource Silver","Standard Silver On Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010007","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010007-02","CareSource Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silverzero-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010007","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010007-03","CareSource Silver Limited","Limited Cost Sharing Plan Variation",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silverltd-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-03","my Connect Blue WV PPO 750S","Limited Cost Sharing Plan Variation","68.65%","0","No","Yes","Yes","63%","37%","$750","$1,400","$0","$0","$750","$1,000","$300","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%","$4,000","$4000 per person","$8000 per group","40.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111261490/I_2111261490_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-04","my Connect Blue WV PPO 750S","73% AV Level Silver Plan","72.35%","0","No","Yes","Yes","63%","37%","$750","$1,400","$0","$0","$750","$1,000","$300","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%","$4,000","$4000 per person","$8000 per group","40.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111261494/I_2111261494_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-05","my Connect Blue WV PPO 750S","87% AV Level Silver Plan","86.51%","0","No","Yes","Yes","63%","37%","$600","$700","$0","$0","$600","$600","$100","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%","$900","$900 per person","$1800 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111261506/I_2111261506_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-06","my Connect Blue WV PPO 750S","94% AV Level Silver Plan","93.75%","0","No","Yes","Yes","63%","37%","$200","$700","$0","$0","$200","$600","$100","$0","$0","$0","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%","$300","$300 per person","$600 per group","20.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111261507/I_2111261507_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-00","my Connect Blue WV PPO 2800SQE","Standard Silver Off Exchange Plan","68.30%","0.704870104789734","No","Yes","Yes","63%","37%","$2,800","$0","$900","$0","$2,800","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-01","my Connect Blue WV PPO 2800SQE","Standard Silver On Exchange Plan","68.30%","0.704870104789734","No","Yes","Yes","63%","37%","$2,800","$0","$900","$0","$2,800","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110843888/I_2110843888_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-02","my Connect Blue WV PPO 2800SQE","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110844106/I_2110844106_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-03","my Connect Blue WV PPO 2800SQE","Limited Cost Sharing Plan Variation","68.30%","0.704870104789734","No","Yes","Yes","63%","37%","$2,800","$0","$900","$0","$2,800","$0","$500","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110844480/I_2110844480_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-04","my Connect Blue WV PPO 2800SQE","73% AV Level Silver Plan","72.15%","0.75694751739502","No","Yes","Yes","63%","37%","$2,250","$0","$500","$0","$2,250","$0","$300","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","10.00%","$2,250","$2250 per person","$4500 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110844569/I_2110844569_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-05","my Connect Blue WV PPO 2800SQE","87% AV Level Silver Plan","86.41%","0.871560275554657","No","Yes","Yes","63%","37%","$850","$0","$600","$0","$850","$0","$400","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110844651/I_2110844651_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF003","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-06","my Connect Blue WV PPO 2800SQE","94% AV Level Silver Plan","93.02%","0.93381005525589","No","Yes","Yes","63%","37%","$350","$0","$350","$0","$350","$0","$350","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10.00%","$350","$350 per person","$700 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110844878/I_2110844878_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-00","my Connect Blue WV PPO 4750S","Standard Silver Off Exchange Plan","68.03%","0.667991876602173","No","Yes","Yes","63%","37%","$4,750","$10","$500","$0","$1,700","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-01","my Connect Blue WV PPO 4750S","Standard Silver On Exchange Plan","68.03%","0.667991876602173","No","Yes","Yes","63%","37%","$4,750","$10","$500","$0","$1,700","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110799570/I_2110799570_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-02","my Connect Blue WV PPO 4750S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110799952/I_2110799952_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-03","my Connect Blue WV PPO 4750S","Limited Cost Sharing Plan Variation","68.03%","0.667991876602173","No","Yes","Yes","63%","37%","$4,750","$10","$500","$0","$1,700","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110800081/I_2110800081_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-04","my Connect Blue WV PPO 4750S","73% AV Level Silver Plan","72.53%","0.705413699150085","No","Yes","Yes","63%","37%","$4,000","$10","$300","$0","$1,700","$600","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%","$4,450","$4450 per person","$8900 per group","30.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110800130/I_2110800130_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-05","my Connect Blue WV PPO 4750S","87% AV Level Silver Plan","86.03%","0.835156679153442","No","Yes","Yes","63%","37%","$900","$10","$600","$0","$900","$600","$80","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","10.00%","$1,350","$1350 per person","$2700 per group","30.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110800175/I_2110800175_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-06","my Connect Blue WV PPO 4750S","94% AV Level Silver Plan","93.61%","0.92594188451767","No","Yes","Yes","63%","37%","$300","$10","$600","$0","$300","$400","$100","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","10.00%","$450","$450 per person","$900 per group","30.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2110800262/I_2110800262_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480006","my Connect Blue WV PPO 6500B","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480006-00","my Connect Blue WV PPO 6500B","Standard Bronze Off Exchange Plan","61.20%","0.604305386543274","No","Yes","Yes","63%","37%","$3,000","$1,800","$0","$0","$1,600","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","40.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480006","my Connect Blue WV PPO 6500B","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480006-01","my Connect Blue WV PPO 6500B","Standard Bronze On Exchange Plan","61.20%","0.604305386543274","No","Yes","Yes","63%","37%","$3,000","$1,800","$0","$0","$1,600","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","40.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111865610/I_2111865610_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480006","my Connect Blue WV PPO 6500B","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480006-02","my Connect Blue WV PPO 6500B","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111866039/I_2111866039_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","31274","SERFF","2017-01-27 18:01:23","Individual","No","55-0624615","31274WV0480006","my Connect Blue WV PPO 6500B","31274WV048",,"WVN001","WVS001","WVF004","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2017-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480006-03","my Connect Blue WV PPO 6500B","Limited Cost Sharing Plan Variation","61.20%","0.604305386543274","No","Yes","Yes","63%","37%","$3,000","$1,800","$0","$0","$1,600","$900","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","40.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/chmptl/chm/jsp/actions/sbcDocProcessor.do?fileName=product/2111867925/I_2111867925_20170101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2017_ProductBrochure.pdf"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010001","CareSource Gold","50328WV001",,"WVN001","WVS001","WVF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010001-00","CareSource Gold","Standard Gold Off Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-gold-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010007","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010007-04","CareSource Silver 1","73% AV Level Silver Plan",,"0.737353086471558","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver1-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010007","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010007-05","CareSource Silver 2","87% AV Level Silver Plan",,"0.874086737632751","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver2-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010007","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010007-06","CareSource Silver 3","94% AV Level Silver Plan",,"0.94385153055191","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver3-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010013","CareSource Bronze","50328WV001",,"WVN001","WVS001","WVF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010013-00","CareSource Bronze","Standard Bronze Off Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-wv-bronze-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010013","CareSource Bronze","50328WV001",,"WVN001","WVS001","WVF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010013-01","CareSource Bronze","Standard Bronze On Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-wv-bronze-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010013","CareSource Bronze","50328WV001",,"WVN001","WVS001","WVF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010013-02","CareSource Bronze Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/mp2017-wv-bronzezero-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0010013","CareSource Bronze","50328WV001",,"WVN001","WVS001","WVF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0010013-03","CareSource Bronze Limited","Limited Cost Sharing Plan Variation","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-wv-bronzeltd-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020001","CareSource Gold Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9634",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020001-00","CareSource Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-gold-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020001","CareSource Gold Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9634",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020001-01","CareSource Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-gold-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020001","CareSource Gold Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9634",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020001-02","CareSource Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-goldzero-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020001","CareSource Gold Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9634",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020001-03","CareSource Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.81673264503479","No","No","No","100%",,"$1,000","$270","$80","$150","$1,000","$0","$220","$80","$0","$0","$0","$0","$300","5","0","0","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-goldltd-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020007","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9564",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020007-00","CareSource Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020007","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9564",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020007-01","CareSource Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020007","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9564",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020007-02","CareSource Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silverzero-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020007","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9564",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020007-03","CareSource Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.714106738567352","No","Yes","No","100%",,"$3,300","$250","$0","$150","$3,300","$0","$170","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$3,300","$3300 per person","$6600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silverltd-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020007","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9564",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020007-04","CareSource Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.737353086471558","No","Yes","No","100%",,"$3,250","$200","$0","$150","$3,250","$0","$180","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver1-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020007","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9564",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020007-05","CareSource Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.874086737632751","No","Yes","No","100%",,"$950","$260","$60","$150","$950","$0","$160","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver2-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020007","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9564",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020007-06","CareSource Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.94385153055191","No","Yes","No","100%",,"$350","$130","$20","$150","$350","$0","$60","$80","$0","$0","$0","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$350","$350 per person","$700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/mp2017-wv-silver3-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020013","CareSource Bronze Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9506",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020013-00","CareSource Bronze Dental and Vision","Standard Bronze Off Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-wv-bronze-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020013","CareSource Bronze Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9506",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020013-01","CareSource Bronze Dental and Vision","Standard Bronze On Exchange Plan","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-wv-bronze-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020013","CareSource Bronze Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9506",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020013-02","CareSource Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/mp2017-wv-bronzezero-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0020013","CareSource Bronze Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9506",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0020013-03","CareSource Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation","60.10%","0.626298666000366","Yes","Yes","No","100%",,"$6,650","$200","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/mp2017-wv-bronzeltd-dv-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030001","CareSource Federal Simple Choice Gold","50328WV003",,"WVN001","WVS001","WVF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9987",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030001-00","CareSource Federal Simple Choice Gold","Standard Gold Off Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-gold-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030001","CareSource Federal Simple Choice Gold","50328WV003",,"WVN001","WVS001","WVF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9987",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030001-01","CareSource Federal Simple Choice Gold","Standard Gold On Exchange Plan",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-gold-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030001","CareSource Federal Simple Choice Gold","50328WV003",,"WVN001","WVS001","WVF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9987",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030001-02","CareSource Federal Simple Choice Gold Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-goldzero-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030001","CareSource Federal Simple Choice Gold","50328WV003",,"WVN001","WVS001","WVF004","New","HMO","Gold","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9987",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030001-03","CareSource Federal Simple Choice Gold Limited","Limited Cost Sharing Plan Variation",,"0.799770832061768","Yes","Yes","No","100%",,"$1,250","$70","$1,010","$150","$1,250","$460","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-goldltd-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030002","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030002-00","CareSource Federal Simple Choice Silver","Standard Silver Off Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-silver-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030002","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030002-01","CareSource Federal Simple Choice Silver","Standard Silver On Exchange Plan",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-silver-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030002","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030002-02","CareSource Federal Simple Choice Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-silverzero-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030002","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030002-03","CareSource Federal Simple Choice Silver Limited","Limited Cost Sharing Plan Variation",,"0.706332862377167","Yes","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$290","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-silverltd-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030002","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030002-04","CareSource Federal Simple Choice Silver 1","73% AV Level Silver Plan",,"0.735507905483246","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$320","$120","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-silver1-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030002","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030002-05","CareSource Federal Simple Choice Silver 2","87% AV Level Silver Plan",,"0.874700248241425","Yes","Yes","No","100%",,"$700","$40","$1,010","$150","$700","$280","$220","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-silver2-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030002","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030002-06","CareSource Federal Simple Choice Silver 3","94% AV Level Silver Plan",,"0.942992269992828","Yes","Yes","No","100%",,"$250","$20","$250","$150","$250","$170","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-silver3-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030003","CareSource Federal Simple Choice Bronze","50328WV003",,"WVN001","WVS001","WVF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030003-00","CareSource Federal Simple Choice Bronze","Standard Bronze Off Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-bronze-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030003","CareSource Federal Simple Choice Bronze","50328WV003",,"WVN001","WVS001","WVF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030003-01","CareSource Federal Simple Choice Bronze","Standard Bronze On Exchange Plan",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-bronze-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030003","CareSource Federal Simple Choice Bronze","50328WV003",,"WVN001","WVS001","WVF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030003-02","CareSource Federal Simple Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-bronzezero-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0030003","CareSource Federal Simple Choice Bronze","50328WV003",,"WVN001","WVS001","WVF006","New","HMO","Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0030003-03","CareSource Federal Simple Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.61881411075592","Yes","Yes","No","100%",,"$6,650","$20","$300","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://caresource.com/documents/mp2017-fedstd-wv-bronzeltd-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0040001","CareSource Low Premium Silver","50328WV004",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0040001-00","CareSource Low Premium Silver","Standard Silver Off Exchange Plan",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-wv-silver-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0040001","CareSource Low Premium Silver","50328WV004",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0040001-01","CareSource Low Premium Silver","Standard Silver On Exchange Plan",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-wv-silver-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0040001","CareSource Low Premium Silver","50328WV004",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0040001-02","CareSource Low Premium Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://caresource.com/documents/mp2017-lp-wv-silverzero-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0040001","CareSource Low Premium Silver","50328WV004",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0040001-03","CareSource Low Premium Silver Limited","Limited Cost Sharing Plan Variation",,"0.687680065631866","Yes","Yes","No","100%",,"$6,150","$20","$170","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://caresource.com/documents/mp2017-lp-wv-silverltd-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0040001","CareSource Low Premium Silver","50328WV004",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0040001-04","CareSource Low Premium Silver 1","73% AV Level Silver Plan",,"0.721862494945526","Yes","Yes","No","100%",,"$5,000","$0","$340","$150","$5,000","$0","$20","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"https://caresource.com/documents/mp2017-lp-wv-silver1-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0040001","CareSource Low Premium Silver","50328WV004",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0040001-05","CareSource Low Premium Silver 2","87% AV Level Silver Plan",,"0.868183672428131","Yes","Yes","No","100%",,"$1,100","$30","$510","$150","$1,100","$90","$110","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","No",,,"https://caresource.com/documents/mp2017-lp-wv-silver2-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","50328","SERFF","2017-01-19 20:15:29","Individual","No","47-3028244","50328WV0040001","CareSource Low Premium Silver","50328WV004",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9986",,,"2017-01-01","2017-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2017-marketplace-formulary/","50328WV0040001-06","CareSource Low Premium Silver 3","94% AV Level Silver Plan",,"0.932700634002686","Yes","Yes","No","100%",,"$500","$10","$250","$150","$500","$50","$60","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"https://caresource.com/documents/mp2017-lp-wv-silver3-sum","https://www.caresource.com/documents/mp2017-wv-broch"
"2017","WV","53843","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","53843WV0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","53843WV002",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0020001-00","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0020001-17"
"2017","WV","53843","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","53843WV0010001","Dentegra Dental PPO Pediatric Basic Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010001-17"
"2017","WV","53843","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","53843WV0010007","Dentegra Dental PPO Family Basic Plan","53843WV001",,"WVN001","WVS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010007-17"
"2017","WV","53843","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","53843WV0020007","Dentegra Dental PPO for Small Businesses Family Basic Plan","53843WV002",,"WVN001","WVS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0020007-01","Dentegra Dental PPO for Small Businesses Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0020007-17"
"2017","WV","53843","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","75-1233841","53843WV0020008","Dentegra Dental PPO for Small Businesses Family Preferred Plan","53843WV002",,"WVN001","WVS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0020008-01","Dentegra Dental PPO for Small Businesses Family Preferred Plan","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0020008-17"
"2017","WV","53843","SERFF","2016-08-20 11:23:22","Individual","Yes","75-1233841","53843WV0010008","Dentegra Dental PPO Family Preferred Plan","53843WV001",,"WVN001","WVS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010008-17"
"2017","WV","55565","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","36-0883760","55565WV0040002","EHB High PPO","55565WV004",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","55565WV0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WV","55565","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","36-0883760","55565WV0040001","EHB Low PPO","55565WV004",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","55565WV0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WV","55565","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","36-0883760","55565WV0030002","EHB High Passive","55565WV003",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","55565WV0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WV","55565","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","36-0883760","55565WV0030001","EHB Low Passive","55565WV003",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","55565WV0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2017","WV","63300","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","47-0098400","63300WV0040002","EHB High PPO","63300WV004",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","63300WV0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WV","63300","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","47-0098400","63300WV0040001","EHB Low PPO","63300WV004",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","63300WV0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WV","63300","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","47-0098400","63300WV0030002","EHB High Passive","63300WV003",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","63300WV0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WV","63300","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","47-0098400","63300WV0030001","EHB Low Passive","63300WV003",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","63300WV0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2017","WV","67072","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","93-0242990","67072WV0040002","EHB High PPO","67072WV004",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","67072WV0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WV","67072","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","93-0242990","67072WV0040001","EHB Low PPO","67072WV004",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","67072WV0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WV","67072","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","93-0242990","67072WV0030002","EHB High Passive","67072WV003",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","67072WV0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WV","67072","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","93-0242990","67072WV0030001","EHB Low Passive","67072WV003",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","67072WV0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2017","WV","72479","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-3757528","72479WV0030001","TruAssure Dental Small Group Basic Plan","72479WV003",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72479WV0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WV","72479","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","72479WV0010001","TruAssure Basic Adult or Child Dental Plan","72479WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV"
"2017","WV","72479","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","72479WV0010001","TruAssure Basic Adult or Child Dental Plan","72479WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV"
"2017","WV","72479","SERFF","2016-08-20 11:23:22","SHOP (Small Group)","Yes","36-3757528","72479WV0040001","TruAssure Dental Small Group Preferred Plan","72479WV004",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72479WV0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WV","72479","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","72479WV0020001","TruAssure Preferred Adult or Child Dental Plan","72479WV002",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV"
"2017","WV","72479","SERFF","2016-08-20 11:23:22","Individual","Yes","36-3757528","72479WV0020001","TruAssure Preferred Adult or Child Dental Plan","72479WV002",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01","2017-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV"
"2017","WV","75441","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","57-0523959","75441WV0020001","Group Dental Policy","75441WV002",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Tradiational with inside maximums","Yes","Traditional with Inside maximums","Yes",,"","75441WV0020001-00","Group Dental Policy","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2017","WV","76526","SERFF","2016-08-04 04:14:10","Individual","Yes","55-0523124","76526WV0010001","Delta Dental PPO Pediatric Basic Plan","76526WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010001-17"
"2017","WV","76526","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","55-0523124","76526WV0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020001-17"
"2017","WV","76526","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","55-0523124","76526WV0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020002-17"
"2017","WV","76526","SERFF","2016-08-04 04:14:10","Individual","Yes","55-0523124","76526WV0010002","Delta Dental PPO Pediatric Preferred Plan","76526WV001",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010002-17"
"2017","WV","76526","SERFF","2016-08-04 04:14:10","Individual","Yes","55-0523124","76526WV0010006","Delta Dental PPO Basic Plan for Families","76526WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010006-17"
"2017","WV","76526","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","55-0523124","76526WV0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020006-01","Delta Dental PPO Basic Plan for Families for Small Businesses","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020006-17"
"2017","WV","76526","SERFF","2016-08-04 04:14:10","SHOP (Small Group)","Yes","55-0523124","76526WV0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020004-01","Delta Dental PPO Preferred Plan for Families for Small Businesses","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020004-17"
"2017","WV","76526","SERFF","2016-08-04 04:14:10","Individual","Yes","55-0523124","76526WV0010004","Delta Dental PPO Preferred Plan for Families","76526WV001",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010004-17"
"2017","WV","94562","SERFF","2016-08-25 03:47:19","SHOP (Small Group)","Yes","13-5581829","94562WV0080001","EHB Basic Dental Plan (Low)","94562WV008",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","94562WV0080001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,